巢式PCR与ABC-ELISA检测单纯疱疹病毒的比较

在Ⅰ型单纯疱疹病毒（HSV－I）TK基因的保守区域设计3个引物，建立巢式PCR方法。敏感性实验显示巢式PCR比单一PCR敏感500倍。用巢式PCR法和ABC－ELISA法平行检测30例临床诊断为单纯疱疹病毒性脑炎（HSE）患者和20例非中枢神经系统感染患者的脑脊液（CSF）标本。结果表明两种方法特异性完全一致，然巢式PCR的敏感性较高。30例HSE中巢式PCR的检出阳。性率为87％（26／30），ABC－ELISA为77％（23／30），且巢式PCR于检查当日即可获得阳性结果。提示其更适用于HSE的早期诊断。     

PCR快速检测病毒性脑炎患者脑脊液中HSV、CXV和CMV

本文应用聚合酶链反应(PCR)和逆转录PCR(RT-PCR)技术检测了27例临床诊断为病毒性脑炎患者和25例其他神经疾病(OND)对照组患者脑脊液(CSF)中单纯疱疹病毒(HSV)、柯萨奇病毒(CXV)和巨细胞病毒(CMV)。27例患者组检出HSV13例、CXV2例、CMV1例，总阳性率为59．3％，而OND对照组皆为阴性。随着检测技术的完善及对更多种类病毒采用PCR早期快速诊断方法的建立，将有效地指导特异性抗病毒药物的选择应用，从而提高治愈率，降低病死率和改进预后。     

用斑点免疫渗滤试验诊断单纯疱疹病毒性脑炎

采用斑点免疫渗滤试验（DIFA）对苏州地区170例散发性脑炎患者240份脑脊液（CSF）标本中单纯疤疹病毒抗原（HSV－Ag）进行检测，结果表明170例散发性脑炎中，经该项检测而能明确单纯疤疹病毒性脑炎（HSE）诊断者42例（24．7％）；240份CSF标本中，HSV－Ag阳性率为35．4％，而其中42例HSE患者的96份CSF阳性率为88．5％，两者差异有非常显著意义（P＜0．001）。将DIFA法检测结果与单纯疤疹病毒抗体检测结果进行比较显示，应用DIFA检测HSV－Ag能在较早期对HSE作出诊断。     

An Improved PCR Assay of Viral DNA in Cerebrospinal Fluid from Patients with Herpes Simplex Virus Type-1 Encephalitis

Abstract: Several investigators have attempted to establish a simple, sensitive and quantitative method for a PCR assay of viral DNA in the cerebrospinal fluid (CSF). However, the rate of a positive DNA test differs between laboratories using the same CSF samples from patients with herpes simplex virus type-1 (HSV-1) encephalitis because of differences in sensitivity of the detection. In the present study, we compared the sensitivity and quantity of nested PCR amplification from the pretreated CSF (nested PCR) with those of direct PCR that was performed by direct PCR amplification of the small amounts of CSF to the PCR "cocktail." We studied the advantages of the two different methods, "the direct and nested PCR," and established a two-step method as an improved PCR assay. HSV-1 DNA from the CSF samples obtained within 4 weeks after onset was detected in all seven cases.     

PCR早期诊断单纯疱疹性脑炎

依据单纯疱疹病毒(HSV)DNA多聚酶基因的保守序列设计其型公共引物，采用二步温控法，成功地建立起PCR反应体糸。将40份拟诊为病毒性脑炎患者的脑脊液(CSF)及多种对照标本进行HSV的PCR扩增分析，并用PCR制备生物素标记的DNA探针与PCR检测产物进行斑点杂交。结果表明，8份CSF标本可检出HSV-DNA。单纯疱疹性脑炎占总数的20％。该PCR可作为单纯疱疹性脑炎的早期诊断手段。     

Evaluation of Auditory Brainstem Potentials in Children with Acute Herpes Simplex Encephalitis

Objective: In this study, auditory brainstem potentials (ABPs) were studied in children with Herpes simplex encephalitis (HSE) to determine the ABP abnormalities in HSE during childhood. We also wished to determine whether or not to use ABP in early diagnosis of HSE. Method: The study includes 28 children; eight children with acute HSE, nine with nonspecific encephalitis, and 11 healthy age-matched control subjects. The diagnosis of HSE was confirmed by the demonstration of Herpes simplex virus type 1 in CSF by polymerase chain reaction. Recordings of ABPs were performed by using Nihon Kohden Neuropack 2 device. Results: The study includes eight children (four females and four males) with acute HSE, nine children (five males and four females) with nonspecific encephalitis, and 11 healthy age-matched control subjects (six males and five females). Age ranges of the patients and controls were between six months and 12 years. There was not statistically significant difference between the groups for age and gender (p > .05). There were significant differences in the mean latencies of the wave IV on the right ear and in the mean interpeak latencies (IPLs) of the waves III–V on the right and left ears between the nonspecific encephalitis group and the control group (p < .05). However, there were no statistically significant differences between the HSV and control groups (p > .05). In addition, there was no significant difference between HSV and nonspecific groups (p > .05). Conclusions: Our findings revealed that there were mild ABP abnormalities in children with nonspecific encephalitis, but no ABP abnormality in patients with HSV encephalitis. However, we think that more extensive and detailed studies should be performed to determine whether or not there were ABP abnormalities in childhood HSV encephalitis.     

Glioblastoma Mimicking Herpes Simplex Encephalitis

We report a case of 70-year-old man with glioblastoma presenting as acute encephalitic illness. The patient exhibited sudden onset of cognitive impairment and headache for 2 days. Initial brain MRI showed left temporal lobe hyperintensity, and cerebrospinal fluid cytology revealed a mild pleocytosis. The patient had initially improved after medical treatment with a presumptive diagnosis of herpes simplex encephalitis (HSE). After 8 months, the patient complained of recurrent seizures. A follow-up brain MRI revealed marked increases in size and surrounding perilesional edema in the left temporal lesion on T2-weighted images and a new contrast-enhancing lesion on gadolinium-enhanced T1-weighted images. Stereotactic brain biopsy revealed a glioblastoma. The atypical encephalitic presentation of glioblastoma should be considered if definitive evidence for the diagnosis of HSE cannot be obtained.     

巢式聚合酶链反应检测脑脊液中单纯疱疹病毒DNA

应用巢式聚合酶链反应(PCR)检测患者脑脊液(CSF)中单纯疱疹病毒1型(HSV-1)DNA。23例经鞘内HSV-1特异性IgG抗体检测阳性的“HSV-1型性脑炎(HSE)”中19例PCR阳性,4例阴性患者病程均超过1个月。22例IgG阴性的“散发性脑炎”中7例PCR阳性,此7例皆于发病1周内检查CSF,其中2例取材于发病当日。1周后复查7例患者,CSF PCR仍为阳性,IgG皆阴性,提示PCR适用于HSE的早期诊断。     

Chronic Herpes Simplex Encephalitis with Somnambulism: CT, MR and SPECT Findings

Abstract: A 64-year-old male with herpes simplex encephalitis had shown somnambulism and memory disturbance for nine months before consciousness disturbance appeared. Brain CT, MR and SPECT revealed lesions in the right temporal lobe. The atypical clinical course of this patient, including chronkity and focal symptom, is discussed.     

单纯疱疹病毒性脑炎脑脊液三项检查的临床评价

为评价目前常用的单纯疱疹病毒性脑炎（ＨＳＥ）脑脊液（ＣＳＦ）３项检查方法的临床应用价值，作者按照平行试验的原则，对４３例ＨＳＥ患者同时进行了ＣＳＦ单纯疱疹病毒抗原（ＨＳＶ－Ａｇ）、抗体（ＨＳＶ－Ａｂ）和ＤＮＡ（ＨＳＶ－ＤＮＡ）检测。结果显示：ＨＳＶ－Ａｂ与ＨＳＶ－ＤＮＡ检测的阳性率高于ＨＳＶ－Ａｇ，分别为８６．０％、７６．７％和４８．８％；４３例患者中２项以上阳性者为３６例，占８３．７％。作者认为：对临床疑诊的所谓“散发性脑炎”患者均应同时进行ＣＳＦＨＳＶ３项检测，如２项或３项阳性者可确诊为ＨＳＥ，１项阳性者应高度怀疑为ＨＳＥ，并应早期使用无环鸟苷等有效药物治疗。     

Focal Perivascular Alterations of White Matter in Herpes Simplex Encephalitis —A Histological and Immunocytochemical Study—

Abstract: Several cases of human herpes simplex encephalitis treated with Vidarabin have been investigated with the histological and immunocytochemical techniques. Cases with a subacute evolution revealed areas of focal perivascular myelin destruction in the white matter. The distribution of herpes simplex antigen did not show any preferential localization of the virus in perivascular oligoglia! cells. In contrast, a spatial and temporal relationship has been found between the appearance of immunoglobulin-bearing cells around the vessels and that of areas of focal perivascular myelin damage. Therefore, it is postulated that the areas of focal destruction of myelin are not related to the cytotoxic effect of the virus but are rather dependent on the immune response of the host.     

免疫增强药物对单纯疱疹病毒性脑炎预后的影响

目的:检测细胞因子IL-2、IL-10、TNF-α在单纯疱疹病毒性脑炎(HSE)中的表达和变化。探讨具有免疫增强作用的药物干预(利比、黄芪)对小胶质细胞细胞因子分泌及对HSE疾病预后的影响。方法:使用逆转录-聚合酶链反应(RT-PCR)检测颅内感染单纯疱疹病毒I型(HSVⅠ)的小鼠在感染后及使用具有免疫增强作用的药物治疗后各细胞因子变化及观察脑组织切片HE染色后的病理变化。结果:HSVⅠ感染后出现脑内出血坏死性的病理改变,各细胞因子均明显上升;各用药组治疗好转后脑内病理变化改善,IL-2保持稳定、IL-10继续升高,TNF-α显著下洚。结论:具有免疫增强作用的药物可调节小胶质细胞分泌细胞因子的动态平衡,改善HSE的预后。     

Herpes simplex virus as a transneuronal tracer

NORGREN, R.B. AND M.N. LEHMAN. Herpes simplex virus as a transneuronal tracer. NEUROSCI BIOBEHAV REV 22 (6) 695–708, 1998. Determining the connections of neural systems is critical for determining how they function. In this review, we focus on the use of HSV-1 and HSV-2 as transneuronal tracers. Using HSV to examine neural circuits is technically simple. HSV is injected into the area of interest, and after several days, the animals are perfused and processed for immunohistochemistry with antibodies to HSV proteins. Variables which influence HSV infection include species of host, age of host, titre of virus, strain of virus and phenotype of infected cell. The choice of strain of HSV is critically important. Several strains of HSV-1 and HSV-2 have been utilized for purposes of transneuronal tract-tracing. HSV has been used successfully to study neuronal circuitry in a variety of different neuroanatomical systems including the somatosensory, olfactory, visual, motor, autonomic and limbic systems.     

Early Dynamic SPECT Imaging in Acute Viral Encephalitis

BACKGROUND AND PURPOSE: Several cases have reported that dynamic single-photon emission computed tomography (SPECT) shows increased tracer uptake in acute herpes simplex viral encephalitis (HSVE). The purpose of this study was to evaluate the clinical usefulness of dynamic Tc-ECD SPECT in patients with acute viral encephalitis. METHOD: We performed the dynamic SPECT in 9 patients with acute viral encephalitis (4 women, 5 men, 49.5 +/- 17.4 years of age at onset). SPECT and magnetic resonance imaging (MRI) were performed within 2 weeks after acute clinical onset and at the time of resolution of acute symptoms. RESULTS: Cranial MRI showed high intensities in all patients (7 medial temporal and 2 lateral temporal lobes, 1 inferior temporal lobe, 2 insula and adjacent regions, 1 thalamus, 1 putamen). The initial dynamic SPECT showed increased accumulation of tracer, corresponding to the lesions on MRI in 3 patients with HSVE. Resolution of acute symptoms was associated with a reduction in increased tracer uptake. Six patients with non-HSVE showed no increased accumulation of tracer. CONCLUSIONS: Dynamic SPECT may be a new optional neuroradiologic technique that may help to establish a diagnosis in patients with suspected HSVE.     

Autopsy neuropathological findings in ''burnt out'' herpes simplex encephalitis and use of the polymerase chain reaction to detect viral DNA

We have conducted an autopsy study of the brains of three patients with 'burnt out' temporal and frontal lobe encephalitis, thought to be due to previous herpes simplex virus infection. The brains showed marked atrophy and yellow-brown discolouration predominantly involving the anterior part of both temporal lobes. Histology revealed destruction of grey and white matter, perivascular and leptomeningeal aggregates of lymphocytes and macrophages, and severe gliosis. Immunohistochemistry for herpesvirus antigens was negative but, by use of the polymerase chain reaction, a segment of the thymidine kinase gene of herpes simplex virus type 1 was detected in sections of temporal lobe from all three brains. These findings support the hypothesis that herpes simplex virus may persist within the central nervous system after acute herpes encephalitis, to cause latent or low-grade productive infection.     

Diagnosis of herpes simplex encephalitis

In a series of six cases of encephalitis caused by herpes simplex virus, type 1, the diagnostic and prognostic value of the electroencephalogram (EEG) was investigated. Special interest was focused on the time relationship between the appearance of abnormal EEG findings, the initial clinical symptoms and the changes in cranial computed tomography (CT). The characteristic periodic EEG pattern can be demonstrated within 2 days of disease, before typical structural changes appear in CT. A unilateral periodic pattern may be associated with a good prognosis, where-as all patients with bilateral changes died in spite of specific antiviral therapy.     

Search for evidence of herpes simplex virus, type 1, or varicella-zoster virus infection in postmortem brain tissue from schizophrenic patients.

The highly sensitive polymerase chain reaction (PCR) was used to search for herpes simplex virus type 1 (HSV-I) or varicella-zoster virus (VZV) in the DNA extracted from postmortem temporal cortex samples of 8 schizophrenic subjects, 8 nonschizophrenic suicide victims and 8 normal controls. HSV-I or VZV-specific DNA amplification was not detected in any of the samples studied.     

应用免疫细胞化学和原位杂交诊断单纯疱疹病毒性脑炎

用免疫细胞化学和原位杂交方法对２０例散发性脑炎脑活检组织进行了研究。结果３例确诊为单纯疱疹病毒性脑炎，其中２例单纯疱疹病毒ＤＮＡ阳性，１例抗原阳性。病毒ＤＮＡ主要分布于神经元和胶质细胞核内，胞浆内罕见；病毒抗原在神经元胞浆内较胞核多，在胶质细胞和单核细胞内则相反。研究表明二种方法联合应用，可提高散发性病毒性脑炎的病因检出阳性率。     

Herpes simplex virus type 2 DNA detected in cerebrospinal fluid of 9 patients with Mollaret's meningitis

We present clinical and virological data on 9 patients, 7 women and 2 men aged 31–56 years, with recurrent aseptic meningitis (Mollaret's meningitis). Polymerase chain reaction detected Herpes simplex virus type 2 DNA in cerebrospinal fluid samples from all patients collected during their latest attacks of meningitis. Six patients had no history of genital herpes. Only 1 patient was offered prophylactic antiviral treatment during the study period (45 months).