Details

Herpes Simplex Virus Type 1 & 2 by PCR

HSV PCR, Herpes Simplex Virus (HSV) Type 1 & 2 by PCR, HSV 1 & 2 by Detection PCR , EPIC: LAB6401, SOFT: IHSVG

Specimen Collection Criteria

Collect: ONE of the following specimen types:

  • Amniotic Fluid: 1.0 mL fluid in a sterile collection container or syringe with the needle removed. (Min: 0.5 mL) 
  • Cerebrospinal Fluid (CSF): 1.0 mL CSF in a sterile collection container. (Min: 0.5 mL)
  • Skin/Mucous Membranes: Swab the lesion and place in viral transport medium.
  • Ocular (Aqueous or Vitreous) Fluids: Submit 1.0 mL vitreous fluid (not the dilute fluid in the cassette) in a sterile collection container. (Min: 0.2 mL)
  • Vesicles: Puncture the vesicle and collect the vesicle fluid with a swab. Place the swab in viral transport medium.
  • Special Situation - Neonatal Surface Culture for HSV:
    • Culture, Virus is the preferred testing option and is mandated by the American Academy of Pediatrics. HSV by PCR should also be performed using the same specimen collected for Culture, Virus.
    • Indicate specimen source as "neonate-surface" on the requisition or in the electronic ordering system.
  • Serum*: Submit a Gold-top SST tube (Min: 1.0 mL); Pediatric: submit 2 Microtainers®
  • Plasma*: Submit a Lavender-top EDTA tube (Min: 1.0 mL) ; Pediatric: submit 2 Microtainers®
  • Bronchoalveolar Lavage (BAL): Submit in a sterile collection container. (Min: 0.5 mL)
  • Sputum (Expectorated, Tracheal, Trans-Tracheal, Nasotracheal, Endotracheal): Submit in a sterile collection container. (Min: 0.5 mL)
  • Tissue: Place in a sterile collection container or in Universal Transport Media (UTM, UVT)

*Blood, serum or plasma will only be helpful in the detection of disseminated HSV infection – this is most common in neonates and immunocompromised individuals.

Other specimen types require approval of the Medical Director of Molecular Pathology or Microbiology.

Physician Office/Drawsite Specimen Preparation

Do not freeze specimens. Maintain all specimen types refrigerated (2-8°C or 36-46°F) prior to transport.

Preparation for Courier Transport

Transport: All specimen types, at room temperature (20-26°C or 68-78.8°F) or refrigerated (2-8°C or 36-46°F).

Rejection Criteria

  • Frozen specimens.
  • Heparinized specimens.
  • Specimens with gross bacterial contamination.

Storage

Specimens are stable at room temperature (20 to 26oC) for 48 hours or up to 30 days when refrigerated (2-8oC).

DO NOT FREEZE SPECIMENS

Performed

Sunday - Saturday.
Results available within 24 hours for CSF, ocular or pediatric specimens. Results for all other specimen types available in 2-3 days.

Reference Range

Negative.

Test Methodology

Real-Time Polymerase Chain Reaction (PCR), followed by Melting Curve Analysis.

Interpretation

A negative result does not rule out HSV infection.

Clinical Utility

This assay provides a highly sensitive and specific test for the diagnosis of Herpes Simplex Virus encephalitis and other HSV infections.

Clinical Disease

Two serotypes of Herpes Simplex Virus (HSV) have been identified: HSV-1 and HSV-2.

  • Primary HSV-1 infections usually occur after contact with infected saliva or a person with oral lesions. Most HSV-1 infections are asymptomatic. Patients with HSV-1 infections can present with gingivostomatitis, conjunctivitis, keratitis, and herpetic whitlow. Gingivostomatitis is common in children under 5 years of age and is characterized by the presence of painful vesicular lesions of the palate, buccal mucosa, pharynx, tongue and the floor of the mouth . Lesions resolve within 2 - 3 weeks after primary infection and 4 - 7 days after recurrent infection.
  • HSV-1 infections are responsible for more than 95% of Herpes Simplex Virus encephalitis cases. HSV encephalitis is the most commonly reported viral infection of the central nervous system, accounting for 10 - 20% of all viral encephalitis in the United States. Left untreated, HSV encephalitis is a vicious, often fatal neurologic infection. Epidemiologic studies indicate that HSV encephalitis may have a biphasic distribution with increased incidence of disease occurring in patients who are 5 - 30 years of age and in patients greater than 50 years of age.
  • Historically, HSV-1 had been associated with oral infections and HSV-2 had been associated with genital infections. This distinction is no longer true, 30 - 50% of genital herpes infections are caused by HSV-1 and 5 - 20% of oral infections are caused by HSV-2. HSV reactivation depends on the virus type and the anatomic site of infection.
  • Primary HSV-2 infections typically present as herpes genitalis and are characterized by extensive, bilaterally distributed papules or vesicles that merge to form large pustular or ulcerative lesions. Lesions often crust after 10 - 15 days and resolve within 2 - 4 weeks. Patients with primary infections may also present with fever, inguinal lymphadenopathy and dysuria.
  • Neonates with HSV infections have the highest incidence of visceral and CNS infections of any patient population with more than 70% of untreated cases producing disseminated or CNS infections. The mortality rate for neonatal infections is 65%. Less than 10% of neonates develop normally following HSV infection.

CPT Code

87529

Test Codes

EPIC: LAB6401, SOFT: IHSVG

Last Updated

7/11/2019