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HSV I & II PCR (CSF)

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No Fasting Required

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Detects HSV DNA in CSF.

₹4,588₹6,554

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HSV I & II PCR (CSF) - Comprehensive Medical Test Information Guide

  • Why is it done?
    • Test Purpose: Detects the presence of Herpes Simplex Virus type I and/or type II (HSV-1 and HSV-2) DNA in cerebrospinal fluid (CSF) using polymerase chain reaction (PCR) amplification methodology. This highly sensitive and specific molecular test identifies viral nucleic acids indicative of active HSV infection in the central nervous system.
    • Primary Indications for Testing: Suspected herpes simplex meningitis or encephalitis; Evaluation of acute aseptic meningitis; Investigation of recurrent meningitis; Assessment of encephalitis with neurological symptoms including fever, headache, altered consciousness, seizures, or focal neurological deficits; Immunocompromised patients with CNS symptoms; Post-operative evaluation following neurosurgery; Monitoring of treatment response in confirmed HSV CNS infection.
    • Typical Timing and Circumstances: Performed during acute phase of suspected CNS infection, preferably within the first 7-10 days of symptom onset for optimal detection; During hospitalization for meningitis or encephalitis workup; In emergency department settings for acute neurological presentations; Repeated if initial results are negative but clinical suspicion remains high; When initiating or evaluating antiviral therapy effectiveness.
  • Normal Range
    • Reference Range/Normal Values: Negative or Not Detected - No HSV-1 or HSV-2 DNA detected in CSF sample; Reported as: 'HSV-1: Not Detected' and/or 'HSV-2: Not Detected'; Result is qualitative (positive/negative) rather than quantitative; No specific numerical threshold or units of measurement.
    • Units of Measurement: Qualitative result (Not Detected/Detected); Some laboratories may report as 'Negative/Positive'; Quantitative PCR may report copies/mL or similar units, but standard reporting is qualitative; Cycle threshold (Ct) values may be included in some reports for semi-quantitative assessment.
    • Interpretation of Results: Negative Result: Absence of HSV-1 and HSV-2 DNA in CSF; Generally excludes active HSV meningitis or encephalitis at time of testing; Does not rule out other viral causes of meningitis; Positive Result: Confirms presence of HSV-1 and/or HSV-2 DNA in CSF; Indicates active CNS infection requiring antiviral therapy; Borderline/Equivocal: Rarely reported; if present, repeat testing may be recommended; What Normal Means: Normal (negative) result indicates no evidence of herpes simplex viral infection in the central nervous system.
  • Interpretation
    • Positive Result for HSV-1: Indicates HSV-1 meningitis or encephalitis; Requires immediate antiviral therapy (typically intravenous acyclovir); Most common cause of sporadic viral encephalitis in adults and children; Associated with more severe disease and higher morbidity/mortality if untreated; HSV-1 typically accounts for 90-95% of HSV CNS infections.
    • Positive Result for HSV-2: Indicates HSV-2 meningitis or, more commonly, aseptic meningitis; May occur during primary genital infection or reactivation; More frequent cause of recurrent meningitis; Requires antiviral therapy; HSV-2 CNS infection accounts for 5-10% of HSV meningitis cases; Often associated with better prognosis than HSV-1.
    • Negative Result: Excludes HSV as cause of current CNS infection; May indicate other viral etiologies (enterovirus, VZV, CMV, etc.); Does not rule out HSV if tested too early in infection course; May occur in immunocompromised patients with low viral loads; Consider alternative diagnoses and additional testing.
    • Factors Affecting Test Results: Timing of CSF collection relative to symptom onset; Timing of antiviral therapy initiation (can reduce viral load and sensitivity); Immunocompetent vs immunocompromised status; Presence of blood contamination in CSF sample; Proper sample collection and preservation procedures; PCR technique sensitivity and laboratory methodology; Presence of PCR inhibitors in the sample.
    • Clinical Significance: Sensitivity: 95-98% for detecting HSV in CNS infection; Specificity: 99-100% (PCR is highly specific); Positive predictive value is very high in patients with clinical meningitis/encephalitis; Superior to viral culture and antibody detection methods; Can differentiate HSV-1 from HSV-2; Gold standard for HSV CNS infection diagnosis; Positive result mandates antiviral therapy regardless of other findings.
  • Associated Organs
    • Primary Organ System Involved: Central Nervous System (CNS) - Primary site of infection; Brain (cerebral parenchyma, particularly temporal lobe regions); Meninges (protective membranes surrounding brain and spinal cord); Cerebrospinal fluid (pathway of viral distribution); Spinal cord (in some cases); Peripheral nervous system involvement may occur secondarily.
    • Diseases and Conditions Associated with Abnormal Results: Herpes Simplex Meningitis (inflammation of meninges); Herpes Simplex Encephalitis (inflammation of brain parenchyma); Aseptic Meningitis (particularly HSV-2); Recurrent Meningitis (especially HSV-2); Neonatal Herpes with CNS involvement; Disseminated herpes infection in immunocompromised patients; Temporal lobe encephalitis; Post-herpetic complications; Status post herpes infection with neurological sequelae.
    • Potential Complications and Risks: Increased intracranial pressure; Cerebral edema (brain swelling); Status epilepticus (prolonged seizures); Altered consciousness and coma; Cognitive impairment and memory deficits; Motor deficits and paralysis; Sensory loss; Hydrocephalus; Hemorrhagic necrosis of temporal lobe; Death if untreated; Long-term neurological sequelae including personality changes, behavioral disorders; Post-encephalitic parkinsonism.
    • Secondary Effects on Other Systems: Cardiovascular: Autonomic dysfunction, arrhythmias from brain involvement; Respiratory: Respiratory depression or failure from brainstem involvement; Endocrine: SIADH (syndrome of inappropriate antidiuretic hormone secretion); Musculoskeletal: Secondary complications from prolonged immobility or seizures; Psychological: Post-traumatic stress disorder, depression from severe illness.
  • Follow-up Tests
    • Recommended Follow-up Testing if Positive: Brain Magnetic Resonance Imaging (MRI) with contrast - to assess extent of brain involvement, temporal lobe changes, and complications; Electroencephalography (EEG) - to detect seizure activity and assess brain electrical activity; MRI Spectroscopy - to evaluate brain metabolite changes in affected regions; Repeat CSF analysis at 24-48 hours - to assess treatment response and cellular changes; Blood HSV PCR - to determine if systemic infection is present; Serum HSV antibodies (IgM/IgG) - to assess immune response and timing of infection.
    • Recommended Follow-up Testing if Negative: PCR for other viral pathogens (enterovirus, parechovirus, VZV, CMV, EBV); CSF bacterial culture if not already performed; Blood cultures if febrile; Repeat lumbar puncture with HSV PCR if clinical suspicion remains high and initial test was negative; Additional CSF studies for other etiologies; Brain imaging to rule out non-infectious causes.
    • Related Complementary Tests: CSF Enterovirus PCR; CSF Varicella-Zoster Virus (VZV) PCR; CSF Cytomegalovirus (CMV) PCR; CSF Epstein-Barr Virus (EBV) PCR; CSF Bacterial Culture; CSF Protein, Glucose, Cell Count; Blood HSV-1/HSV-2 Serology; Herpes Simplex Virus Culture from other sites (if applicable); Viral Throat, Nasopharyngeal, or Genital Cultures.
    • Monitoring and Surveillance: For confirmed HSV CNS infection: Repeat CSF HSV PCR at end of therapy (if clinically indicated) to document viral clearance; Neuroimaging follow-up at 2-4 weeks post-discharge; Neuropsychological testing if cognitive deficits suspected; Long-term neurology follow-up for seizure management; Monitoring for recurrent meningitis (especially HSV-2) with repeat testing if symptoms recur; For HSV-2 recurrent meningitis: Consider prophylactic antiviral therapy with long-term monitoring.
  • Fasting Required?
    • Fasting Status: No fasting required. The test requires cerebrospinal fluid (CSF) obtained via lumbar puncture (spinal tap), not blood. Fasting does not affect CSF composition or HSV PCR results.
    • Special Dietary Restrictions: None. No special dietary preparation is required for this test.
    • Medications to Avoid: No medications need to be held specifically for the collection procedure; However, if antiviral medications (acyclovir, valacyclovir, famciclovir) are being considered, do NOT delay starting them while awaiting test results if HSV CNS infection is suspected - empiric therapy should be initiated based on clinical presentation; Anticoagulants (warfarin, direct oral anticoagulants, heparin) may need adjustment per hematology or prescribing physician due to bleeding risk with lumbar puncture; NSAIDs should generally not be held; Discuss all current medications with the healthcare provider before the procedure.
    • Patient Preparation Requirements: Informed consent required after procedural explanation; Baseline coagulation studies (PT/INR, aPTT) or platelet count may be ordered before lumbar puncture; Urinalysis and urine pregnancy test (for women of childbearing age) may be required; Empty bladder before procedure; Remove metal jewelry from neck and upper back; Wear loose, comfortable clothing; Meet with procedural staff 15-30 minutes before appointment; Position correctly during procedure (sitting bent forward or lying on side); Remain in the recumbent position for 30 minutes to 2 hours post-procedure; Increased fluid intake post-procedure to help restore CSF volume; Pain management as needed; Neurological monitoring for 2-4 hours post-procedure in hospital setting.
    • Sample Collection Details: Sterile lumbar puncture performed, typically at L3-L4 or L4-L5 interspace; Minimum 0.5-1 mL of clear/translucent CSF required; Sample must be collected in sterile, preservative-free container; Samples should not contain preservatives (formalin or other fixatives); Prompt delivery to laboratory within 15-30 minutes of collection; Do not refrigerate or freeze CSF sample unless significant delays expected; Maintain at room temperature or body temperature when possible; Avoid contamination with blood or other bodily fluids.

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