Artikel
Diagnostic Pitfalls in a Case of Acute Retinal Necrosis after Herpes Simplex Encephalitis
Suche in Medline nach
Autoren
Veröffentlicht: | 22. September 2004 |
---|
Gliederung
Text
Objective
Herpes simplex virus (HSV) type-specific antibody tests based on gG antigens have replaced less specific tests in many laboratories.
Methods
We report a patient with acute retinal necrosis of the left eye. Demonstration of HSV DNA in aqueous humour confirmed the diagnosis. Negative results of HSV type-specific antibody tests based on gG antigens suggested a primary HSV infection. However, the patient had a past history of laboratory-confirmed herpes simplex encephalitis six years previously. Using antibody tests based on whole viral lysate antigens he was seropositive from the onset, and immunoblot testing confirmed a lack of anti-gG reactivity.
Results
To be able to assess whether this might be related to the apparent inability of his immune system to suppress clinically symptomatic HSV infection, serial samples were tested by an HSV neutralisation test and a whole-blood flow cytometric assay to determine the frequency of HSV-specific CD4 lymphocytes. However, this did not yield evidence of obvious immunodeficiency.
Conclusions
Although type-specific HSV serological tests based on gG are generally more specific than those based on whole viral lysate antigens, they have a somewhat lower sensitivity. Thus there is a risk of missing individual infected patients. We recommend careful interpretation of negative results when highly specific antibody assays based on recombinant proteins are employed.