Herpes Virus Antigen by DFAMain Content
Test code: 34290
CPT code(s): 87274
Methodology: Direct Immunofluorescence Assay
Alternative name(s): N/A
Clinical significance: Herpes Simplex Virus (HSV) 1 and 2 are members of the Herpesviridae family. They are large, enveloped viruses about 190nm in diameter containing linear, double stranded DNA. Both viruses cause a multitude of human diseases and are particularly severe in immunocompromised patients. There are two biologically distinct serotypes of HSC classified as Type 1 (HSV-1) and Type 2 (HSV-2). The serotypes are closely related with extensive sequence homologies of their DNA’s. HSV is a major cause of conjunctival, respiratory, central nervous system, genital and generalized disease. HSV infects mucocutaneous surfaces, then enters the dorsal root ganglia where further viral replication occurs, followed by a period of latency. Reactivation is accompanied by viral excretion at, or close to the original mucocutaneous site of infection, with or without, the associated clinical signs and symptoms. Recurrent lesions are usually less severe than primary infection. HSV-1 causes gingivostomatitis, intense pharyngitis, tonsillitis, and occasionally encephalitis in infants and children during their primary infections. Ocular, nasal, orolabial, and oropharyngeal lesions occur in both children and adults. Due to ubiquity of HSV-1 and its ease of spread by aerosolized droplets, fomites, and direct contact, most adults experience HSV-1 infection during their lifetimes.
HSV-2 is more frequently associated with painful genital lesions, urethritis, and cervicitis in adults. If the virus is present in the birth canal around the time of delivery, either from the primary or recurrent infection, severe generalizes infection in the neonate may occur. Thus, maternal genital HSV infections pose a substantial risk to the fetus and newborn.
Shedding of virus at the time of delivery is frequently the route of transmission from mother to neonate. Neonatal HSV infection is generally symptomatic and often fatal, with a mortality rate in untreated cased of 70%. The clinical presentation may be localized infection of the skin, eyes and mucosa, encephalitis, or disseminated disease.
Acyclovir, famciclovir, foscarnet, and other nucleoside analogs can reduce clinical symptoms and virus shedding in oral and genital herpes, herpes encephalitis, neonatal herpes, and hepatic ceratitis, HSV can be readily recovered from clinical specimens following culture in cell lines such as Hep-2, MRC-5, A549, HEK, NCI-H292, and others. Incubation time in stationary or roller cultures ranges from 1 to 7 days with evident cypathology. Adequate specimens include eye swabs, swabs of vesicular lesions, saliva, throat swabs, cerebrospinal fluid, and tissues, as dictated by the clinical symptoms. Urine may also be valid specimen. HSV must be identified to prevent the spread of the virus to neonates at birth and to prevent spread of the venereal disease to other adults. Specific identification of virus in conjunctival specimens allows prompt treatment with acyclovir to reduce the chance of blindness.
Supply: S03 - VCM, Lesion
Preferred specimen(s): Vesicle, Lesion, CSF, Tissue, Urine
Preferred volume: 1 Viral Transport Medium
Transport container: M4 media or VCM medium
Transport temperature: Refrigerated (cold packs)
Specimen stability: Refrigerated: 3 days
Rejection Criteria: Quantity not sufficient
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