A nested-PCR assay for the simultaneous amplification of HSV-1, HSV-2, and HCMV genomes in patients with presumed herpetic CNS infections.

To facilitate early diagnosis of herpes virus infection of the central nervous system (CNS), a nested polymerase chain reaction (nPCR) assay was developed to test simultaneously for the presence of HSV-1, HSV-2, and HCMV DNA in the cerebrospinal fluid (CSF) of patients with herpetic CNS disease suspected on clinical grounds. The virus type-specific PCR products were differentiated either by agarose gel electrophoresis or by DNA enzyme immunoassay. Using titrated viral stocks as standards, a sensitivity of at least 0.03 infectious units was obtained for HSV-1, HSV-2 and HCMV and no cross-reactions were recorded. Among 178 CSF specimens (171 patients), which were tested under routine conditions, three contained HSV-1 DNA, one contained HSV-2 DNA and one contained HCMV DNA. No double or triple infection was diagnosed. The presence of inhibitors of the Taq DNA polymerase was monitored by spiking aliquots of the above CSF samples with 3 infectious units each of HSV-1 and HSV-2 or HCMV. Whereas none of 93 samples spiked with HSV-1 and HSV-2 contained inhibitors, the PCR reaction was inhibited in three out of 175 samples (1.7%) spiked with HCMV. The complete procedure which requires only 150 microl of CSF is easily completed within 8 h. Through its speed, reliability and sensitivity, this nPCR assay has met the specific criteria of the diagnostic laboratory.