Herpes Simplex Virus PCR, CSF

Test Code

HSVQPCR

CPT Codes
87529 x 2

Includes

Herpes Simplex Virus Type 1 and Type 2

Preferred Specimen

110 ul CSF

Minimum Volume

55 ul CSF

Instructions

CSF can be stored at 2-8C up to 7 days. After 7 days CSF must be frozen at -70C or below.

Transport Container

Sterile Screw Top Vial

Transport Temperature

CSF can be stored at 2-8C up to 7 days. After 7 days CSF must be frozen at -70C or below. It is recommended to transport on ice.

Specimen Stability

Indefinitely at -70C.

Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)

Not collected in specified container

Does not meet specified source requirement

Not stored at specified temperature

Methodology
Real-Time PCR on Focus Diagnostics Integrated Cycler

Setup Schedule

7 days a week.

6am-9:30pm, M-F

6am-2:30pm, weekends and holidays

Report Available

2 hours during staffed work hours.

Limitations

LIMITATIONS:

The detection of viral nucleic acid is dependent upon proper sample collection, transport, handling and storage. Failure to observe proper procedures in any one of these steps can lead to incorrect results.
The prevalence of viral infections may affect the test’s predictive value.
Negative results do not rule out HSV infections of the CNS and should not be used as the sole basis for treatment or other patient management decisions.
False-negative results may occur if the viruses are present at a level that is below the analytical sensitivity of the assay or if the virus has genomic mutations, insertions, deletions, or rearrangements or if performed very early in the course of illness.
For encephalitis patients with a negative herpes simplex PCR result, consideration should be given to repeating the test 3–7 days later for patients demonstrating a compatible clinical syndrome or temporal lobe localization on neuroimaging.
As with other tests, false-positive results may occur. Repeat testing or testing with a different device may be indicated in some settings.
A positive result by this test cannot rule out infections caused by other viral or bacterial pathogens. Viral nucleic acids may persist in vivo independent of virus viability. Detection of target analyte(s) does not imply that the corresponding viruses are infectious or are the causative agent for clinical symptoms.
When very high levels of HSV-2 are present with very low levels of HSV-1, the signal from the HSV-1 reaction may not be adequate to be detected, due to competitive interference.
This test is a qualitative test and does not provide the quantitative value of detected virus present.

Reference Range

Negative-normal; However, a negative result does not exclude the possibility of infection with Herpes Simplex Virus

Clinical Significance

CLINICAL SIGNIFICANCE:
HSV-1 and HSV-2 are members of the alpha-herpesviridae subfamily. It is an enveloped virus with capsid containing viral DNA and causes about 5-10% of all encephalitis cases. It is one of the most common causes of identified sporadic encephalitis globally. HSV encephalitis occurs in all ages and during all seasons. HSV-1 encephalitis is more common in adults; and HSV-2 encephalitis is more common in neonates. Clinical features involved with HSV encephalitis include fever, hemicranial headache, language and behaviorial abnormalities, memory impairment, and seizures. The utility of rapid nucleic acid amplification testing of CSF to diagnose Central Nervous System (CNS) infections has greatly increased, especially since CSF cultures are generally of limited value for viral infections of the CNS and take longer to result.

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.