Journal of Clinical Virology - Volume 82 - Supplement 1 - September 2016

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S108 Abstracts / Journal of Clinical Virology 82S (2016) S1–S142
Abstract no: 4
Presentation at ESCV 2016: Poster 176
Investigation of HSV1 positivity of patients with
neurological symptoms by real time PCR
method
A. Altay ∗, M. Colak , C. Irkec , A. Serdaroglu ,
I. Fidan , G. Bozdayi
1 Department of Medical Microbiology, Gazi
University, Ankara, Turkey
2 Gazi University, Faculty of Medicine, Department of
Neurology, Ankara, Turkey
3 Gazi University, Faculty of Medicine, Department of
Pediatric Neurology, Ankara, Turkey
Introduction: Herpes simplex virus type 1 (HSV-1) is a highly
infectious virus which is neurotropic and highly prevalent. The
majority of HSV-1 infections occur during childhood and infection
is never cleared, with lifelong potential for symptomatic or asymp-
tomatic viral shedding episodes. In rare cases, infection can lead
to more serious complications, such as encephalitis. Herpes sim-
plex encephalitis is the most common of the sporadically occurring
forms of viral encephalitis. The aim of this study was detection of
HSV-1 DNA in patients applying to our hospital with neurological
symptoms by real time PCR, retrospectively and investigation of
the association between HSV-1 and clinical characteristics.
Material and methods: Totally 152 patients (77 female, 75
male), between 0–82 years old, who applied to Department of
Neurology, Infectious Diseases and other clinics in Gazi University
Faculty of Medicine, Molecular Microbiology Laboratory between
April 2014–January 2016 were included in this study. DNAs were
extracted from blood and CSF samples that were sent to our lab-
oratory by spin-column method (High Pure Viral Nucleic Acid Kit,
Roche, Germany). Amplificationwas done by Real Time PCRmethod
(LightCycler® HSV1/2 Qual Kit, Roche, Germany) in Light Cycler 2.0
(Roche, Germany) device and the results were evaluated qualita-
tively. HSV-1 IgM and HSV-1 IgG antibody titres of the patients
were studied by ELISA (DIA. PRO, Milan, Italy).
Results: Totally 166 samples were composed of 83% (138/166)
CSF and 17% (28/166) blood. Sixty five percent (108/166) of the
samples were send from neurology and the others 13%, 10%, 8%
and 4%, paediatrics, infectious diseases clinics, intensive care units
and other clinics respectively. HSV-1 DNAwas found positive for 6%
(10/166) of the samples while all samples were negative for HSV-2
DNA. Two of 7 positive CSF samples were belong to same patient
and the patient’s blood sample was also send to our laboratory at
the same time, hence 5% (8/152) of patients were HSV-1 DNA pos-
itive. HSV-1 IgM was positive for 1% (2/152) and HSV-1 IgG was
positive for 8% (12/152) of the patients. Three (37.5%) of positive
patients hospitalized at neurology clinics, 3 (37.5%) of them were
from various intensive care units, 1 (12.5%) was from paediatrics
and 1 (12.5%) was from paediatric infectious diseases clinics. Three
(37.5%) of positive patients were associated with Herpes simplex
encephalitis, the other positive patients had meningitis, Wilson
disease, Guillain Barre syndrome, multiple sclerosis and immuno-
deficiency (autoimmune haemolytic anaemia) diagnosis.
Conclusion: Real time PCR is a reliable and sensitive method
for early diagnosis of viral infections which are quite important
in central nervous system infections. The results are obtained in
a short time through this method and because of it is very sen-
sitive, low positive results can be detected. Thus early treatment
prevents sequels. There are studies about the association of HSV-1
and Multiple sclerosis, Guillain Barre Syndrome and other neuro-
logical disorders. Therefore, we consider that using real time PCR
method can be sensible for the patients with variable neurological
disorders like the patients with encephalitis suspicion.
Abstract no: 105
Presentation at ESCV 2016: Poster 177
Chickenpox exposure in pregnancy – A
comparison of a qualitative and a quantitative
varicella zoster virus antibody assay and follow
up of patient outcome
Claire Williams ∗, Philip Rice
Specialist Virology Centre, Norfolk and Norwich
University Hospital, UK
Background: Public Health England recently issued new guid-
ance on how to best use tests for varicella zoster virus (VZV)
antibody when deciding who should receive VZ immunoglobulin
(VZIG) after exposure to VZV. Among pregnant women, testing
is restricted to those who do not have a history of chickenpox
as commercial antibody assays lack sensitivity. This includes one
of the most widely used, the qualitative VIDAS VZV IgG assay
(BioMérieux). When qualitative assays produce negative or equiv-
ocal results, the decision to recommend VZIG should now be based
upon the result of a quantitative antibody test. The level of VZV IgG
deemed protective has been set at 100mIU/ml. As a result of this
guidance we decided to compare the clinical utility of a negative
VIDAS antibody result with the result of a newquantitative VZV IgG
assay (Alegria – Orgentec) when advising on VZIG administration.
Methods: The audit was of the outcomes of pregnant women,
exposed to chickenpox, who tested VZV IgG negative by VIDAS
between 2013 and 2015. Stored serum samples from these patients
were re-tested using the Alegria. This assay categorizes sam-
ples as follows: VZV IgG <50mIU/ml (negative), 50–100mIU/ml
(borderline) and >100mIU/ml (positive). Information regarding
administration of VZIG, development of a rash and follow-up VZV
IgG results was collated for the patients.
Results: A total of 29 pregnant women were re-tested by Ale-
gria; 10 women had an antibody level of >100mIU/ml, 10 had
borderline results (50–100mIU/ml) and 9 had negative results
(<50mIU/ml). Infectionwith VZV, defined as either development of
chickenpox or seroconversion, was seen in only 4/29 (14%) and was
confined to those with an antibody level <50mIU/ml. On follow-
up of these 4 patients, 1 developed a typical chickenpox rash, 1
seroconverted by both VIDAS and Alegria assays, but 2 developed
only a borderline antibody response by Alegria and were still neg-
ative by VIDAS at follow-up. All four of the women with evidence
of VZV infection had been exposed to their own child with chick-
enpox. This contrasts with the other 5 women with an antibody
level <50mIU/ml, with no evidence of virus transmissionwho were
exposed only during the 1–2 days before rash onset. The mean
time to administration of VZIG was the same in both groups (5.6
days vs 5.8 days). Of the 20 women who were either antibody
positive (n = 10) or borderline (n = 10) by Alegria, none developed
chickenpox. This included six with antibody positive and four with
borderline results who had elected not to receive VZIG because of
previous childhood exposures which had not resulted in chicken-
pox.
Conclusions: This study highlights the importance of test choice
when assessing VZV immune status, with 10/29 (34%) of our
patients negative by a qualitative assay, having antibody levels
>100mIU/ml when tested by a quantitative assay. Secondly, given
that none of our patients with antibody levels of 50–100mIU/ml
developed infection, even when VZIG was not administered, we