Diagnosis

The diagnosis of HSV-1 infection is best confirmed by isolating the virus in tissue culture. Results of tissue culture are often positive within 48 hours after inoculation, and immunofluorescent staining of the tissue culture cells can enable quick identification of HSV and distinction between HSV types 1 and 2 (7).

Because innumerable cases of recurrent HSV-1 infections occur daily, this method of diagnosis is neither practical nor necessary. Histologic diagnosis using scrapings from a mucocutaneous lesion shows multinucleated giant cells as well as epithelial cells that contain eosinophilic inclusion bodies (visible on Tzank smears). Polymerase chain reaction (PCR) techniques can rapidly detect HSV DNA in clinical specimens: Whereas confirmation of HSV encephalitis previously required brain biopsy, PCR study of cerebral spinal fluid is a noninvasive technique as sensitive as brain biopsy (6).

Antibody testing can document seroconversion in patients with primary HSV-1 but has no value for confirming recurrent infection.

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