Detailed description
1. Clinical diagnosis
According to the typical clinical manifestations of skin and mucous membrane herpes, combined with some predisposing factors, recurrent attacks and other characteristics, clinical diagnosis is not difficult. However, it is difficult to diagnose skin herpes in cornea, conjunctiva, deep cavity (such as genital tract, urethra, rectum, etc.), herpetic encephalitis, and other visceral lesions.
Clinical diagnosis basis of herpetic encephalitis and meningoencephalitis: ① symptoms of acute encephalitis and meningoencephalitis, but the epidemiological history does not support encephalitis B or forest encephalitis. ② Viral cerebrospinal fluid manifestations, such as bloody cerebrospinal fluid or a large number of red blood cells detected, highly suggest that the disease may. ③ Brain spot map and MRI showed that the lesions were mainly in frontal lobe and temporal lobe, showing diffuse asymmetric damage.
2. Laboratory diagnosis
(1) Microscopic examination of scraping and biopsy tissue samples from the base of herpes showed multinucleated cells and eosinophilic inclusions in the nucleus to identify herpes diseases, but it could not be differentiated from other herpesviruses.
(2) Detection of HSV specific IgM antibody is positive, which is helpful for the diagnosis of recent infection. The diagnosis can be confirmed when the virus specific IgG titer increases more than 4 times during the recovery period.
(3) The positive detection of HSV DNA by RT-PCR can be confirmed.
Criteria for laboratory diagnosis of HSV encephalitis and meningoencephalitis: ① HSV specific IgM antibody is positive in cerebrospinal fluid (CSF). ② CSF was positive for viral DNA. ③ Virus specific IgG titer: serum/CSF ratio ≤ 20. ④ In CSF, the virus specific IgG titer increased more than 4 times during the recovery period. HSV encephalitis or meningoencephalitis will be determined if any one of the four items is met.
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