Herpes simplex encephalitis.: A study of seven patients and their immunological response prior to routine acyclovir treatment

Objectives. A retrospective study on cerebrospinal fluid (CSF) samples was made possible by access to a large CSF bank, which has been supplemented by the well characterised prior collection of CSF from patients with Herpes simplex encephalitis (including serial samples from some patients and kindly donated by Professor Maurice Longson, Manchester). These samples are of particular interest because they were collected prior to the routine administration of acyclovir. Methods. Although an earlier study had shown that there was indeed a correlation between higher titres of antibody and a better outcome, the data did not emerge with statistical significance. The current study was based upon an improved method, which demonstrates the antigen-specific clonality of the immune response. Results. The primitive polyclonal anamnestic response was contrasted with the strong antigen-specific response, which was manifested by a monoclonal pattern in some patients. A clear distinction emerged between two sub-groups of patients on the basis of these findings, which showed a statistically significant (P < 0.03) correlation with outcome. Conclusions. This has allowed us to further support the hypothesis that a strong immunological response has positive prognostic value during the course of the disease. (C) 2003 The British Infection Society. Published by Elsevier Science Ltd. All rights reserved.