Elsevier

Mayo Clinic Proceedings

Volume 78, Issue 11, November 2003, Pages 1347-1352
Mayo Clinic Proceedings

Original Article
Clinical Spectrum and Laboratory Characteristics Associated With Detection of Herpes Simplex Virus DNA in Cerebrospinal Fluid

https://doi.org/10.4065/78.11.1347Get rights and content

Objective

To determine the clinical, neurologic, and laboratory characteristics of patients with herpes simplex virus (HSV) type 1 (HSV-1) or HSV type 2 (HSV-2) DNA detected in cerebrospinal fluid (CSF) with use of polymerase chain reaction.

Patients and Methods

Clinical, laboratory, and demographic data were determined from 249 CSF specimens (collected from 247 patients >10 years of age) that tested positive for HSV-1 or HSV-2 DNA at the Mayo Clinic from January 1999 to August 2000.

Results

The median age of the 200 patients whose age was available was 70 years vs 40 years for those with HSV-1 or HSV-2 DNA in CSF, respectively. Detailed data were available for 39 and 78 patients with positive polymerase chain reaction results for HSV-1 and HSV-2, respectively. Of those with HSV-1 DNA detected in CSF, 89% had encephalitis, whereas most patients with HSV-2 DNA detected in CSF had findings compatible with meningitis. Only 5 (7%) of 69 patients in whom HSV-2 was detected in CSF had genital lesions at presentation, and none of the assessable patients with HSV-2 who had recurrent meningitis had active genital lesions at presentation.

Conclusion

The vast majority (82%) of patients with HSV-2 detected in CSF had no history of genital herpes and no lesions at the time of presentation. Polymerase chain reaction assays designed to detect HSV in CSF should detect HSV-1 and HSV-2 and differentiate between HSV-1 and HSV-2.

Section snippets

Data Collection

All patients older than 10 years with HSV-1 or HSV-2 DNA detected in CSF by PCR from January 1999 to August 2000 were included in the study. Of the 247 study patients, information was provided on age and sex with the submitted specimen for 200 (81%); a total of 249 specimens were submitted (for 2 patients, 2 specimens were submitted for each).

Because most testing was performed on specimens referred to our laboratory from institutions elsewhere, we sought additional clinical and laboratory

Results

Of the 249 CSF specimens, HSV-1 DNA was detected in 82 and HSV-2 in 167. Of the 200 patients in whom age and sex were available (Figure 1), the median age of those with HSV-1 and HSV-2 detected in CSF by PCR was 70 years and 40 years, respectively. Most cases (82%) of HSV-2 occurred in patients aged 50 years or younger, whereas most cases (79%) of HSV-1 occurred in those older than 50 years. Almost 9% of patients with HSV-2 were older than 60 years.

Of Mayo Clinic patients, 5 had HSV-1 and 9 had

Discussion

In our study patients, HSV-2 DNA was detected more commonly in CSF than was HSV-1 DNA. As expected, encephalitis and meningitis were the predominant HSV-1 and HSV-2 illnesses, respectively. Rare cases of HSV-1 meningitis and HSV-2 encephalitis were also documented.

The most notable finding was HSV-2 in the CSF of patients without a known history of genital herpes or active genital lesions at presentation. Of those presenting with HSV-2 meningitis, 82% had neither a history of genital herpes nor

Conclusion

In light of the absence of genital lesions and the broad age range affected, the only practical option to diagnose HSV-2 neurologic infection is the detection of HSV-2 DNA in CSF by molecular methods. The ready availability of a rapid method to detect this virus together with the availability of antiviral therapy suggests that performance of a controlled trial to determine optimal therapy for HSV-2 meningitis is now warranted. The need to detect and differentiate HSV-1 and HSV-2 is also

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1

Dr O'Sullivan is now with St Elizabeth's Hospital, Brighton, Mass.

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