Original ArticleClinical Spectrum and Laboratory Characteristics Associated With Detection of Herpes Simplex Virus DNA in Cerebrospinal Fluid
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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Dr O'Sullivan is now with St Elizabeth's Hospital, Brighton, Mass.