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Primary and recurrent herpes simplex virus type 2-induced meningitis
T Bergström1, A Vahlne, K Alestig
1Department of Clinical Virology, University of Göteborg, Sweden.
Abstract:
In 27 patients with a first episode of herpes simplex virus type 2 (HSV-2)-induced meningitis, confirmed by virus isolation from the cerebrospinal fluid (CSF) or seroconversion to HSV-2, initial neurologic complications were found in 10 (37%) but subsided before 6 months in all patients. Long-term complications were recurrent meningitis in 5 (19%) and periodic headache related to genital HSV recrudescences in 4 (15%). Seven additional patients had possible HSV-2-induced recurrent meningitis. In contrast to the first episode of meningitis, virus isolation, HSV antigen detection, and IgG analyses in consecutive serum samples were of no diagnostic value in episodes of HSV-2-induced recurrent meningitis. Instead, immunoblotting was used to assay intrathecally produced IgG antibodies to the HSV-2 type-specific protein gG-2 in recurrent meningitis, when CSF was collected at a minimum of 3 days after onset.
Insights
Herpes simplex virus type 2 (HSV-2) meningitis can cause initial neurological issues, but long-term problems like recurrent meningitis and headaches are also possible. Diagnosis of recurrent meningitis requires specific antibody testing in cerebrospinal fluid (CSF).
Area of Science:
- Neurology
- Infectious Diseases
- Virology
Background:
- Herpes simplex virus type 2 (HSV-2) can cause meningitis, a serious infection of the brain and spinal cord.
- Understanding the complications and diagnostic challenges of HSV-2 meningitis is crucial for patient management.
Purpose of the Study:
- To investigate the initial and long-term neurological complications of first-episode HSV-2 meningitis.
- To evaluate diagnostic methods for recurrent HSV-2 meningitis.
Main Methods:
- Analysis of 27 patients with confirmed first-episode HSV-2 meningitis.
- Assessment of neurological complications, including recurrent meningitis and headaches.
- Evaluation of diagnostic techniques (virus isolation, antigen detection, serology, immunoblotting) for recurrent episodes.
Main Results:
- 37% of patients experienced initial neurological complications, which resolved within 6 months.
- Long-term complications included recurrent meningitis (19%) and headaches (15%).
- Standard diagnostic tests were ineffective for recurrent meningitis; immunoblotting for intrathecal IgG antibodies to HSV-2 gG-2 proved valuable.
Conclusions:
- While initial neurological complications of HSV-2 meningitis are often transient, long-term issues like recurrence can occur.
- Diagnosing recurrent HSV-2 meningitis necessitates advanced techniques like CSF immunoblotting for specific antibodies, as conventional methods are insufficient.