Skip to main content

Advertisement

Log in

Herpes simplex virus 2 meningitis: a retrospective cohort study

  • Published:
Journal of NeuroVirology Aims and scope Submit manuscript

Abstract

Herpes simplex virus 2 is a leading cause of viral meningitis and the most commonly recognized infectious cause of benign, recurrent meningitis. We report a retrospective, observational cohort study of patients with herpes simplex virus type 2 (HSV-2) meningitis, confirmed by polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF). The terms “herpes simplex,” “meningitis,” or “encephalitis” were searched in the medical records system of the Mayo Clinic in Rochester, Minnesota (1995–2008). Patients were included if they had a clinical diagnosis of meningitis and HSV-2 detected by PCR in the CSF. There were 28 patients with 33 episodes identified (83 % female; mean age at presentation of meningitis 36 years, range 17–53; mean time to HSV2 detection from symptom onset 3 days, range 0–6; history of genital herpes 23 %). No patient took oral antiviral treatment at the time of presentation. Episodes were most likely to include headache (100 %), photophobia (47 %), self-reported fever (45 %), meningismus (44 %), and nausea and/or vomiting (29 %). CSF at the time of meningitis was notable for elevated protein (mean 156 g/dL, range 60–258) and white cell count (mean 504 cells/μL, range 86–1,860) with normal glucose (mean 54 mg/dL, range 32–80). Mollaret cells were never detected. Neuroimaging was most often normal (83 %) when performed, although some cases showed nonspecific (14 %) or meningeal changes (3 %). There was no consistent relationship to genital herpes. The duration of treatment with intravenous acyclovir ranged from 3 to 14 days for the first meningitic episode (daily dose range from 500 to 1,000 mg and total dose range from 500 mg q8h for 3 days to 800 mg q8h for 14 days). For subsequent episodes, the duration of treatment of intravenous acyclovir ranged from less than 1 to 14 days (total dose range from 1,390 mg for 1 day to 900 mg q8h for 10 days). The dose of valacyclovir ranged from 500 mg once daily to 500 mg four times daily. The median duration of valacyclovir treatment following the first episode was 10 days (range 3 to 14 days, n = 13). The median duration of valacyclovir treatment following a subsequent meningitic episode was 9 days (range 7 days to indefinite period, n = 9). No patient was reported to have seizures, neurological disability, or death in extended follow-up (mean follow-up 3.4 years). Recurrence of meningitic symptoms was not universal.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Abu Khattab M, Al Soub H, Al Maslamani M, Al Khuwaiter J, El Deeb Y (2009) Herpes simplex virus type 2 (Mollaret’s) meningitis: a case report. Int J Infect Dis 13:e476–e479

    Article  PubMed  Google Scholar 

  • Aurelius E, Forsgren M, Gille E, Skoldenberg B (2002) Neurologic morbidity after herpes simplex virus type 2 meningitis: a retrospective study of 40 patients. Scand J Infect Dis 34:278–283

    Article  PubMed  Google Scholar 

  • Berger JR, Houff S (2008) Neurological complications of herpes simplex virus type 2 infection. Arch Neurol 65:596–600

    Article  PubMed  Google Scholar 

  • Bergstrom T, Vahlne A, Alestig K, Jeansson S, Forsgren M, Lycke E (1990) Primary and recurrent herpes simplex virus type 2-induced meningitis. J Infect Dis 162:322–330

    Article  PubMed  CAS  Google Scholar 

  • Cinque P, Cleator GM, Weber T, Monteyne P, Sindic CJ, van Loon AM, for the EU Concerted Action on Virus Meningitis and Encephalitis (1996) The role of laboratory investigation in the diagnosis and management of patients with suspected herpes simplex encephalitis: a consensus report. J Neurol Neurosurg Psychiatry 61:339–345

    Article  PubMed  CAS  Google Scholar 

  • Forsgren M, Skoog M, Jeansson S, Olofsson S, Giesecke J (1994) Prevalence of antibodies to herpes simplex virus in pregnant women in Stockholm in 1969, 1983, and 1989: implications for STD epidemiology. Int J STD AIDS 5:113–116

  • Kallio-Laine K, Seppänen M, Kautiainen H, Lokki ML, Lappalainen M, Valtonen V, Färkkilä M, Kalso E (2009) Recurrent lymphocytic meningitis positive for herpes simplex virus type 2. Emerg Infect Dis 15:1119–1122

    Article  PubMed  Google Scholar 

  • Kupila L, Vuorinen T, Vainionpaa R, Hukkanen V, Marttila RJ, Kotilainen P (2006) Etiology of aseptic meningitis and encephalitis in an adult population. Neurology 66:75–80

    Article  PubMed  CAS  Google Scholar 

  • Landry ML, Greenwold J, Vikram H (2009) Herpes simplex type-2 meningitis: presentation and lack of standardized therapy. Am J Med 122:688–691

    Article  PubMed  Google Scholar 

  • Mateen FJ, Mohr DN (2008) 45-year-old woman with recurrent headache and photophobia. Mayo Clin Proc 83:951–955

    PubMed  Google Scholar 

  • Momméja-Marin H, Lafaurie M, Scieux C, Galicier L, Oksenhenndler E, Molina J (2003) Herpes simplex virus type 2 as a cause of severe meningitis in immunocompromised adults. Clin Infect Dis 37:1527–1533

    Google Scholar 

  • Najioullah F, Bosshard S, Thouvenot D, Boibieux A, Menager B, Biron F, Aymard M, Lina B (2000) Diagnosis and surveillance of herpes simplex virus infection of the central nervous system. J Med Virol 61:68–73

    Google Scholar 

  • Omland LH, Vestergaard BF, Wandall JH (2008) Herpes simplex virus type 2 infections of the central nervous system: a retrospective study of 49 patients. Scand J Infect Dis 40:59–62

    Article  PubMed  Google Scholar 

  • O’Sullivan CE, Aksamit AJ, Harrington JR, Harmsen WS, Mitchell PS, Patel R (2003) Clinical spectrum and laboratory characteristics associated with detection of herpes simplex virus DNA in cerebrospinal fluid. Mayo Clin Proc 78:1347–1352

    Article  PubMed  Google Scholar 

  • Stalder H, Oxman MN, Dawson DM, Levin MJ (1973) Herpes simplex meningitis: isolation of herpes simplex virus type 2 from cerebrospinal fluid. N Engl J Med 289:1296–1298

    Google Scholar 

  • Tedder DG, Ashley R, Tyler KL, Levin MJ (1994) Herpes simplex virus infection as a cause of benign recurrent lymphocytic meningitis. Ann Intern Med 121:334–338

    Article  PubMed  CAS  Google Scholar 

  • Tyler KL, Adler D (1983) Twenty-eight years of benign recurring Mollaret’s meningitis. Arch Neurol 40:42–43

    Article  PubMed  CAS  Google Scholar 

  • Wald A, Zeh J, Selke S, Warren T, Ryncarz AJ, Ashley R, Krieger JN, Corey L (2000) Reactivation of genital herpes simplex virus type 2 infection in asymptomatic seropositive persons. N Engl J Med 342:844–850

    Article  PubMed  CAS  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Farrah J. Mateen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Miller, S., Mateen, F.J. & Aksamit, A.J. Herpes simplex virus 2 meningitis: a retrospective cohort study. J. Neurovirol. 19, 166–171 (2013). https://doi.org/10.1007/s13365-013-0158-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13365-013-0158-x

Keywords

Navigation