| Herpesviral meningitis | |
|---|---|
 | |
| Specialty | Infectious disease, Neurology |
| Symptoms | Headache, fever, neck stiffness, photophobia |
| Causes | Viruses of the herpesviridae family |
| Diagnostic method | CSF findings, lumbar puncture |
| Treatment | Symptom management, antivirals |
Herpes meningitis is inflammation of the meninges, the protective tissues surrounding the spinal cord and brain,[1] due to infection from viruses of the herpesviridae family [2] most common of which is HSV-2.[3]
Clinical Presentation
Common symptoms include nausea, vomiting, neck-stiffness, photophobia, and severe frontal headaches.[4] Patients with meningitis secondary to the HSV-2 virus may also present with genital lesions.[5]
HSV-2 is the most common cause of Mollaret's meningitis, a type of recurrent viral meningitis.[6] This condition was first described in 1944 by French neurologist Pierre Mollaret. Recurrences usually last a few days or a few weeks, and resolve without treatment. They may recur weekly or monthly for approximately 5 years following primary infection.[7]
Diagnosis
Lumbar puncture must be performed to rule out meningitis in patients presenting with combinations of fever, headache, stiff neck, and altered mental status.[8] CSF findings in herpes meningitis present with lymphocytic pleocytosis, normal glucose, and normal-to-elevated protein.[9]
DNA analysis techniques such as polymerase chain reaction can be used to look for DNA of herpesviruses in spinal fluid or blood. However, the results may be negative even in cases where other definitive symptoms exist.[10]
Treatment
Although guidelines strongly recommend acyclovir for treatment of herpes encephalitis, there are currently no such guidelines for managing herpes meningitis.[11] Herpes meningitis is typically self-limiting over 2 weeks without treatment. However, empirical use of antiviral medications such as acyclovir are considered in cases of suspected HSV meningitis to prevent progression to the more rapid and fatal HSV meningoencephalitis.[12]
See also
References
- ^ Kohil, Amira; Jemmieh, Sara; Smatti, Maria K.; Yassine, Hadi M. (February 2021). "Viral meningitis: an overview". Archives of Virology. 166 (2): 335–345. doi:10.1007/s00705-020-04891-1. ISSN 0304-8608. PMC 7779091. PMID 33392820.
- ^ Spear, Patricia G.; Longnecker, Richard (October 2003). "Herpesvirus Entry: an Update". Journal of Virology. 77 (19): 10179–10185. doi:10.1128/JVI.77.19.10179-10185.2003. ISSN 0022-538X. PMC 228481. PMID 12970403.
- ^ Logan, Sarah A E; MacMahon, Eithne (2008-01-05). "Viral meningitis". BMJ. 336 (7634): 36–40. doi:10.1136/bmj.39409.673657.AE. ISSN 0959-8138. PMC 2174764. PMID 18174598.
- ^ Gundamraj, Vaishnavi; Hasbun, Rodrigo (June 2023). "Viral meningitis and encephalitis: an update". Current Opinion in Infectious Diseases. 36 (3): 177–185. doi:10.1097/QCO.0000000000000922. ISSN 0951-7375. PMID 37093042. S2CID 258299272.
- ^ Corey, Lawrence (1983-06-01). "Genital Herpes Simplex Virus Infections: Clinical Manifestations, Course, and Complications". Annals of Internal Medicine. 98 (6): 958–972. doi:10.7326/0003-4819-98-6-958. ISSN 0003-4819. PMID 6344712.
- ^ Tyler KL (2004). "Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's". Herpes. 11. Suppl 2: 57A–64A. PMID 15319091.
- ^ Sendi P, Graber P (2006). "Mollaret's meningitis". CMAJ. 174 (12): 1710. doi:10.1503/cmaj.051688. PMC 1471823. PMID 16754896.
- ^ Carter, Emma; McGill, Fiona (September 2022). "The management of acute meningitis: an update". Clinical Medicine. 22 (5): 396–400. doi:10.7861/clinmed.2022-cme-meningitis. ISSN 1470-2118. PMC 9594998. PMID 36507811.
- ^ Mount, Hillary R.; Boyle, Sean D. (2017-09-01). "Aseptic and Bacterial Meningitis: Evaluation, Treatment, and Prevention". American Family Physician. 96 (5): 314–322. ISSN 1532-0650. PMID 28925647.
- ^ "Recurrent Herpes Simplex Virus Type 2 Meningitis: A Case Report of Mollaret's Meningitis" (PDF). Jpn. J. Infect. Dis. July 2002.
- ^ Noska, Amanda; Kyrillos, Ramona; Hansen, Glen; Hirigoyen, Diane; Williams, David N. (2015-01-15). "The role of antiviral therapy in immunocompromised patients with herpes simplex virus meningitis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 60 (2): 237–242. doi:10.1093/cid/ciu772. ISSN 1537-6591. PMID 25273082.
- ^ Roberts, James R.; Custalow, Catherine B.; Thomsen, Todd W., eds. (2019). Roberts and Hedges' clinical procedures in emergency medicine (Seventh ed.). Philadelphia: Elsevier. ISBN 978-0-323-35478-3.
External links
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This page was last edited on 11 March 2024, at 18:32