Varicella zoster vs. herpes simplex meningoencephalitis in the PCR era. A single center study.

BACKGROUND: The introduction of polymerase chain reaction (PCR) for the diagnosis of herpesvirus central nervous system infections is reshaping our understanding of these illnesses. Varicella-zoster virus (VZV) is increasingly recognized as an important etiology of sporadic viral meningoencephalitis (ME). Furthermore, mild cases of herpes simplex virus (HSV) ME, traditionally considered a devastating infection, are frequently reported. METHODS: We compared the demographic and clinical features of patients with VZV (20) and HSV (17) ME diagnosed by Real-Time PCR of cerebrospinal samples in a single center during the years 2002-2010. RESULTS: VZV and HSV patients were comparable with respect to age, sex, underlying diseases, immune suppression, and the rates of fever, headache and altered mental status on presentation. Seizures, focal neurological signs, systemic complications and in-hospital death were noted only in the HSV group. CONCLUSIONS: Our study confirms the prevalence of VZV as a cause of sporadic ME over the last decade. While patients with HSV ME had more manifestations of severe disease, there also was a significant overlap with clinical and laboratory parameters of VZV ME. In the absence of dermatomal rash, differentiation between VZV and HSV ME on clinical grounds alone may represent a true challenge.

Herpes simplex virus type 1 in saliva of patients with vestibular neuronitis: a preliminary study.

OBJECTIVES: Vestibular neuronitis (VN) is an inflammatory disease of the vestibular nerve, presumably caused by reactivation of the herpes simplex virus type l (HSV-1). We hypothesized that HSV-1 might be detected in saliva of patients with VN due to migration of the reactivated virus from the vestibular ganglia to the parotid gland. METHODS: Twenty-one patients with VN and 15 healthy controls participated. HSV-1 DNA detection was performed using the real-time polymerase chain reaction method. Sera were collected and stored to be later analyzed for immunoglobulin (Ig) G and IgM antibody titers against HSV-1 by immunofluorescence and enzyme linked immunosorbent assay methods, respectively. RESULTS: HSV-1 was detected in saliva of 14% of VN patients and in 6% of controls (P>0.05). Serological testing revealed borderline IgM (optical density±10% average of 2 cut off serums) antibodies to HSV-1 in 75% of patients versus 13% of controls (P=0.01). The IgG antibody test was positive in 17 of 20 patients and borderline (IgG ≤1:16) in 2 of 20 patients tested whereas 13 of 15 controls had positive IgG test results (P>0.05). CONCLUSIONS: In this preliminary study we found serological evidence of higher exposure of patients with VN to HSV-1 in the past. We were not able to demonstrate that the virus can be detected in saliva of VN patients as evidence for herpetic infection or reactivation.

Fetal outcome and amniocentesis results in pregnancies complicated by varicella infection.

OBJECTIVE: To evaluate the outcome of infants born to mothers with varicella zoster virus (VZV) infection in pregnancy who had second trimester amniocentesis for detection of placental transfer. METHODS: We interviewed women who had had VZV infection in pregnancy and who underwent diagnostic amniocentesis to detect transplacental infection using both polymerase chain reaction (PCR) and cell culture methods to characterize their children's clinical and psychomotor development. RESULTS: Twenty women who had a diagnosis of primary VZV during pregnancy were available for interview. The mean gestational age at which primary VZV was acquired was 11±3.5 weeks. One infant had hypospadias and developmental delay. He was born to an epileptic mother who had been treated during pregnancy with sodium valproate and clonazepam. Another infant had abnormal brainstem auditory-evoked potentials. All other infants were reported to have normal clinical and psychomotor development. CONCLUSION: In cases of varicella infection during pregnancy, negative studies of amniotic fluid using PCR may contribute to decision making.

Presence of viremia in patients with primary herpetic gingivostomatitis.

BACKGROUND: Presence of viremia during primary herpes simplex virus (HSV) infections has been previously investigated, but the findings for immunocompetent individuals have only rarely been reported. METHODS: With use of polymerase chain reaction (PCR), we evaluated blood samples obtained from children with primary herpes simplex virus (HSV) gingivostomatitis for viremia. RESULTS: There were 16 girls and 16 boys, aged 9-44 months (median age, 19 months). Serological test results for HSV type 1 were positive for 3 subjects (10.3%), borderline for 7 (24.1%), and negative for 19 (65.5%). Results of PCR of peripheral blood samples were positive for 11 subjects (34.4%). Time from disease onset to specimen collection was 24-216 h (median, 72 h) and was longer for subjects with positive results of serological tests (P =.014) and shorter for subjects with positive PCR results (P=.42). No cases with positive results of both PCR and serological tests were found. CONCLUSION: PCR detected viremia in 34% of patients with primary herpetic gingivostomatitis. Presence of viremia may play a potential role in viral dissemination, providing a better understanding of the pathogenesis of HSV infections, especially of the central nervous system.