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  • Title: Herpes simplex type-2 meningitis: presentation and lack of standardized therapy.
    Author: Landry ML, Greenwold J, Vikram HR.
    Journal: Am J Med; 2009 Jul; 122(7):688-91. PubMed ID: 19559173.
    Abstract:
    BACKGROUND: Herpes simplex type-2 (HSV-2) causes both primary and recurrent lymphocytic meningitis, but optimal patient management is not well defined. METHODS: In this retrospective observational study, we reviewed the medical records of patients with HSV-2-positive cerebrospinal fluid samples in our laboratory between January 2001 and January 2005. RESULTS: During the study period, 23 patients, aged 16 to 83 years, had HSV-2 detected in spinal fluid. Nineteen (83%) had meningitis and 4 (17%) had evidence of meningoencephalitis. Seventy-four percent were female. Two (8.7%) had a history of prior genital herpes, and one (4.3%) had genital lesions noted at the time of presentation. Genital examinations were performed at presentation in only 3 patients. Seven (30.4%) patients reported previous episodes of meningitis. Two celibate women developed HSV-2 meningitis or meningoencephalitis following lumbar steroid injection for spinal stenosis. One woman developed HSV-2 meningoencephalitis 3 days postpartum following cesarean section. Antiviral treatment for uncomplicated HSV-2 meningitis varied from none (4 patients) to 14-21 days of intravenous (IV) acyclovir therapy (4 patients). The 11 remaining patients with meningitis received 1-7 days of IV therapy, followed by 7-21 days of oral antiviral therapy. Three of 4 patients with meningoencephalitis received 21 days of IV acyclovir, and one received 3 days IV acyclovir followed by 14 days of oral therapy. CONCLUSIONS: HSV-2 meningitis presents most often without a history of genital herpes, recurrent meningitis, or genital symptoms. Current management practices are highly variable and may lead to unnecessary hospitalization and prolonged intravenous therapy.
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