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Neurological Disease in Herpes Simplex Virus Type 2 (HSV-2) Infection
Published in Marie Studahl, Paola Cinque, Tomas Bergström, Herpes Simplex Viruses, 2017
Mollaret’s syndrome may be of heterogeneous, infectious, and noninfectious origin. It has been suggested to be associated with allergic, autoimmune, or chemical induction, and with dermoid cysts. A microbiological etiology of Mollaret’s meningitis has been suspected for a long time. Mollaret himself suggested that the disease in some patients might be caused by a virus (48) and the disease entity has been associated with EBV and borreliosis (49,50).
Herpes Simplex Virus and Human CNS Infections
Published in Sunit K. Singh, Daniel Růžek, Neuroviral Infections, 2013
Marcela Kúdelová, Július Rajčáni
Very recently, the reactivation of HSV in the CNS has proved to be a causative agent of Mollaret’s meningitis with different prognoses as described for HSVE (Tyler 2004). Most often, HSV-2 is implicated, although HSV-1 has also been reported (Yamamoto et al. 1991). Women are at higher risk than men. The initial episode often develops during acquisition of genital HSV-2, with subsequent recurrent episodes. Thus, the epidemiology of Mollaret’s meningitis parallels that of genital herpes. However, not infrequently, meningitis is the presenting complaint, and the association with HSV-2 is not always recognized. Spinal fluid findings are consistent with “aseptic meningitis,” with positive results of PCR diagnostics searching the presence of HSV DNA (also see Section 7.4.2). Patients usually respond well to antiviral therapy.
Herpes simplex virus 2 (HSV-2)
Published in Peter M. Lydyard, Michael F. Cole, John Holton, William L. Irving, Nino Porakishvili, Pradhib Venkatesan, Katherine N. Ward, Case Studies in Infectious Disease, 2010
Peter M. Lydyard, Michael F. Cole, John Holton, William L. Irving, Nino Porakishvili, Pradhib Venkatesan, Katherine N. Ward
There are a number of possible complications. In primary disease, there may be meningeal irritation, such that the patient presents with a clinical diagnosis of meningitis. This may rarely happen even with recurrent disease – so-called Mollaret’s meningitis. HSV meningitis is more common in women. Irritation of the sacral nerve roots (radiculomyelopathy) may present with aching pain in the sacral dermatomes associated with parasthesiae or dysasthesiae in the lower limbs. Accidental inoculation elsewhere in the body has been mentioned above, for example giving rise to herpetic keratitis (infection of the cornea). One disastrous complication of genital herpes in a female is spread to her baby, resulting in neonatal herpes (Figure 3). This usually arises in women suffering a primary attack of genital herpes in late pregnancy, of which she may be unaware. However, the birth canal is rich in virus, and there has not yet been time for the mother to generate and pass protective antibodies transplacentally to the fetus. The majority of neonates infected in this way acquire internally disseminated infection, including herpes encephalitis, which has a high mortality and morbidity even with appropriate therapy. Only about half of these neonates have herpetic lesions evident on their skin or mucous membranes, making the diagnosis very difficult. It is only the babies whose infection is limited to the skin and mucous membrane who make a complete recovery – only about 10–15% of all neonatally infected babies. Fortunately, neonatal HSV infection is not common – about 1 in 50 000 births in the UK, but perhaps 1 in 5000 in the USA.
Recurrent benign lymphocytic (Mollaret’s) meningitis due to herpes simplex virus type 2
Published in Baylor University Medical Center Proceedings, 2022
Michael Grinney, Michael M. Mohseni
Ceftriaxone 2 g intravenous was administered. Neurology maintained the patient on acyclovir 10 mg/kg intravenous every 8 hours and added gabapentin 300 mg three times daily. CSF PCR was ultimately positive for HSV-2; PCR testing for HSV-1, varicella-zoster virus, cytomegalovirus, enterovirus, Epstein-Barr virus, influenza A, and influenza B remained negative. Given the patient’s previous episodes, RBLM or Mollaret’s meningitis was considered a likely diagnosis. Infectious disease recommended valacyclovir 1 g orally 3 times daily upon discharge for a total treatment duration of 10 days, followed by prophylactic antiviral therapy. The patient improved significantly over 2 days. Her discharge medications included prophylactic valacyclovir 1 g orally twice a day for 6 months.