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The Role of Herpesviruses

Laura Kupila, MD; Raija Vainionpää, PhD; Tytti Vuorinen, MD, PhD; Reijo J Marttila, MD, PhD; Pirkko Kotilainen, MD, PhD

Arch Neurol. 2004;61:1553-1557.

Background  Herpes simplex virus 2 (HSV-2) and HSV-1 have been recognized as causes of recurrent aseptic lymphocytic meningitis (RALM). However, the role of other herpesviruses has not been systematically assessed.

Objectives  To evaluate the cause of RALM by using polymerase chain reaction (PCR) tests detecting varicella-zoster virus (VZV), cytomegalovirus (CMV), or human herpesvirus 6 (HHV-6), in addition to HSV, on cerebrospinal fluid (CSF) samples; and to assess the utility of PCR and antibody analyses in consecutive episodes of RALM.

Design  The PCR and antibody results for herpesviruses were analyzed from 14 patients having 48 episodes of RALM.

Results  The CSF PCR results for VZV, CMV, and HHV-6 were negative in 12, 10, and 11 patients investigated, respectively, and antibodies against VZV, CMV, and HHV-6 showed only old immunity. Herpes simplex virus 2 was detected from the CSF in 10 patients, and HSV-1 in 1 patient. In 6 of these 11 patients, the HSV PCR result was positive in more than one disease episode. A significant increase of serum antibodies for HSV was seen in only 1 of 15 episodes examined. An intrathecal antibody response to HSV was not recognized in 9 episodes investigated in these 11 patients.

Conclusions  We could not find evidence of VZV, CMV, or HHV-6 in the pathogenesis of RALM, although most patients were previously infected by those viruses. Herpes simplex virus 2 was detected from the CSF in most patients, and often repeatedly, which further confirms the role of this virus in RALM. The causative diagnosis was obtained only by PCR, whereas antibody analysis was not clinically useful.

Author Affiliations: Departments of Neurology (Drs Kupila and Marttila) and Medicine (Dr Kotilainen), Turku University Central Hospital, Turku, Finland; Department of Neurology, Satakunta Central Hospital, Pori, Finland (Dr Kupila); and Department of Virology, University of Turku, Turku (Drs Vainionpää and Vuorinen).

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