Herpes simplex and varicella zoster CNS infections: clinical presentations, treatments and outcomes

Quanhathai Kaewpoowat; Lucrecia Salazar; Elizabeth Aguilera; Susan H Wootton; Rodrigo Hasbun

doi:10.1007/s15010-015-0867-6

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Herpes simplex and varicella zoster CNS infections: clinical presentations, treatments and outcomes

Journal article

Peer reviewed

Herpes simplex and varicella zoster CNS infections: clinical presentations, treatments and outcomes

Quanhathai Kaewpoowat, Lucrecia Salazar, Elizabeth Aguilera, Susan H Wootton and Rodrigo Hasbun

Infection, Vol.44(3), pp.337-345

06/2016

DOI: 10.1007/s15010-015-0867-6

PMID: 26680781

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Abstract

To describe the clinical manifestations, cerebrospinal fluid (CSF) characteristics, imaging studies and prognostic factors of adverse clinical outcomes (ACO) among adults with herpes simplex virus (HSV) or varicella zoster virus (VZV) CNS infections. Retrospective review of adult patients with positive HSV or VZV polymerase chain reaction on CSF from an observational study of meningitis or encephalitis in Houston, TX (2004-2014), and New Orleans, LA (1999-2008). Ninety-eight adults patients were identified; 25 had encephalitis [20 (20.4 %) HSV, 5 (5.1 %) VZV], and 73 had meningitis [60 (61.1 %) HSV and 13 (13.3 %) VZV]. HSV and VZV had similar presentations except for nausea (P < 0.01) and rash (P < 0.001). The CSF profile did not differ between HSV and VZV infection. Abnormal neuroimaging findings were found in 11.6 % (10/86) brain CTs and 21.3 % (16/75) brain MRIs. The EEG was abnormal in 57.9 % (11/19). Sixteen patients (16.3 %) had an ACO (10 HSV encephalitis, 3 VZV encephalitis and 3 VZV meningitis). Intravenous acyclovir administered within 48 h was protective against an ACO [OR 0.19 (0.04-0.80), P = 0.02). However, on logistic regression only Charlson comorbidity score >1 and an encephalitis presentation were independently associated with an ACO. The treatment for HSV meningitis was variable, and all patients had a good clinical outcome. Alpha herpes CNS infections due to HSV and VZV infections have similar clinical and laboratory manifestations. ACO was observed more frequently in those patients with comorbidities and an encephalitis presentation.

Adolescent

Adult

Aged

Aged, 80 and over

Encephalitis, Herpes Simplex - diagnosis

Encephalitis, Herpes Simplex - epidemiology

Encephalitis, Herpes Simplex - virology

Female

Herpesvirus 3, Human

Humans

Male

Meningitis, Viral - diagnosis

Meningitis, Viral - epidemiology

Meningitis, Viral - virology

Middle Aged

Retrospective Studies

Simplexvirus

Treatment Outcome

Young Adult

Details

Title: Subtitle: Herpes simplex and varicella zoster CNS infections: clinical presentations, treatments and outcomes
Creators: Quanhathai Kaewpoowat - The University of Texas Health Science Center
Lucrecia Salazar - The University of Texas Health Science Center
Elizabeth Aguilera - The University of Texas Health Science Center at Houston
Susan H Wootton - The University of Texas Health Science Center
Rodrigo Hasbun - The University of Texas Health Science Center
Resource Type: Journal article
Publication Details: Infection, Vol.44(3), pp.337-345
DOI: 10.1007/s15010-015-0867-6
PMID: 26680781
ISSN: 0300-8126
eISSN: 1439-0973
Grant note: name: Grant A Starr Foundation; DOI: 10.13039/100000097, name: National Center for Research Resources, award: NIH-1 K23 RR018929-01A2
Language: English
Date published: 06/2016
Academic Unit: Internal Medicine
Record Identifier: 9984359838102771

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