Herpes simplex virus type 2 recurrent meningitis (Mollaret's meningitis): a consideration for the recurrent pathogenesis

Sato, Rumi; Ayabe, Mitsuyoshi; Shoji, Hiroshi; Ichiyama, Takashi; Saito, Yumiko; Hondo, Ryo; Eizuru, Yoshito

doi:10.1016/j.jinf.2005.02.018

Cited by 15 publications

(8 citation statements)

References 14 publications

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“…14 A 44-year-old woman successfully used suppressive oral aciclovir having attempted, unsuccessfully, to use episodic therapy. 15 The advent of widespread PCR testing has highlighted HSV-2, and not HSV-1, as the predominant cause of recurrent lymphocytic (Mollaret's) meningitis. Neurological recurrences may be a more common cause of severe debility associated with genital HSV-2 than is currently recognized, especially as at least one-third of cases occur in the absence of a history of genital lesions.…”

mentioning

confidence: 99%

Mollaret's meningitis and herpes simplex virus type 2 infections

2011

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confidence: 99%

Mollaret's meningitis and herpes simplex virus type 2 infections

2011

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“…In particular, herpes simplex virus type 2 was frequently reported to be associated with this disease. [2][3][4][5] However, our laboratory testing (blood and CSF examination) in this patient did not reveal the presence of herpes simplex virus type 2 or other viruses. Instead, MRI revealed a spinal cyst at T12, with pathologic epidermoid confirmation (Figs 2 and 3).…”

Section: Discussionmentioning

confidence: 54%

“…To date, ϳ50 cases have been reported in the world, and most have been associated with viral infection, especially herpes simplex type 2. [2][3][4][5] Other reported etiologies include Vogt-Koyanagi syndrome, Harada syndrome, Behçet disease, 6 allergic, systemic lupus erythematosus, familial Mediterranean fever, 7 glioblastoma, and Whipple disease, as well as intracranial hydatid, sarcoidosis, and epidermoid cysts. 8 In 1962, Bruyn 6 proposed criteria for the clinical diagnosis of Mollaret meningitis: (1) recurrent episodes of severe headache, meningismus, and fever; (2) cerebrospinal fluid (CSF) pleocytosis with large "endothelial" cells, neutrophils, and lymphocytes; (3) attacks separated by symptom-free periods that last weeks to months; (4) spontaneous remission of symptoms and signs; and (5) no causative etiologic agent.…”

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confidence: 99%

Mollaret Meningitis Associated With an Intraspinal Epidermoid Cyst

Gao

Yang²,

Zhuang³

et al. 2007

Pediatrics

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Mollaret meningitis, a benign recurrent aseptic disease, is known to be associated with intracranial epidermoid cysts. In this report, we describe a case of Mollaret meningitis caused by an intraspinal epidermoid cyst located at thoracic level 12. The patient's clinical manifestations and cerebrospinal fluid features were similar to those with bacterial meningitis characterized by predominant polymorphonuclear leukocytes. However, Mollaret cells, not bacteria, were identified in the patient's cerebrospinal fluid. The illness ceased after surgical resection of the cyst, and the cyst tissue was pathologically diagnosed as epidermoid. Therefore, an intraspinal epidermoid cyst can be etiologically associated with Mollaret meningitis and should be included in the differential diagnosis of recurrent aseptic meningitis.

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“…They suggested that the immunodysregulation induced by HHV-6 could be accounted by a shift from a T H 1 to a T H 2 type cytokine profile. Finally, Sato et al (2005) suggested that in the pathogenesis of HSV-2-induced recurrent meningitis involved is the low-immune response, including immune evasion.…”

Section: Discussionmentioning

confidence: 99%

Mollaret Meningitis may be Caused by Reactivation of Latent Cerebral Toxoplasmosis

Prandota

2009

International Journal of Neuroscience

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Mollaret meningitis (MM) occurs mainly in females and is characterized by recurrent episodes of headache, transient neurological abnormalities, and the cerebrospinal fluid containing mononuclear cells. HSV-2 was usually identified as the causative agent. Recently, we found that recurrent headaches in non-HIV-infected subjects were due to acquired cerebral toxoplasmosis (CT). The aim of the study was therefore to focus on molecular pathomechanisms that may lead to reactivation of latent CT and manifest as MM. Literature data cited in this work were selected to illustrate that various factors may affect latent CNS Toxoplasma gondii infection/inflammation intensity and/or host defense mechanisms, i.e., the production of NO, cytokines, tryptophan degradation by indoleamine 2,3-dioxygenase, mechanisms mediated by an IFN-gamma responsive gene family, limiting the availability of intracellular iron to T. gondii, and production of reactive oxygen/nitrogen species, finally inducing choroid plexitis and/or vasculitis. Examples of triggers revealing MM and accompanying disturbances of IFN-gamma-mediated immune responses that control HSV-2 and T. gondii include: female predominance (female mice are more susceptible to T. gondii infection than males); HSV-2 infection (increased IFN-gamma, IL-12); metaraminol (increased plasma catecholamine levels, changes in cytokine expression favoring T(H)2 cells responses); probably cholesterol contained in debris from ruptured epidermoid cysts (decreased NO; increased TNF-alpha, IL-6, IL-8). These irregularities induced by the triggers may be responsible for reactivation of latent CT and development of MM. Thus, subjects with MM should have test(s) for T. gondii infection performed obligatorily.

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Herpes simplex virus type 2 recurrent meningitis (Mollaret's meningitis): a consideration for the recurrent pathogenesis

Cited by 15 publications

References 14 publications

Mollaret's meningitis and herpes simplex virus type 2 infections

Mollaret's meningitis and herpes simplex virus type 2 infections

Mollaret Meningitis Associated With an Intraspinal Epidermoid Cyst

Mollaret Meningitis may be Caused by Reactivation of Latent Cerebral Toxoplasmosis

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