High variability in viral load in cerebrospinal fluid from patients with herpes simplex and varicella-zoster infections of the central nervous system

Růžek, Daniel; Piskunova, N. V.; Žampachová, Eva

doi:10.1111/j.1469-0691.2007.01831.x

Cited by 11 publications

(14 citation statements)

References 11 publications

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“…In our study, we analyzed the relationship between viral load and outcome, introducing viral load as a continuous variable. Our results are in agreement with Wildeman et al [10], Ruzek et al [11] and Hjalmarsson A et al . [19].…”

Section: Resultssupporting

confidence: 94%

“…First, although our sample size was greater than in other studies [8,10,11], the number of patients with available CSF samples was still small. This limitation is due to the low prevalence of HSE.…”

Section: Resultsmentioning

confidence: 95%

“…Previous histopathological descriptions of HSE also showed a relationship between a high number of viral particles upon brain biopsy and poor disease outcome [7]. However, since HSV load in the cerebrospinal fluid (CSF) is not routinely determined, data on the impact of high HSV load upon HSE outcome are scarce and contradictory [8-11]. …”

Section: Introductionmentioning

confidence: 99%

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Impact of Herpes simplex virus load and red blood cells in cerebrospinal fluid upon herpes simplex meningo-encephalitis outcome

et al. 2012

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BackgroundHerpes simplex encephalitis (HSE) often leads to severe disability or death. Factors usually associated with outcome include Simplified Acute Physiology Score, age and delay of initiation of acyclovir treatment.Our aim was to determine the impact of Herpes simplex virus (HSV) load in cerebrospinal fluid (CSF) upon HSE outcome.MethodsWe retrospectively determined HSV load in the CSF of 43 patients with confirmed HSE, hospitalized in northern France from 1998 to 2005, using CSF samples collected the day of hospital admission and stored at −20°C. We analyzed the association between HSV load and mortality/morbidity by the Glasgow Outcome Scale. Fisher’s exact test and Wilcoxon’s test were used for statistical analysis.ResultsThe M/F sex ratio was 1.7 and median patient age was 61 years. Median HSV load in CSF was 2.0 log copies/μL (IQR 25-75=1.2-2.6). The mortality rate was 32.6% six months after HSE diagnosis. Higher age was associated with mortality (p=0.03). Longer delay in acyclovir initiation tended to be associated with higher mortality but did not reach statistical significance (p=0.08). Severe disability and death due to HSV were associated with a higher Knaus score (p=0.004), later acyclovir initiation (p=0.006), older age (p=0.04) and presence of red blood cells in CSF (p=0.05). HSV load in CSF was neither associated with mortality (p=1.00) nor with morbidity (p=0.90).ConclusionIn this study, HSV load in CSF was not found to be associated with poor outcome in patients with HSE. These data do not support measurement of HSV load at admission in patients with HSE.

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Section: Resultssupporting

confidence: 94%

Section: Resultsmentioning

confidence: 95%

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Impact of Herpes simplex virus load and red blood cells in cerebrospinal fluid upon herpes simplex meningo-encephalitis outcome

et al. 2012

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“…Investigators have compared viral load in cerebrospinal fluid and prognosis in herpes encephalitis. Most of them demonstrate no correlation between viral load and prognosis/mortality 28–30…”

Section: Discussionmentioning

confidence: 99%

Alpha herpes virus type and viral load in intraocular fluids in patients with acute retinal necrosis

2019

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ObjectivesTo identify all patients tested positive for herpes viruses in intraocular samples between 2007 and 2016 in South-Western Sweden and evaluate which of these met the criteria of acute retinal necrosis (ARN). To compare viral load in intraocular samples and virus type with clinical outcome.Method and analysisRetrospective case series. Intraocular samples and serum were analysed with quantitative real-time PCR (qPCR) and presence of antibodies (IgG and IgM) were detected by ELISA in serum.ResultsBetween 2007 and 2016, 13 patients met the clinical criteria of ARN and were PCR-positive in aqueous or vitreous for herpes simplex virus 1 (HSV1; n=4), herpes simplex virus 2 (HSV2; n=3) and varicella zoster virus (VZV; n=6). None of the patients tested positive for cytomegalovirus (n=13) or Epstein Barr virus (n=2) met the criteria of ARN. All ARN patients had specific serum IgG and three patients exhibited virus DNA in serum. There was no correlation between high viral load and worse visual outcome. However, higher viral loads were seen in samples taken earlier in the disease process. Median age was higher (p=0.049) in VZV-ARN than for HSV-ARN patients (60.5 and 45.4 years, respectively) with a tendency of worse best corrected visual acuity at presentation (1.62 and 0.79 log MAR, respectively; p=0.079).ConclusionARN is a reactivation of alpha herpes virus and presence of herpes DNA in serum may occur. VZV-ARN are older than HSV-ARN patients. High viral load does not appear to be a predictor of worse visual outcome, but rather indicates earlier sampling.

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“…1,6,7 The quantitation of other viral pathogens in CSF, reported in patients with neurological diseases, has demonstrated clear associations between viral load and the severity of neurological symptoms. 5,[8][9][10] To date, most studies have relied solely on qualitative methods of EV RNA detection in CSF, with only a few determining the EV viral load and its correlation with clinical characteristics in individuals with enteroviral neurological conditions. 7,[11][12][13][14][15] Additionally, relatively few studies have examined the prevalence of EV species in Brazil.…”

mentioning

confidence: 99%

Evaluation of enterovirus concentration, species identification, and cerebrospinal fluid parameters in patients of different ages with aseptic meningitis in São Paulo, Brazil

Honorato,

Ferreira,

Domingues

et al. 2024

Journal of Medical Virology

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Human enteroviruses (EV) are the most common cause of aseptic meningitis worldwide. Data on EV viral load in cerebrospinal fluid (CSF) and related epidemiological studies are scarce in Brazil. This study investigated the influence of EV viral load on CSF parameters, as well as identifying the involved species. CSF samples were collected in 2018–2019 from 140 individuals at The Hospital das Clínicas, São Paulo. The EV viral load was determined using real‐time quantitative polymerase chain reaction, while EV species were identified by 5′UTR region sequencing. Median viral load was 5.72 log10 copies/mL and did not differ by subjects' age and EV species. Pleocytosis was observed in 94.3% of cases, with the highest white blood cell (WBC) counts in younger individuals. Viral load and WBC count were correlated in children (p = 0.0172). Elevated lactate levels were observed in 60% of cases and correlated with the viral load in preteen‐teenagers (p = 0.0120) and adults (p = 0.0184). Most individuals had normal total protein levels (70.7%), with higher in preteen‐teenagers and adults (p < 0.0001). By sequencing, 8.2% were identified as EV species A and 91.8% as species B. Age‐specific variations in CSF characteristics suggest distinct inflammatory responses in each group.

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High variability in viral load in cerebrospinal fluid from patients with herpes simplex and varicella-zoster infections of the central nervous system

Cited by 11 publications

References 11 publications

Impact of Herpes simplex virus load and red blood cells in cerebrospinal fluid upon herpes simplex meningo-encephalitis outcome

Impact of Herpes simplex virus load and red blood cells in cerebrospinal fluid upon herpes simplex meningo-encephalitis outcome

Alpha herpes virus type and viral load in intraocular fluids in patients with acute retinal necrosis

Evaluation of enterovirus concentration, species identification, and cerebrospinal fluid parameters in patients of different ages with aseptic meningitis in São Paulo, Brazil

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