Presence of herpesvirus DNA in cerebrospinal fluid of patients with tick-borne encephalitis and enteroviral meningoencephalitis

Abstract

Reactivation of HHVs in the CNS due to inflammation has not been well described yet. The primary aim of this study was to investigate the frequency of HHV DNA detection in the cerebrospinal fluid (CSF) of immunocompetent patients with meningoencephalitis of other than HHV origin. The secondary aim of this study was to evaluate the impact of herpesvirus co-infection on the clinical course and patient outcome. Ninety-six patients with clinically and laboratory proven tick-borne encephalitis (TBE) and 77 patients with a confirmed diagnosis of enteroviral meningitis (EVM), along with a control group of 107 patients without evidence of inflammation in the CSF were retrospectively tested by nested PCR for the presence of DNA of the neurotropic herpesviruses HSV1, HSV2, VZV, and HHV6 in the CSF. The clinical course, laboratory tests, antiviral treatment, and neurological complications in a 6-month follow-up were compared between the groups positive or negative for HHV DNA in the CSF. HHV DNA was found in the CSF of 12 (6.9%) patients (6.3% and 7.8% in the TBE and EVM groups, respectively) and in 1 (0.9%) control patient. None of the patients had recent blisters or rash. The clinical course was comparably mild in all patients. No permanent neurological sequelae were observed. Only the CSF total protein level was significantly higher in HHV DNA-positive than in HHV-negative patients.

The spectrum of aseptic central nervous system infections in southern Germany – demographic, clinical and laboratory findings

“…TBE occurs at a different age and often leads to meningoencephalitis. TBE positive patients often had leukocytosis in peripheral blood and symptoms lasted longer, as shown in previous studies .…”

“…TBE occurs at a different age and often leads to meningoencephalitis. TBE positive patients often had leukocytosis in peripheral blood and symptoms lasted longer, as shown in previous studies [15]. In other studies HHV-6 has been observed as the causative agent in 1.75% of CNS infections [16].…”

Etiology and prognosis of acute viral encephalitis and meningitis in Chinese children: a multicentre prospective study

“…It has been reported that herpes virus DNA was detected in CSF of some patients with confirmed enterovirus meningitis [10]. However, the occurrence of coinfection of herpes viruses and enteroviruses in CNS seems to be a rather rare event in immunocompetent patients.…”

Implementation of the FilmArray ME panel in laboratory routine using a simple sample selection strategy for diagnosis of meningitis and encephalitis

“…Beside the probable useless administration of Acyclovir following a false positive HSV-1 result, one should also consider the questionable relevance of Herpesviridae detection in CSF in general. As these viruses feature life-long latency after primary infection, subclinical reactivation with replication can be seen in conjunction with different underlying clinical conditions [43,44]. Thus, in a worst case scenario, Herpesviridae detection in multiplex PCR testing might lead to delayed diagnosis of the actual underlying disease, as described by Gomez et al for a patient suffering from tuberculous meningitis [14].…”