Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
Research Unit for Infectious Diseases, Odense University Hospital, Odense, Denmark.
Clin Infect Dis. 2022 Sep 14;75(5):753-760. doi: 10.1093/cid/ciab1071.
Data on the clinical presentation are scarce and prognostic factors of herpes simplex virus type 2 (HSV-2) meningitis remain unknown.
Prospective, nationwide, population-based database identifying all adults treated for HSV-2 meningitis at departments of infectious diseases in Denmark from 2015 to 2020. Unfavorable outcome was defined as Glasgow Outcome Scale (GOS) scores of 1-4 and Extended GOS scores of 1-6. Modified Poisson regression was used to compute relative risks with 95% confidence intervals for unfavorable outcome.
HSV-2 meningitis was diagnosed in 205 patients (76% female; median age [interquartile range (IQR)], 35 [27-49] years) yielding an incidence of 0.7/100 000 population/y. Common symptoms were headache (195 of 204 patients [95%]), photophobia or phonophobia (143 of 188 [76%]), and neck stiffness (106 of 196 [54%]). The median (IQR) time to lumbar puncture was 2.0 (1-4.8) hours, and the median cerebrospinal fluid (CSF) leukocyte count was 360 (166-670) × 10 × 6/L, with a mononuclear predominance of 97% (91%-99%). Lumbar puncture was preceded by brain imaging in 61 of 205 patients (30%). Acyclovir or valacyclovir was administered in 197 of 205 patients (96%) for a median (IQR) of 10 (7-14) days. Unfavorable outcome was observed in 64 of 205 patients (31%) at discharge and 19 of 181 (11%) after 6 months and was not associated with female sex (relative risk [95% confidence interval], 1.08 [.65-1.79]), age ≥35 years (1.28 [.83-1.97]), immunocompromise (1.07 [.57-2.03]), or CSF leukocyte count >1000 × 10 × 6/L (0.78 [.33-1.84]).
HSV-2 meningitis often presented as meningeal symptoms in younger women. Unfavorable outcome at discharge was common and was not associated with sex, age, immunocompromise, or CSF leukocyte count. Sequelae persisted beyond 6 months in one-tenth of patients.
单纯疱疹病毒 2 型（HSV-2）脑膜炎的临床特征数据有限，其预后因素仍不清楚。
本研究为前瞻性、全国性、基于人群的数据库，纳入了 2015 年至 2020 年期间在丹麦传染病科接受 HSV-2 脑膜炎治疗的所有成年患者。不良结局定义为格拉斯哥结局量表（GOS）评分为 1-4 分和扩展 GOS 评分为 1-6 分。采用校正泊松回归计算不良结局的相对风险比及其 95%置信区间。
共诊断出 205 例 HSV-2 脑膜炎患者（76%为女性；中位年龄[四分位间距（IQR）]，35[27-49]岁），发病率为 0.7/100000 人/年。常见症状包括头痛（204 例患者中的 195 例[95%]）、畏光或畏声（188 例患者中的 143 例[76%]）和颈部僵硬（196 例患者中的 106 例[54%]）。腰椎穿刺的中位（IQR）时间为 2.0（1-4.8）小时，中位脑脊液（CSF）白细胞计数为 360（166-670）×10×6/L，单核细胞占优势为 97%（91%-99%）。205 例患者中有 61 例（30%）在腰椎穿刺前进行了脑部影像学检查。205 例患者中有 197 例（96%）接受了阿昔洛韦或伐昔洛韦治疗，中位（IQR）治疗时间为 10（7-14）天。205 例患者中有 64 例（31%）在出院时和 181 例患者中有 19 例（11%）在 6 个月后预后不良，且与女性（相对风险[95%置信区间]，1.08[0.65-1.79]）、年龄≥35 岁（1.28[0.83-1.97]）、免疫功能低下（1.07[0.57-2.03]）或 CSF 白细胞计数>1000×10×6/L（0.78[0.33-1.84]）无关。
HSV-2 脑膜炎常表现为年轻女性的脑膜症状。出院时的不良结局较为常见，与性别、年龄、免疫功能低下或 CSF 白细胞计数无关。十分之一的患者在 6 个月后仍存在后遗症。
