Schlesinger Y, Tebas P, Gaudreault-Keener M, Buller R S, Storch G A
Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.
Clin Infect Dis. 1995 Apr;20(4):842-8. doi: 10.1093/clinids/20.4.842.
Herpes simplex virus type 2 (HSV-2) is known to cause aseptic meningitis, which can be recurrent. The diagnosis of HSV-2 infection is suggested when meningitis occurs simultaneously with genital lesions but may be obscure if genital lesions are not present or are not appreciated. Viral culture of the CSF is sometimes positive, but it may also be negative, especially in cases of recurrent disease. We report three cases of HSV meningitis in young women who did not have a history of genital herpetic lesions and for whom genital lesions were not noted on presentation. With use of the polymerase chain reaction (PCR), HSV DNA was detected in CSF from all three patients. The diagnosis of HSV meningitis was further confirmed by a positive culture of CSF in one patient's case and by demonstration of intrathecal synthesis of HSV antibodies in a second patient's case. The use of PCR can improve the recognition of HSV meningitis in adults presenting with aseptic meningitis, even in the absence of herpetic lesions.
已知2型单纯疱疹病毒（HSV-2）可引起无菌性脑膜炎，且该病可能会复发。当脑膜炎与生殖器病变同时出现时提示HSV-2感染，但如果没有生殖器病变或未被发现，则诊断可能不明确。脑脊液的病毒培养有时呈阳性，但也可能为阴性，尤其是在复发性疾病的情况下。我们报告了3例年轻女性HSV脑膜炎病例，她们既往无生殖器疱疹病史，就诊时也未发现生殖器病变。通过聚合酶链反应（PCR），在所有3例患者的脑脊液中均检测到HSV DNA。1例患者脑脊液培养阳性，另1例患者鞘内合成HSV抗体，进一步证实了HSV脑膜炎的诊断。即使在没有疱疹病变的情况下，PCR的应用也能提高对患有无菌性脑膜炎的成年人HSV脑膜炎的诊断率。
