Clinical and Laboratory Findings That Differentiate Herpes Simplex Virus Central Nervous System Disease from Enteroviral MeningitisReport as inadecuate




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Canadian Journal of Infectious Diseases and Medical Microbiology - Volume 2016 2016, Article ID 3463909, 8 pages -

Research Article

Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada K1Y 4E9

Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada K1Y 4E9

Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L1

Regional Virology Laboratory, Children’s Hospital of Eastern Ontario, Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8M5

Received 2 July 2015; Accepted 14 November 2015

Copyright © 2016 Layli Sanaee et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. It can be difficult for clinicians to distinguish between the relatively benign enteroviral EnV meningitis and potentially lethal herpes simplex virus HSV central nervous system CNS disease. Very limited evidence currently exists to guide them. Objective. This study sought to identify clinical features and cerebrospinal fluid CSF findings associated with HSV CNS disease. Methods. Given that PCR testing often is not immediately available, this chart review study sought to identify clinical and cerebrospinal fluid CSF findings associated with HSV meningitis over a 6-year period. In cases where PCR was not performed, HSV and EnV were assigned based on clinical criteria. Results. We enrolled 166 consecutive patients: 40 HSV and 126 EnV patients. HSV patients had a mean 40.4 versus 31.3 years for EnV, , seizures 21.1% versus 1.6% for EnV, , altered mental status 46.2% versus 3.2% for EnV, , or neurological deficits 44.7% versus 3.9% for EnV, . CSF neutrophils were lower in HSV median 3.0% versus 9.5%, ; median lymphocytes 87.0% versus 67.0%, and protein 0.9 g-L versus 0.6 g-L, were elevated. Conclusion. Our study found that HSV patients were older and more likely to have seizure, altered mental status, or neurological deficits than patients with benign EnV meningitis. HSV cases had lower CSF neutrophils, higher lymphocytes, and higher protein levels.





Author: Layli Sanaee, Monica Taljaard, Tim Karnauchow, and Jeffrey J. Perry

Source: https://www.hindawi.com/



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