Clinical Spectrum and Laboratory Characteristics Associated With Detection of Herpes Simplex Virus DNA in Cerebrospinal Fluid

Objective: To determine the clinical, neurologic, and laboratory characteristics of patients with herpes simplex virus (HSV) type 1 (HSV-1) or HSV type 2 (HSV-2) DNA detected in cerebrospinal fluid (CSF) with use of polymerase chain reaction. Patients and Methods: Clinical, laboratory, and demographic data were determined from 249 CSF specimens (collected from 247 patients >10 years of age) that tested positive for HSV-1 or HSV-2 DNA at the Mayo Clinic from January 1999 to August 2000. Results: The median age of the 200 patients whose age was available was 70 years vs 40 years for those with HSV-1 or HSV-2 DNA in CSF, respectively. Detailed data were available for 39 and 78 patients with positive polymerase chain reaction results for HSV-1 and HSV-2, respectively. Of those with HSV-1 DNA detected in CSF, 89% had encephalitis, whereas most patients with HSV-2 DNA detected in CSF had findings compatible with meningitis. Only 5 (7%) of 69 patients in whom HSV-2 was detected in CSF had genital lesions at presentation, and none of the assessable patients with HSV-2 who had recurrent meningitis had active genital lesions at presentation. Conclusion: The vast majority (82%) of patients with HSV-2 detected in CSF had no history of genital herpes and no lesions at the time of presentation. Polymerase chain reaction assays designed to detect HSV in CSF should detect HSV-1 and HSV-2 and differentiate between HSV-1 and HSV-2.