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- Title
Herpes Simplex Virus 2 Meningitis in Adults: A Prospective, Nationwide, Population-Based Cohort Study.
- Authors
Jakobsen, Anna; Skov, Marie Thaarup; Larsen, Lykke; Petersen, Pelle Trier; Brandt, Christian; Wiese, Lothar; Hansen, Birgitte Rønde; Lüttichau, Hans Rudolf; Tetens, Malte Mose; Helweg-Larsen, Jannik; Storgaard, Merete; Nielsen, Henrik; Bodilsen, Jacob
- Abstract
Background Data on the clinical presentation are scarce and prognostic factors of herpes simplex virus type 2 (HSV-2) meningitis remain unknown. Methods 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. Results 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]). Conclusions 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.
- Subjects
DENMARK; RELATIVE medical risk; VIRAL meningitis; CONFIDENCE intervals; ACYCLOVIR; VALACYCLOVIR; HERPES simplex; RISK assessment; DESCRIPTIVE statistics; LUMBAR puncture; LEUKOCYTE count; LONGITUDINAL method; POISSON distribution; DISEASE risk factors; SYMPTOMS
- Publication
Clinical Infectious Diseases, 2022, Vol 75, Issue 5, p753
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciab1071