Herpes simplex virus 2 meningitis in adults: A prospective, nationwide, population-based cohort study

Anna Jakobsen, Marie Thaarup Skov, Lykke Larsen, Pelle Trier Petersen, Christian Brandt, Lothar Wiese, Birgitte Rønde Hansen, Hans Rudolf Lüttichau, Malte Mose Tetens, Jannik Helweg-Larsen, Merete Storgaard, Henrik Nielsen, Jacob Bodilsen, DASGIB study group

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.

Original languageEnglish
Article numberciab1071
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America
Volume75
Issue number5
Pages (from-to)753-760
Number of pages8
ISSN1058-4838
DOIs
Publication statusPublished - 14 Sep 2022

Keywords

  • acyclovir
  • adults
  • cohort
  • Herpes simplex virus 2
  • HSV-2
  • incidence
  • meningitis
  • nationwide
  • population-based
  • prognosis
  • prognostic factors
  • risk factors
  • virus
  • Prospective Studies
  • Valacyclovir/therapeutic use
  • Humans
  • Male
  • Herpesvirus 2, Human
  • Acyclovir/therapeutic use
  • Herpes Simplex/drug therapy
  • Adult
  • Female
  • Meningitis/drug therapy
  • Cohort Studies

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