HERPES-SIMPLEX VIRUS-INFECTION AS A CAUSE OF BENIGN RECURRENT LYMPHOCYTIC MENINGITIS

Objective: To identify the role of herpes simplex virus (HSV) in causi ng benign recurrent lymphocytic meningitis. Design: Prospective cohort study. Setting: Tertiary referral center. Patients: 20 consecutive pa tients with a provisional diagnosis of benign recurrent lymphocytic me ningitis had cerebrospinal fluid specimens submitted between 1990 and 1993 to the diagnostic virology laboratory. Thirteen patients met our criteria for benign recurrent lymphocytic meningitis. Measurements: He rpes simplex virus DNA was detected in cerebrospinal fluid specimens u sing the polymerase chain reaction, followed by hybridization with a H SV-specific DNA probe. Herpes simplex virus type 1 and type 2 DNA prod ucts were distinguished by digestion with restriction enzymes and anal ysis by gel electrophoresis. Anti-HSV antibodies in cerebrospinal flui d were detected by immunoblot. Results: The patients had 3 to 9 attack s (mean, 4.6 attacks) of benign recurrent lymphocytic meningitis durin g periods ranging from 2 to 21 years (mean, 8.4 years). Three of 13 pa tients had known recurrent genital herpes. Cerebrospinal fluid analysi s showed 48 to 1600 cells/mu L, glucose levels of more than 2.22 mmol/ L (40 mg/dL), and protein levels of 41 to 240 mg/dL (0.41 to 2.4 g/L). Herpes simplex virus DNA and anti-HSV antibodies were detected in cer ebrospinal fluid samples in 11 of 13 patients (84.6%; 95% CI, 55% to 9 8%). Ten of these 11 patients had HSV type 2 DNA and HSV type 2 antibo dies. One patient had HSV type 1 DNA and HSV type 1 antibodies in the cerebrospinal fluid. The remaining two patients had only anti-HSV type 2 antibodies. Conclusions: Herpes simplex virus, predominantly HSV ty pe 2, was the major agent causing benign recurrent lymphocytic meningi tis that met our specified diagnostic criteria.