Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
Don’t Forget HSV Testing in Meningitis Patients
Open Forum Infect Dis; 2017 Oct 1; Parra, et al
Testing patients for Herpes simplex virus (HSV) may reduce the incidence of meningitis and encephalitis, suggests a retrospective review of children and adults with either disorder who were cared for at 9 Texas hospitals. Among the findings:
- HSV is a common cause of meningitis and encephalitis.
- A review of 751 patients revealed that only 44% had their cerebrospinal fluid checked for HSV with polymerase chain reaction testing.
- Adults were more likely to have the test performed than children (84% vs 69%).
- Patients were more likely to have a positive HSV test if they had a stiff neck, lymphocyte pleocytosis >50% lymphocytes, and CSF protein above 100 mg/dl.
Parra L, Hasbun R, Salazar L, et al. CSF HSV PCR testing in adults and children with meningitis and encephalitis. Open Forum Infect Dis. 2017;4(Suppl 1):S358. doi:10.1093/ofid/ofx163.866.
This Week's Must Reads
Must Reads in Meningitis
Cerebral Venous Thrombosis & Steroids in Meningitis, Open Forum Infect Dis; 2017 Oct; Gallegos, et al
Early Onset GBS Meningitis Drops, Late Onset Jumps, Clin Infect Dis; 2017 Oct 16; Romain, et al
Better Diagnostic Tests for Histoplasma Meningitis, Clin Infect Dis; 2017 Aug 20; Block, et al
Understanding Meningococcal Disease, Asian Pac J Trop Med; 2017 Nov; Batista, et al
Cryptococcal Meningitis Takes Toll on HIV Patients, Clin Infect Dis; 2017 Oct 4; Pasquier, et al
Herpes simplex virus (HSV) meningitis and encephalitis is a well-recognized entity, and represents one of the treatable viral infections of the central nervous system (CNS). Decreased morbidity and mortality associated with HSV CNS infection requires an early diagnosis and treatment. Diagnosis of HSV CNS infection, however, remains a challenge, requiring cerebrospinal fluid (CSF). HSV CNS infection is usually included in a differential for neonates suspected to have late-onset sepsis. Clinical characteristics and CSF profile (cell counts, protein and glucose) of HSV CNS infection are not unique, and detection of HSV nucleic acids in the CSF by polymerase chain reaction is diagnostic.
—Kwang Sik Kim, MD
Director, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
Professor of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD