Herpetic meningitis

Description:

Herpetic meningitis is caused by a virus of a herpes simplex (Herpes simplex) 1 and 2 of type.

Reasons of herpetic meningitis:

The virus of a herpes simplex of the 2nd type (VPG-2) and virus of chicken pox and shingles can be the causative agent of herpetic meningitis.

VPG-2 - first of all the causative agent of genital herpes. Aseptic meningitis arises at 16% of patients against the background of the first exacerbation of genital herpes. Less often meningitis arises at repeated exacerbations of genital herpes. Diagnosis of the meningitis caused by VPG-2 is facilitated at detection of vesicular rashes in the field of generative organs, and also in the presence of complaints to the complicated urodynia, lumbosacral radicular pains, paresthesias and anesthesia in an anogenitalny zone.

Pathogeny:

The activator gets into a human body in preferential airborne way. Further the activator for life persistirut in various nervous gangliya with periodic reactivation of infectious process at persons with an immunodeficiency.

Herpetic meningitis is quite often observed against the background of primary genital infection – at 36% of women and 13% of men. At most of patients herpetic rashes on average in a week precede symptoms of meningitis. Herpetic meningitis can cause complications in the form of disturbances of sensitivity, radicular pains, etc. In 18–30% of cases a disease recurrence is described.

Thus, the most characteristic neurologic display of the infection caused by VPG-2 is the combination of recurrent meningitis and lumbosacral radiculitis.

Symptoms of herpetic meningitis:

Herpetic serous meningitis (0,5-3% of all serous meningitis) develops more often than streets with primary genital herpes. Body temperature increases, the headache, a photophobia, meningeal symptoms, in cerebrospinal liquid a moderate cytosis with dominance of lymphocytes develops.

The headache accruing, persistent, diffusion or with localization in frontotemporal area. Vomiting is repeated, it is not connected with meal. In an onset of the illness meningeal symptoms (a stiff neck, Kernig's signs and Brudzinsky) come to light. Often the first displays of meningitis are preceded by symptoms of a SARS, a vesicular enanthesis and mucous membranes. However more often the disease proceeds in the form of an encephalomeningitis. For 2 4 days brain hypostasis symptoms appear: disturbance of consciousness in the form of confusion, lack of orientation in time and space. Patients quite often become aggressive. There are visual, auditory hallucinations, local or generalized spasms; focal symptoms in the form of mono - or a hemiparesis, frustration of coordination of movement, a static ataxy.
Course of meningitis acute. Body temperature is normalized within a week, headaches and meningeal symptoms disappear. At extremely severe forms of meningitis and encephalomeningitis the lethal outcome is possible.

The herpetic meningitis caused by a shingles virus is shown by fever, a headache and very easy meningeal symptoms. The beginning of a disease acute, body temperature sometimes reaches 38-39 °C. Confusion, a sopor, a coma are observed extremely seldom.

Diagnosis:

At research TsSZh usually are found a lymphocytic pleocytosis (300-400 cells in 1 мкл), increase in level of protein. Content of glucose can be normal or reduced.

For confirmation of meningitis the virus of herpes has to be allocated from liquor and blood. Express methods allow quickly and in early terms to define availability of VPG antigen in liquor and blood (IFA) or DNA of a virus (PTsR). For the purpose of definition of specific antibodies in blood and liquor use PH, PCK in dynamics. Antibodies appear at primary infection on the 2nd week and reach a maximum on the 3rd week. Further they can remain throughout all life.

The Likvorny syndrome at herpetic meningitis, caused by shingles arises extremely seldom. The Likvorny syndrome is characterized by preferential lymphocytic pleocytosis (from 25 to 150 cells in 1 мкл). The pleocytosis decreases of the first days by 6th week of a disease. In comparison with other serous meningitis longer terms of sanitation of TsSZh are characteristic of herpetic. The lymphocytic pleocytosis meets in 40-80% of cases of the manifest infection caused by a shingles virus.

Treatment:

At the meningitis caused by VPG-2 and a virus of shingles purpose of an acyclovir is shown (5 mg/kg intravenously kapelno 3 times a day within 5 days).