title: Varicella zoster vs. herpes simplex meningoencephalitis in the PCR era. A single center study.
abstract: BACKGROUND
  The introduction of polymerase chain reaction (PCR) for the diagnosis of herpesvirus central nervous system infections is reshaping our understanding of these illnesses. Varicella-zoster virus (VZV) is increasingly recognized as an important etiology of sporadic viral meningoencephalitis (ME). Furthermore, mild cases of herpes simplex virus (HSV) ME, traditionally considered a devastating infection, are frequently reported.
  
  
  METHODS
  We compared the demographic and clinical features of patients with VZV (20) and HSV (17) ME diagnosed by Real-Time PCR of cerebrospinal samples in a single center during the years 2002-2010.
  
  
  RESULTS
  VZV and HSV patients were comparable with respect to age, sex, underlying diseases, immune suppression, and the rates of fever, headache and altered mental status on presentation. Seizures, focal neurological signs, systemic complications and in-hospital death were noted only in the HSV group.
  
  
  CONCLUSIONS
  Our study confirms the prevalence of VZV as a cause of sporadic ME over the last decade. While patients with HSV ME had more manifestations of severe disease, there also was a significant overlap with clinical and laboratory parameters of VZV ME. In the absence of dermatomal rash, differentiation between VZV and HSV ME on clinical grounds alone may represent a true challenge.
authors.affiliation: Department of Neurology, Assaf Harofeh Medical Center, Zerifin, Israel. lea.pollak@gmail.com
authors.forename: Lea
authors.initials: L
authors.lastname: Pollak
authors.forename: Sarah
authors.initials: S
authors.lastname: Dovrat
authors.forename: Mazal
authors.initials: M
authors.lastname: Book
authors.forename: Ella
authors.initials: E
authors.lastname: Mendelson
authors.forename: Miriam
authors.initials: M
authors.lastname: Weinberger
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000235:genetics / Q000302:isolation & purification; D004569:Electroencephalography; D020803:Encephalitis, Herpes Simplex / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D020804:Encephalitis, Varicella Zoster / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D060888:Real-Time Polymerase Chain Reaction; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D000212:Acyclovir