title: Prolonged detection of herpes simplex virus type 2 (HSV-2) DNA in cerebrospinal fluid despite antiviral therapy in a patient with HSV-2-associated radiculitis.
abstract: Herpes simplex virus type 2 (HSV-2) can cause radiculo-myelitis as a neurological manifestation. We report a case of ongoing HSV-2 DNA positivity in the cerebrospinal fluid (CSF) of at least eight weeks under antiviral therapy with acyclovir in a highly immunocompromised hemato-oncologic patient with HSV-2-associated radiculitis. Upon admission, the patient presented with pain, leg paresis, and urinary incontinence, as well as pleocytosis in the CSF. Quantitative real-time PCR of the CSF at day 3 after admission revealed HSV-2 with a concentration of 2.0×10(5) copies/ml and treatment with acyclovir intravenously and prednisolone by mouth was started. Clinical symptoms resolved almost completely after approximately 3 weeks of antiviral therapy. However, CSF samples of day 12, 19, 26, 33, 39, 48 and 54 after admission showed a slow decline of HSV-2 DNA concentrations. HSV-2 DNA was still detectable (1.6×10(4) copies/ml) at day 54 after admission. Genotypic resistance testing showed, as far as available, no mutations indicative for acyclovir resistance. Since an increasing specific antibody index for HSV was observed, we speculate that the prolonged detectability of HSV-2 DNA in the CSF might not necessarily indicate ongoing viral replication but neutralized virus. Other hypotheses and the consequences on treatment are discussed. To our knowledge this is the first report about the long-term viral load kinetics of HSV-2 in the CSF of a patient with radiculitis under antiviral therapy, highlighting the need for further studies on HSV DNA kinetics in the CSF and their significance for an appropriate antiviral treatment.
authors.affiliation: Institute of Virology, Hannover Medical School, Hannover, Germany. Ganzenmueller.Tina@mh-hannover.de.
authors.forename: Tina
authors.initials: T
authors.lastname: Ganzenmueller
authors.forename: Deniz
authors.initials: D
authors.lastname: Karaguelle
authors.forename: Corinna
authors.initials: C
authors.lastname: Schmitt
authors.forename: Wolfram
authors.initials: W
authors.lastname: Puppe
authors.forename: Rita
authors.initials: R
authors.lastname: Stachan-Kunstyr
authors.forename: Paul
authors.initials: P
authors.lastname: Bronzlik
authors.forename: Andreas
authors.initials: A
authors.lastname: Sauerbrei
authors.forename: Florian
authors.initials: F
authors.lastname: Wegner
authors.forename: Albert
authors.initials: A
authors.lastname: Heim
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage / Q000627:therapeutic use; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D056915:DNA Copy Number Variations; D004279:DNA, Viral / Q000134:cerebrospinal fluid*; D005260:Female; D006561:Herpes Simplex / Q000134:cerebrospinal fluid / Q000150:complications / Q000188:drug therapy / Q000821:virology*; D018258:Herpesvirus 2, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D016393:Lymphoma, B-Cell / Q000134:cerebrospinal fluid / Q000150:complications / Q000188:drug therapy / Q000821:virology*; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D011843:Radiculopathy / Q000134:cerebrospinal fluid / Q000150:complications / Q000188:drug therapy / Q000821:virology*; D060888:Real-Time Polymerase Chain Reaction; D013997:Time Factors; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D011239:Prednisolone; D000212:Acyclovir