title: Herpes simplex and varicella zoster CNS infections: clinical presentations, treatments and outcomes.
abstract: OBJECTIVE
  To describe the clinical manifestations, cerebrospinal fluid (CSF) characteristics, imaging studies and prognostic factors of adverse clinical outcomes (ACO) among adults with herpes simplex virus (HSV) or varicella zoster virus (VZV) CNS infections.
  
  
  METHODS
  Retrospective review of adult patients with positive HSV or VZV polymerase chain reaction on CSF from an observational study of meningitis or encephalitis in Houston, TX (2004-2014), and New Orleans, LA (1999-2008).
  
  
  RESULTS
  Ninety-eight adults patients were identified; 25 had encephalitis [20 (20.4 %) HSV, 5 (5.1 %) VZV], and 73 had meningitis [60 (61.1 %) HSV and 13 (13.3 %) VZV]. HSV and VZV had similar presentations except for nausea (P < 0.01) and rash (P < 0.001). The CSF profile did not differ between HSV and VZV infection. Abnormal neuroimaging findings were found in 11.6 % (10/86) brain CTs and 21.3 % (16/75) brain MRIs. The EEG was abnormal in 57.9 % (11/19). Sixteen patients (16.3 %) had an ACO (10 HSV encephalitis, 3 VZV encephalitis and 3 VZV meningitis). Intravenous acyclovir administered within 48 h was protective against an ACO [OR 0.19 (0.04-0.80), P = 0.02). However, on logistic regression only Charlson comorbidity score >1 and an encephalitis presentation were independently associated with an ACO. The treatment for HSV meningitis was variable, and all patients had a good clinical outcome.
  
  
  CONCLUSIONS
  Alpha herpes CNS infections due to HSV and VZV infections have similar clinical and laboratory manifestations. ACO was observed more frequently in those patients with comorbidities and an encephalitis presentation.
authors.affiliation: Department of Internal Medicine, University of Texas Health Science Center, 6431 Fannin St. 2.112 MSB, Houston, TX, 77030, USA. Quanhathai.kaewpoowat@uth.tmc.edu.
authors.forename: Quanhathai
authors.initials: Q
authors.lastname: Kaewpoowat
authors.affiliation: Department of Internal Medicine, University of Texas Health Science Center, 6431 Fannin St. 2.112 MSB, Houston, TX, 77030, USA.
authors.forename: Lucrecia
authors.initials: L
authors.lastname: Salazar
authors.affiliation: Department of Pediatrics, University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Aguilera
authors.affiliation: Department of Pediatrics, University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Susan H
authors.initials: SH
authors.lastname: Wootton
authors.affiliation: Department of Internal Medicine, University of Texas Health Science Center, 6431 Fannin St. 2.112 MSB, Houston, TX, 77030, USA.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Hasbun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020803:Encephalitis, Herpes Simplex / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D005260:Female; D014645:Herpesvirus 3, Human; D006801:Humans; D008297:Male; D008587:Meningitis, Viral / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D008875:Middle Aged; D012189:Retrospective Studies; D018139:Simplexvirus; D016896:Treatment Outcome; D055815:Young Adult
keywords: Clinical outcome; Encephalitis; Herpes simplex virus; Meningitis; Varicella zoster virus