Features of the course of serious meningites of herpetic ethiology

Abstract

Meningitis is an acute infectious lesion of the meninges caused by bacteria, viruses, fungi, or protozoa. The etiological structure is dominated by serous meningitis. At the present stage, the most severe consequences of serous viral meningitis are associated with herpes virus damage to the central nervous system.

Aim. To identify the features of the course of serous meningitis of herpetic etiology in children and adults.

Materials and methods. The article presents a retrospective analysis of case histories of 25 patients who during 2018–2019 were treated at the Regional Regional Infectious Clinical Hospital of the Zaporizhzhya Regional State Administration for serous meningitis. All patients underwent DNA determination of herpes viruses (EBV, type 1 and type 2 HSV and CMV) using polymerase chain reaction in cerebrospinal fluid. According to the results of the examination, the patients were divided into 2 groups: I – 11 patients with meningitis of herpetic etiology; II – 15 patients with serous meningitis of unknown etiology.

Results and conclusions. 73.4% of patients of group I were hospitalized with a diagnosis of meningitis, among patients of group II 6 (40%) patients were diagnosed with acute respiratory viral infections, tonsillitis and fever of unknown etiology. Herpetic etiology of the disease was more often recorded in the older group, and in the group of serous meningitis of another etiology there were significantly more patients 10–18 years old (p=0.02). Herpetic lesion was manifested by a more expressed meningeal and focal symptoms in the onset of the disease. In a laboratory study, patients with meningitis had blood with lymphocytosis of non-herpetic etiology more often reliably (p=0.04) and lymphocytic pleocytosis of cerebrospinal fluid with a cell count of 100 to 300. In patients with herpetic meningitis, cerebrospinal fluid chloride was reduced more often reliably, p=0.02 marked or low (up to 100 cells) or higher (more than 300 cells) lymphocytic pleocytosis reliably. In patients with herpetic meningitis, the increase in body temperature to subfebrile numbers (p=0.09), nystagmus (p=0.04), and the Kernig symptom were reliably.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of an participating institution.