cqvip:Background: Herpes simplex virus 2 (HSV 2) and HSV 1 have been recognized as causes of recurrent aseptic lymphocytic meningitis (RALM). However, the role of other herpesviruses has not been systematically assessed. Objectives: To evalua te the cause of RALM by using polymerase chain reaction (PCR) tests detecting v aricellazoster virus (VZV), cytomegalovirus (CMV), or human herpesvirus 6 (HHV 6), in addition to HSV, on cerebrospinal fluid (CSF) samples; and to assess the utility of PCR and antibody analyses in consecutive episodes of RALM. Designs: T he PCR and antibody results for herpesviruses were analyzed from 14 patients hav ing 48 episodes of RALM. Results: The CSF PCR results for VZV, CMV, and HHV 6 w ere negative in 12, 10, and 11 patients investigated, respectively, and antibodi es against VZV, CMV, and HHV 6 showed only old immunity. Herpes simplex virus 2 was detected from the CSF in 10 patients, and HSV 1 in 1 patient. In 6 of thes e 11 patients, the HSV PCR result was positive in more than one disease episode. A significant increase of serum antibodies for HSV was seen in only 1 of 15 epi sodes examined. An intrathecal antibody response to HSV was not recognized in 9 episodes investigated in these 11 patients. Conclusions: We could not find evide nce of VZV, CMV, or HHV 6 in the pathogenesis of RALM, although most patients w ere previously infected by those viruses. Herpes simplex virus 2 was detected fr om the CSF in most patients, and often repeatedly, which further confirms the ro le of this virus in RALM. The causative diagnosis was obtained only by PCR, wher eas antibody analysis was not clinically useful.
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