Herpes Virus Infection and Peripheral Neuropathy

  • All Herpes virus are DNA viruses
  • Eight human herpes viruses have been identified
    • Herpes Simplex Virus
      • HSV-1
      • HSV-2
    • Varicella Zoster Virus-VZV
    • Epstein-Barr Virus-EBV
    • Cytomegalovirus-CMV
    • Human herpesviruses
      • HHV-6
      • HHV-7
      • HHV-8

 

Herpes Simplex Virus

  • Primary HSV infection typically involves the oropharynx and genitals
  • Most infections are subclinical and followed by latency in ganglionic neurons
  • Periodic activation produces recurrent painful eruptions around the  mouth (HSV-1) and genitals (HSV-2)
  • Neurologic complications
    • Encephalitis – usually HSV-1
    • Aseptic meningitis and recurrent radiculopathy-usually HSV-2.
    • Myelitis-rare-HSV-2
    • HSV-1 associated with Bells Palsy
  • Latency
    • HSV-1 latency mostly restricted to cranial ganglia
    • Most humans have HSV-1 in their trigeminal ganglia
    • HSV-2 is latent primarily in the lumbosacral ganglia; reactivation produces genital herpes.
    • Extension of HSV-2 into the meninges may produce aseptic meningitis, often recurrent.
    • HSV-2 may manifest as sciatica or trigeminal distribution pain.
  • Diagnosis-amplification of viral DNA from CSF

 

Varicella Zoster Virus

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