PCR Detection of Herpes Viruses in Patients with Acute „Idiopathic“ Facial Paresis

Česká verzia

Authors: E. Vlčková ¹; E. Švecová ¹; P. Štourač ¹; H. Štroblová ²; J. Bednařík ¹
Authors place of work: Neurologická klinika LF MU a FN Brno, 2Oddělení klinické mikrobiologie FN Brno ¹
Published in the journal: Cesk Slov Neurol N 2008; 71/104(2): 201-205
Category: Short Communication

Summary

Introduction:
Bell's palsy represents about 70 % of all acute facial palsies. Recently, there has been growing evidence of herpes simplex virus (HSV) type I or II or varicella-zoster virus (VZV) reactivation as the main cause of idiopathic facial palsy. With respect to a high proportion of seropositive individuals in general population, the reactivation of herpes viruses cannot be easily verified by serological methods while PCR (polymerase chain reaction) seems to be more promising for this purpose. The objective of the study was to evaluate the possibility to verify the reactivation of herpes viruses in patients with Bell's palsy using PCR serum and CSF (cerebrospinal fluid) examination.

Patient group and methodology:
PCR detection of herpes viruses was performed in CSF and serum samples of 25 patients with acute facial palsy. In all these patients, common causes of facial palsy including Lyme borreliosis were excluded (i.e., by normal CSF examination results) and the paresis was classified as idiopathic in all the cases (14 women, 11 men, mean age 44.72 ± 17.64, range 18–77). Also present was one patient with Ramsay Hunt syndrome (a 72 years old male). HSV type I and II were examined in all patients including the Ramsay Hunt patient, and PCR detection of VZV was performed in 11 of the idiopathic cases.

Results:
VZV DNA was only found in the CSF (not in the serum) of the Ramsay-Hunt patient. In all the idiopathic cases, PCR detection of both HSV and VZV was negative in the serum and CSF.

Conclusion:
Our findings show poor diagnostic validity of PCR detection of herpes viruses in serum and CSF in patients with acute idiopathic facial palsy and normal CSF cytological findings. Rather than casting doubt on the assumption of reactivation of virus infection as the cause of Bell's paresis, the above results suggest that the reactivation is only local, limited to the facial nerve and thus not detectable in CSF.

Key words:
facial nerve – Bell's palsy – herpes simplex virus – varicella-zoster virus – Ramsay-Hunt syndrome – polymerase chain reaction

Zdroje

1. Bojar M. Obrna lícního nervu. Cesk Slov Neurol N 2007; 70/103: 613–624.

2. Rowlands S, Hooper R, Hughes R, Burney P. The epidemiology and treatment of Bell's palsy in the UK. Eur J Neurol 2002; 9: 63–67.

3. Murakami S, Hato N, Mizobuchi M, Doi T, Yanagihara N. Role of herpes simplex virus infection in the pathogenesis of facial paralysis in mice. Ann Otol Rhinol Laryngol 1996; 105: 49–53.

4. Furuta Y, Ohtani F, Kawabata H, Fukuda S, Bergström T. High prevalence of varicella-zoster virus reactivation in herpes simplex virus-seronegative patients with acute peripheral facial palsy. Clin Infect Dis 2000; 30: 529–533.

5. Stjernquist-Desatnik A, Skoog E, Aurelius E. Detection of herpes simplex and varicella-zoster viruses in patients with Bell's palsy by the polymerase chain reaction technique. Ann Otol Rhinol Laryngol 2006; 115: 306–311.

6. Furuta Y, Fukuda S, Chida E, Takasu T, Ohtani F, Inuyama Y et al. Reactivation of herpes simplex virus type 1 in patients with Bell's palsy. J Med Virol 1998; 54: 162–166.

7. Furuta Y, Ohtani F, Sawa H, Fukuda S, Inuyama Y. Quantitation of varicella-zoster virus DNA in patients with Ramsay Hunt syndrome and zoster sine herpete. J Clin Microbiol 2001; 39: 2856–2859.

8. Ohtani F, Furuta Y, Aizawa H, Fukuda S. Varicella-zoster virus load and cochleovestibular symptoms in Ramsay Hunt syndrome. Ann Otol Rhinol Laryngol 2006; 115: 233–238.

9. Tomita H, Tanaka M, Kukimoto N, Ikeda M. An ELISA study on varicella-zoster virus infection in acute peripheral facial palsy. Acta Otolaryngol Suppl 1988; 446: 10–16.

10. Peitersen E. The natural history of Bell's palsy. Am J Otol 1982; 4: 107–111.

11. Robillard RB, Hilsinger RL jr, Adour KK. Ramsay Hunt facial paralysis: clinical analyses of 185 patients. Otolaryngol Head Neck Surg 1986; 95: 292–297.

12. Adour KK, Ruboyianes JM, Von Doersten PG, Byl FM, Trent CS, Quesenberry CP jr et al. Bell's palsy treatment with acyclovir and prednisone compared with prednisone alone: a double blind, randomized, controlled trial. Ann Otol Rhinol Laryngol 1996; 105: 371–378.

13. Murakami S, Hato N, Horiuchi J, Honda N, Gyo K, Yanagihara N. Treatment of Ramsay Hunt syndrome with acyclovir-prednisone: significance of early diagnosis and treatment. Ann Neurol 1997; 41: 353–357.

14. Hanson KE, Alexander BD, Woods C, Petti C, Reller LB. Validation of laboratory screening criteria for herpes simplex virus testing of cerebrospinal fluid. J Clin Microbiol 2007; 45: 721–724.

15. Gregoire SM, van Pesch V, Goffette S, Peeters A, Sindic CJ. Polymerase chain reaction analysis and oligoclonal antibody in the cerebrospinal fluid from 34 patients with varicella-zoster virus infection of the nervous system. J Neurol Neurosurg Psychiatry 2006; 77: 938–942.

16. .Roubalová K, Suchánková A, Bojar M, Glosová L, Machová H, Šoltysová K et al. Průkaz aktivní infekce varicela-zoster virem (VZV) u pacientů s neurologickými komplikacemi. Klin Mikrobiol Inf Lek 2007; 13: 109–114.

17. Bednařík J. Hlavové nervy. In: Ambler Z, Bednařík J, Růžička E. Klinická neurologie. I. Část obecná. Praha: Triton 2004: 223–398.