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Bell Palsy and Herpes Simplex Virus: Identification of Viral DNA in Endoneurial Fluid and Muscle

Shingo Murakami, MD; Mutsuhiko Mizobuchi, MD; Yuki Nakashiro, MD; Takashi Doi, MD; Naohito Hato, MD; and Naoaki Yanagihara, MD
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From Ehime University School of Medicine, Ehime, Japan. Acknowledgments: The authors thank Dr. S. Shinkai for conducting the statistical analysis. Grant Support: By a Grant-in-Aid for Scientific Research from the Ministry of Education, Science and Culture (06454488), Japan. Requests for Reprints: Shingo Murakami, MD, Department of Otolaryngology, Ehime University School of Medicine, Shigenobu-cho, Onsen-gun, Ehime 791-02, Japan. Current Author Addresses: Drs. Murakami, Hato, and Yanagihara: Department of Otolaryngology, Ehime University School of Medicine, Shigenobu-cho, Onsen-gun, Ehime 791-02, Japan.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;124(1_Part_1):27-30. doi:10.7326/0003-4819-124-1_Part_1-199601010-00005
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Objective: To determine whether herpes simplex virus type 1 (HSV-1) causes Bell palsy.

Design: Prospective study.

Setting: University inpatient service.

Patients: 14 patients with Bell palsy, 9 patients with the Ramsay-Hunt syndrome, and 12 other controls.

Measurements: Viral genomes of HSV-1, varicella-zoster virus, and Epstein-Barr virus were analyzed in clinical samples of facial nerve endoneurial fluid and posterior auricular muscle using polymerase chain reaction (PCR) followed by hybridization with Southern blot analysis.

Results: Herpes simplex virus type 1 genomes were detected in 11 of 14 patients (79%) with Bell palsy but not in patients with the Ramsay-Hunt syndrome or in other controls. The nucleotide sequences of the PCR fragments were identical to those of the HSV-1 genome.

Conclusions: Herpes simplex virus type 1 is the major etiologic agent in Bell palsy.


Grahic Jump Location
Figure 1.
Amplification of herpes simplex virus type 1 (HSV-1) and varicella-zoster virus (VZV) genomes from clinical samples.topbottommiddle

Ethidium bromide staining ( ) and Southern blot analysis ( ) of polymerase chain reaction products obtained from endoneurial fluids (lanes 1 to 9, top; lanes 1 to 9, middle; and lanes 1 to 3, bottom), nerve tissues (lanes 4 to 6, bottom), and posterior auricle muscles (lanes 7 to 9, bottom) are shown. Using the primer set 1, HSV-1 specific 221-base pair (bp) DNA fragments were amplified only from patients with Bell palsy (top). On the other hand, 272-base pair fragments specific to varicella-zoster virus were amplified only from patients with the Ramsay-Hunt syndrome by the primer set 3 ( ). Plasmid DNAs used as a carrier for DNA extraction are seen in lanes 1 to 9 but not in lanes M and P. M equals molecular size marker of 100-base pair ladder; P equals positive control amplified from each viral genome. Lanes 1 to 9 correspond to patients 1 to 9.

Grahic Jump Location




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