A Study on Herpes Simplex Encephalitis in 18 Children, Including 3 Relapses (original) (raw)
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Journal of Clinical Virology, 2014
Background: Herpes simplex virus (HSV) is one the most common causes of sporadic encephalitis worldwide. Objective: We aimed to determine clinical characteristics and prognosis of HSV encephalitis (HSVE) cases reviewed retrospectively from several collaborating centers. Study design: We searched hospital archives of the last 10 years for patients with HSVE diagnosis, i.e. clinical presentation compatible with encephalitis and brain involvement on magnetic resonance imaging (MRI) or detection of HSV DNA in the cerebrospinal fluid by polymerase chain reaction (PCR). Clinical characteristics were noted and patients were phone-interviewed. HSVE cases were grouped and analyzed as proven and probable, based on virological confirmation by PCR. Univariate and multivariate analyses were used to determine factors associated with prognosis. Results: A total of 106 patients (63 males; mean age, 44 years; range, 18-83 years) were included. Most common symptoms were changes in mental status, fever, headache, and seizure. HSV PCR was positive in 69% of patients tested, while brain involvement was detected on MRI in 95%. Acyclovir was started mostly within five days of main symptom and continued for ≥14 days. Case fatality rate was 8%, while 69% of patients recovered with sequelae. Favorable prognosis was observed in 73% of patients. Multivariate analysis identified the duration of disease before hospital admission (odds ratio (OR) = 1.24) and the extent of brain involvement on MRI at the time of admission (OR = 37.22) as two independent risk factors associated with poor prognosis. Conclusions: Although HSVE fatality regressed considerably with acyclovir treatment, many patients survive with sequelae. Our results emphasize the importance of early diagnosis and prompt treatment of HSVE.
Management and outcome predictors during Herpes simplex virus encephalitis
Annals of Infection, 2021
Background: Herpes simplex virus encephalitis (HSE) is the most common cause of sporadic acute viral encephalitis in adults associated with a high incidence of severe and permanent neurologic sequelae. We aimed to identify the epidemiological, clinical, evolutionary features and to study the outcome predictors of HSE. Methods: We carried out a retrospective study including all patients hospitalized for HSE in the infectious diseases department between January 1994 and December 2018. Results: We encountered 30 patients with HSE, among whom 15 patients were male (50%). The mean age was 44±16 years. The most common clinical features were fever (96.6%), cephalalgia (70%) and aggressive behaviour (63.3%). Analysis of cerebrospinal fluid (CSF) revealed an elevated white blood cell (WBC) count (86.6%) with lymphocyte-predominant pleocytosis (96.1%). Herpes simplex virus (HSV) PCR assay in the CSF was positive in 73.3% of the cases. Brain computed tomography scan demonstrated parenchymal hypodensity (66.6%), while brain magnetic resonance imaging (MRI) was pathological (88.8%). Temporal involvement was characteristic in 66.6% of the cases. All patients received intravenous acyclovir for a mean duration of 19±7 days. There were 17 cases with a favourable prognosis (56.6%). Comparison of the disease evolution showed that poor prognosis was significantly more frequent in patients hospitalized after a delay of 3 days after the onset of symptoms [odds ratio (OR) =13.5 (1.4-80.2); P=0.017], in patients presenting hemiparesis (P=0.02) and when hypoglycorrhachia was noted [OR =10.5 (1.8-58.3); P=0.008]. Starting acyclovir therapy after a delay of 3 days was significantly more associated with a poor prognosis [OR =10.6 (1.2-74.3); P=0.04]. Conclusions: Our study highlighted the burden of HSE which remains a fatal, life threatening disease associated with a poor prognosis and neurological sequelae especially when the diagnosis and the treatment were delayed.
Herpes Simplex Encephalitis: Successful Treatment with Acyclovir
2019
Introduction: One of the most common causes of encephalitis is due to viral infections, such as herpes simplex. Traditionally, brain biopsy was required for the diagnosis of HSV encephalitis; however, here CSF PCR detection for herpes simplex encephalitis is reported which was successfully treated with Acyclovir. Case presentation: A 52 year old female patient was brought to emergency department with fever (40 0 C), constipation, abdominal pain, fatigue, disorientation and agitation for the last two days. DNA extraction and Real Time PCR was performed on CSF sample for HSV-1/2 and HSV-1 was positive. Moreover, the brain MRI report showed left and basal temporal oppression, together with left and basal frontal pus. The patient was discharged after 20 days of hospitalization and treatment with acyclovir and normal physiological indexes and had a good clinical and neurologic outcome with resolution of all the symptoms. Conclusion: It is worthy to emphasize that despite the normal bioch...
Case Report HERPES SIMPLEX ENCEPHALITIS AS A FATAL DISEASE :
disease with high mortality if misdiagnosed or untreated. It can presents with acute features such as a headache, fever, seizures and confusion. It sometimes suspected as meningitis before MRI, and then the patient loses a chance for survival because of late diagnosis, and late treatment as a result. The combination of clinical history and examination, brain computed tomography scan, magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) analysis have been used to establish the diagnosis. Here, we are presenting a rare case of HSE presenting as confusion, fever and disorientation with nonspecific CSF analysis, then seizures, and typical MRI findings consistent with HSE and CSF polymerase chain reaction positive for herpes simplex virus-1 DNA. Unfortunately the diagnosis was late, and even with acyclovir the patient died after 2 weeks. Herpes simplex encephalitis must be suspected in a patient with disoriented with coma or seizures, and MRI gives the best view for direction the management.
Herpes simplex virus encephalitis: A literature review
Romanian Journal of Neurology
HSVE (Herpes simplex virus encephalitis) is an infection caused by herpes simplex virus type 1 (HSV-1) or type 2 that produces neurologic problems. HSVE is associated with significant morbidity and mortality in adults even with antiviral medication, and it is a fatal disease in babies and children regardless of treatment. The most likely pathways include retrograde transmission through the olfactory or trigeminal nerves, as well as hematogenous spread. The most common presenting symptoms are encephalopathy, fever, convulsions, headache, and regional neurologic dysfunction. An accurate history and physical examination are required to identify Herpes simplex virus encephalitis (HSVE), and a prompt assessment is advised after the diagnosis has been established. HSVE is a neurodegenerative disease that may be fatal. Rapid diagnostic work-up and early diagnosis in all suspected or confirmed cases will result in early initiation of intravenous acyclovir, which may decrease morbidity and d...
Case Reports in Medicine, 2017
Herpes Simplex Virus (HSV) encephalitis is an acute infectious disease of the Central Nervous System (CNS), usually affecting the limbic structures, the median temporal cortex, and the orbitofrontal regions. Its annual incidence has significantly increased over the last 20 years and the mortality rate is 7%, if early diagnosed and treated, and 70%, if left untreated, while it is associated with high rates of morbidity. It should be noted that even when Cerebrospinal fluid (CSF) analysis seems normal, imaging studies are not specific and HSV Polymerase Chain Reaction (PCR) test is negative; the clinician should be more aggressive, if clinical presentation is indicative for HSV encephalitis, by administrating acyclovir early after patient’s admission. The latter may be a vital intervention for the patient, modifying the patient’s clinical course. Through the presentation of two cases of HSV-1 encephalitis that we managed in our department over the last 1 year and after systematic and ...
A Probable Case of Herpes simplex Encephalitis despite Negative PCR Findings Findings
Infection, 2001
A 54-year-old woman was admitted to the hospital suffering from fever and personality changes. Laboratory examination of her cerebrospinal fluid (CSF) showed 270 mononuclear cells, 30 polynuclear cells and a clinically low number of erythrocytes/mm 3. Empirical clinical findings from this case suggested treatment with acyclovir. Magnetic resonance imaging (MRI) showed bilateral temporal hyperintense signals in T2-weighted images. PCR with specific primer for herpes simplex virus type 1 (HSV-1) and HSV-2 were negative. There was no elevation of oligoclonal antibodies specific to HSV in CSF after 2 weeks. Although we did not prove the presence of the agent microbiologically at the clinical onset of the disease, the MRI and electroencephalogram (EEG) findings, erythrocytes in CSF and the dramatic response to acyclovir therapy are suggestive of a diagnosis of herpes simplex encephalitis (HSE).