Management and outcome predictors during Herpes simplex virus encephalitis (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.
A Study on Herpes Simplex Encephalitis in 18 Children, Including 3 Relapses
The Open Pediatric Medicine Journal, 2009
Background: Herpes Simplex Virus (HSV) is the most common cause of acute sporadic focal encephalitis. Early Diagnosis is, therefore, crucial for predicting outcome. Improved laboratory technology and improved neuroimaging accessibility have enhanced our ability to diagnose this condition.
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 ...
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...
Herpes Simplex Encephalitis in Sweden, 1990-2001: Incidence, Morbidity, and Mortality
Clinical Infectious Diseases, 2007
Background. Herpes simplex encephalitis (HSE) is a devastating disease. Methods. In Sweden, a nationwide retrospective study of the incidence, morbidity, and mortality associated with HSE during the 12-year period 1990-2001 was conducted. The national inpatient register data were used, and diagnostic data from the virus laboratories were validated. Results. In the study period, 638 patients hospitalized in Sweden received a primary diagnosis of HSE. Of these, 236 patients had a confirmed infection of the central nervous system due to herpes simplex virus type 1. This corresponds to an incidence of confirmed HSE due to herpes simplex virus type 1 of 2.2 cases per million population per year. Of the survivors, 87% were readmitted to the hospital. The most frequent diagnosis at readmission was epilepsy, which was found in 49 patients (21% of the 236 total patients; 24% of 203 survivors), with a median onset 9.3 months after the diagnosis of HSE. This corresponds to a 60-to 90-fold increase in risk, compared with that for the general population. Neuropsychiatric sequelae were evident in 45 (22%) of 203 surviving patients. The incidence of venous thromboembolism, including pulmonary embolism, was 5-14 times higher than that in the general population. Among patients with HSE due to herpes simplex virus type 1, the 1-year mortality was 14% (33 of 236 patients died), which was 8 times higher than expected. Conclusions. This is, to our knowledge, the first study to report long-term, nationwide follow-up data for patients with virologically confirmed HSE. There is considerable morbidity after HSE, with epilepsy being the most common diagnosis. This demonstrates the need for expanding our knowledge of the pathogenesis of HSE to direct more effective antiviral and antiinflammatory treatments.
ACase ofHerpes Simplex Virus-1 Encephalitis from aMedicolegal Point of View
2018
Herpes simplex virus-1 (HSV-1) encephalitis (HSVE) is a rare viral infection of the human central nervous system (CNS) entailing neurological dysfunction. However, it is the commonest infectious cause of sporadic encephalitis. 'e annual incidence of HSVE worldwide is estimated to be 1–4 cases/1,000,000 [1, 2]. HSVE has a bimodal age distribution, with peak incidences in children less than 3 years old and those aged 50 years or more. Most cases occur in subjects older than 50 years of both sexes. HSVE is difficult to diagnose and has a poor prognosis. Morbidity and mortality are greater if treatment is delayed or inadequate. In these cases, there could be medicolegal consequences, particularly legal liability for medical malpractice and nervous system injury assessment. We report the case of a 60-year-old man with HSVE.
Challenges in HSV encephalitis: normocellular CSF, unremarkable CCT, and atypical MRI findings
Infection, 2018
Purpose Herpes simplex virus (HSV) encephalitis continues to be the most common form of sporadic lethal encephalitis worldwide. The wide spectrum of clinical presentations and laboratory findings often poses a diagnostic challenge for physicians which might delay administration of life-saving therapy with acyclovir. Atypical presentations of HSV encephalitis have become increasingly prevalent with better diagnostic techniques and have not been well studied. Methods We retrospectively evaluated all consecutive PCR-proven HSV encephalitis cases treated at the Hospital of the
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 encephalitis: A new type of “ICU-acquired infection”?
Heliyon
Although it is a well-known disease, the occurrence of Herpes simplex encephalitis (HSE) during a hospital stay may render the diagnosis particularly challenging. The objective of this report is to alert clinicians about the diagnostic pitfalls arising from hospital-developed HSE. Materials and methods: Clinical observation of one patient. Case report: An 87-year-old male was admitted to the Intensive Care Unit (ICU) because of respiratory failure due to an exacerbation of myasthenia gravis. After corticoids and azathioprine treatment, his clinical condition improved, allowing weaning from mechanical ventilation. One month after admission, while still hospitalized in the ICU, the patient developed fever and confusion. In the context of confounding factors, HSE was not suspected before a convulsive status epilepticus occurred, resulting in a significant delay in treatment. Diagnosis was confirmed by PCR-analysis in the cerebrospinal fluid. Serological status confirmed reactivation of prior herpes simplex infection. The patient died one week after the onset of confusion. Conclusions: Hospital-"acquired" HSE must be suspected in case of new neurologic symptoms associated with fever, even in ICU-hospitalized patients. The diagnosis is made even more difficult by nonspecific symptoms due to previous diseases, leading to an even more severe prognosis in those vulnerable patients.