Herpes simplex encephalitis -A case series

Abstract

The prognosis of Herpes simplex encephalitis (HSE) depends on the early and appropriate administration of specific antiviral therapy. We retrospectively reviewed 42 children with acute CNS infection, over a period of 18 months, of which 4 were positive for HSV antibodies. All four showed CSF pleocytosis, with mildly elevated protein and rising titers of antibodies to HSV in the CSF. All the 4 cases were started on i.v. acyclovir on day 1 and continued for a total duration of 14 days. The patients responded well to the treatment and on follow up did not show any significant CNS morbidity. The point of presenting this case series is to emphasize the fact that HSE is very fatal encephalitis if left untreated. There are a very few viral encephalitis which have a definite treatment and HSE is one of them.

Keywords

• Herpes simplex encephalitis (HSE), Herpes simplex virus (HSV), Cerebrospinal fluid CSF

Kaynakça

1. Whitley RJ. Herpes simplex encephalitis: adolescents and adults. Antivral Res.2006; 71: 141-8.
2. Twomey J, Barker C, Robinson G, et al. Olfactory mucosa in herpes simplex encephalitis. J Neurol Neurosurg Psychiatry 1979; 42: 983–987.
3. Whitney RJ. Herpes Simplex Virus. In WM Scheld, RJ. Whitney, DT Durack (eds), Infections of the the Central Nervous System. Philadelphia: Lippincott Raven 1997;73-89.
4. Whitney RJ, Cobbs CJ , Alford CA Jr, Soong SJ, Hirsch MS, Connor JD, et al. Diseases that mimic herpes simplex encephalitis. Diagnosis, presentation, and outcome. NIAD Collaborative Antiviral study Group. JAMA. 1989;262(2):234-9.
5. Raschilas F, Wolff M, Delatour F, et al. Outcome of and prognostic factors for herpes simplex encephalitis in adult patients : results of a multicenter study. Clin Infect Dis 2002;35:254-60.
6. Koskiniemi M, Vaheri A, Taskinen E. Cerebrospinal fluid alterations in herpes simplex virus encephalitis. Rev Infect Dis 1984;6:608-18.
7. Weil AA, Glaser CA, Amad Z, Forghani B. Patients with suspected herpes simplex encephalitis: rethinking an initial negative polymerase chain reaction result. Clin Infect Dis 2002;34:1154-7.
8. Boerman RH, Peters AC, Bloem BR, Raap AK, van der Ploeg M. Spread of herpes simplex virus to the cerebrospinal fluid and the meninges in experimental mouse encephalitis. Acta Neuropathol 1992;83:300-7.

9. Cinque P, Cleator GM, Weber T, Sindic CJ, van Loon AM. The role of laboratory investigation in the diagnosis and management of patients with suspected herpes simplex encephalitis: a consensus report. The EU Concerted Action on Virus Meningitis and Encephalitis. J Neurol Neurosurg Psychiatry 1996;61:339-45.
10. Tiege XD, Heron B, Lebon P, Ponsot G, Rozenberg F. Limits of early diagnosis of Herpes simplex encephalitis in children : a Retrosceptive study of 38 cases. Clin Infect Dis.2003; 36: 1335-1339.