Clinical Spectrum of the Herpes Simplex Encephalitis in Children: Clinical Features, Neuroimaging, Treatment, and Outcomes

Yıl 2015, Cilt: 22 Sayı: 2, 90 - 93, 09.12.2015

Ayşe Kartal Kürşad Aydın

Öz

Abstract

Objective: Herpes simplex encephalitis is one of the most common causes of sporadic encephalitis in children and it is associated with high mortality and morbidity. This study aims at describing the clinical spectrum of herpes simplex encephalitis in children by identifying their neurological imaging features and assessing potential treatment outcomes.

Methods: Clinical, laboratory, and imaging findings in 14 patients with herpes simplex encephalitis were retrospectively reviewed during the period between January 2005 and January 2010 at Selcuk University, Department of Pediatric Neurology.

Results: Our study consisted of 14 patients including a patient who had a relapsing course. The median age of the patients was 3,6 years. Seizure and fever were the most common findings at admission. Cerebrospinal fluid glucose concentration was normal in all patients. Protein and red blood cell levels were elevated in 28% patients. Polymerase chain reaction testing for HSV was positive in 92% and cranial magnetic resonance imaging was suggestive of herpes simplex encaphalitis in all the patients. Prominent thalamic involvement was observed in patients less than 2 years of age, however cerebrospinal fluid findings in these patients were normal. 9 patients were left with no neurological sequelae however persistent neurological sequelae was present in 5 patients.

Conclusion: The findings suggested how challenging it could get to diagnose herpes encephalitis in children, especially those under the age of 2. Due to its diagnostic possibility in children presenting with convulsion and other encephalitic processes, treatment with acyclovir must be initiated as soon as herpes encephalitis is suspected to avoid further neurological insults.

Key Words: Herpes Encephalitis; Children; Acyclovir; Neuroimaging.

Anahtar Kelimeler

-

Journal of Turgut Ozal Medical Center

Öz

Amaç: Herpes simpleks ensefaliti çocuklarda sporadik ensefalitlerin en sık görülen nedenlerinden biridir ve yüksek morbidite ve mortalite oranına sahiptir. Bu çalışmada çocuklarda klinik ve nörogörüntüleme bulgularıyla tedavi sonuçlarının değerlendirilerek herpes simpleks ensefalitinin klinik spektrumunun belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Selçuk Üniversitesi, Çocuk Nöroloji kliniğinde 2005-2010 yılları arasında herpes simpleks ensefaliti tanısı ile izlenen 14 hastanın klinik, laboratuvar ve görüntüleme bulguları geriye yönelik olarak değerlendirildi. Bulgular: Serimiz rekürrens gösteren 1 olgu da dahil olmak üzere 14 hastadan oluşuyordu. Olgularımızın ortalama yaşı 3,6 yıl, en sık başvuru şikayetleri ise nöbet ve ateşti. Beyin omurilik sıvısı glukoz konsantrasyonu olguların tümünde normal bulunurken yüksek protein ve eritrosit değerleri olguların %28'inde tespit edildi. Herpes simpleks virüs polimeraz zincir reaksiyonu olguların %92’sinde pozitifti ve kraniyal manyetik rezonans görüntüleme bulguları olguların tümünde herpes simpleks ensefalitini düşündürmekteydi. 2 yaş altındaki çocuklarda beyin omurilik sıvısı bulguları normal olmasına rağmen talamik tutulum ön plandaydı. 9 olgu sekelsiz iyileşirken 5 olguda kalıcı nörolojik sekel gelişti. Sonuç: Bu bulgular çocuklarda özellikle de 2 yaşın altındaki çocuklarda herpes simpleks ensefaliti tanısının zor olduğunu göstermektedir. Konvulziyon ya da diğer ensefalit bulgularıyla başvuran çocuklarda olası tanılar içerisinde herpes simpleks ensefaliti mutlaka düşünülmeli ve kalıcı nörolojik sekelleri önlemek için asiklovir en erken dönemde başlanmalıdır

Anahtar Kelimeler

Herpes Ensefaliti, Çocuk, Asiklovir, Nörogörüntüleme

Kaynakça

• Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D, et al. Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis 2010;10:835-44.
• Whitley RJ, Kimberlin DW. Herpes simplex encephalitis: children and adolescents. Semin Pediatr Infect Dis 2005;16:17-23.
• De Tie`ge X, Heron B, Lebon P, Ponsot G, Rozenberg F. Limits of early diagnosis of herpes simplex encephalitis in children: a retrospective study of 38 cases. Clin Infect Dis 2003;36:1335-39.
• Lakeman FD, Whitley RJ. Diagnosis of herpes simplex encephalitis: application of polymerase chain reaction to cerebrospinal fluid from brain-biopsied patients and correlation with disease: National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. J Infect Dis 1995;171:857-63.
• Kennedy PG, Chaudhuri A. Herpes simplex encephalitis. J Neurol Neurosurg Psychiatry 2002;73:237-38.
• Leonard JR, Moran CJ, Cross 3rd DT, Wippold 2nd FJ, Schlesinger Y, Storch GA. MR imaging of herpes simplex type 1 encephalitis in infants and young children: a separate pattern of findings. AJR Am J Roentgenol 2000;174:1651-55.
• Whitley RJ. Herpes simplex encephalitis: adolescents and adults. Antiviral Res 2006;71:141-48.
• Lahat E, Barr J, Barkai G, Paret G, Brand N, Barzilai A. Long term neurological outcome of herpes encephalitis. Arch Dis Child. 1999;80:69-71.
• McGrath N, Anderson NE, Croxson MC, Powell KF. Herpes simplex encephalitis treated with acyclovir: diagnosis and long term outcome. J Neurol Neurosurg Psychiatry. 1997;63:321-26.
• Elbers JM, Bitnun A, Richardson SE, Ford-Jones EL, Tellier R, Wald RM, et al. A 12-year prospective study of childhood herpes simplex encephalitis: is there a broader spectrum of disease? Pediatrics 2007;119:399-407.
• Whitley RJ, Soong SJ, Linneman Jr C, Liu C, Pazin G, Alford CA. Herpes simplex encephalitis. Clinical Assessment JAMA 1982;247:317-20.
• Raschilas F, Wolff M, Delatour F, Chaffaut C, De Broucker T, Chevret S, 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.
• Uren EC, Johnson PD, Montanaro J, Gilbert GL. Herpes simplex virus encephalitis in pediatrics: diagnosis by detection of antibodies and DNA in cerebrospinal fluid. Pediatr Infect Dis J 1993;12:10016.
• 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.
• Maschke M, Kastrup O, Forsting M, Diener HC. Update on neuroimaging in infectious central nervous system disease. Curr Opin Neurol 2004;17:475–80.
• De Tie`ge X, Rozenberg F, Des Portes V, Lobut JB, Lebon P, Ponsot G, et al. Herpes simplex encephalitis relapses in children: differentiation of two neurologic entities. Neurology 2003;61:241-3.
• De Tie`ge X, Rozenberg F, Burlot K, Gaudelus J, Ponsot G, Heron B. Herpes simplex encephalitis: diagnostic problems and late relapse. Dev Med Child Neurol 2006;48:60-3.
• Panisset S, Adamasbaum C, Heron B, Panisset S, Adamsbaum C, Heron B, et al. Imaging in pediatric herpes simplex virus type I encephalitis. J Radiol 1999;80:31-5.
• Wasay M, Mekan SF, Khelaeni B, Saeed Z, Hassan A, Cheema Z, et al. Extra temporal involvement in herpes simplex encephalitis. Eur J Neurol 2005;12:475-9.
• Lai CW, Gragasin ME. Electroencephalography in herpes simplex encephalitis. J Clin Neurophysiol 1988;5:87-103.
• Brick JF, Brick JE, Morgan JJ, Gutierrez AR. EEG and pathologic findings in patients undergoing brain biopsy for suspected encephalitis. Electroencephalogr Clin Neurophysiol 1990;76:86-9.
• Schleede L, Bueter W, Baumgartner-Sigl S, Opladen T, Weigt-Usinger K, Stephan S, et al. Pediatric herpes simplex virus encephalitis: a retrospective multicenter experience. J Child Neurol 2013;28:321-31.
• Ito Y, Kimura H, Yabuta Y, Ando Y, Murakami T, Shiomi M, et al. Exacerbation of herpes simplex encephalitis after successful treatment with acyclovir. Clin Infect Dis 2000;30:185-87.