ABSTRACT
Abstract The incidence of herpes simplex virus-1 (HSV-1) infection in kidney transplant patients is 3% in those who have received antiviral prophylaxis versus 9.8% without prophylaxis. Herpes viruses usually cause mucocutaneous lesions and only occasionally cause visceral disease or central nervous system infection in immunosuppressed and immunocompetent patients. The gold standard for diagnosis is DNA detection using polymerase chain reaction (PCR) in the affected organ. According to the literature, it is treated with acyclovir, with which remission is expected in most cases without sequelae. Here we present the clinical case of a kidney transplant patient who had HSV-1 encephalitis (with the virus detected in the cerebrospinal fluid (CSF) through PCR), and received the standard treatment with complete recovery of his neurological state. (Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1387).
Resumen La infección por herpes simple tipo 1 (HSV tipo 1) en los pacientes con trasplante renal tiene una incidencia de 3% en quienes han recibido profilaxis antiviral versus 9.8% sin profilaxis. Los virus herpes habitualmente producen lesiones mucocutáneas y sólo en ocasiones causan patología visceral o infección del sistema nervioso central en pacientes inmunosuprimidos e inmunocompetentes. La prueba de oro estándar para su diagnóstico es la detección del ADN mediante la reacción de cadena polimerasa (PCR) en el órgano afectado. El tratamiento de acuerdo con la literatura es con aciclovir, con el cual se espera una remisión de la enfermedad en la mayoría de los casos sin secuelas. A continuación, presentamos el caso clínico de un paciente con trasplante renal quien cursó con encefalitis por HSV tipo 1 detectado en líquido cefalorraquídeo (LCR) mediante PCR, quien recibió tratamiento estándar con recuperación completa de su estado neurológico.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1387).
Subject(s)
Humans , Male , Middle Aged , Kidney Transplantation , Central Nervous System Infections , Antibiotic Prophylaxis , Encephalitis, Herpes Simplex , InfectionsABSTRACT
La encefalitis por herpes simple (EHS) es la causa más frecuente de encefalitis focal esporádica en todo el mundo. El aciclovir es el tratamiento preferido para la EHS desde la década de 1980. Después del uso generalizado del aciclovir, se redujo la tasa de mortalidad relacionada con la EHS pero surgieron cepas resistentes. Se ha informado que la incidencia de virus del herpes simple (VHS) resistente al aciclovir es del 0,5 % y del 3,5 %-10 % aproximadamente en los pacientes inmunocompetentes e inmunocomprometidos, respectivamente. En este artículo, describimos el caso de un paciente inmunocompetente de 12 años de edad con encefalitis por VHS-1 tratado satisfactoriamente con aciclovir y foscarnet. En el caso de una condición clínica que desmejora con el tratamiento con aciclovir, incluso si no se demuestra un aumento de la carga viral del VHS en el líquido cefalorraquídeo, se podría considerar la posibilidad de EHS resistente al aciclovir y el agregado de foscarnet al tratamiento con aciclovir.
Herpes simplex encephalitis (HSE) is the most common cause of sporadic focal encephalitis worldwide. Acyclovir is the treatment of choice of HSE since the 1980s. After the widespread use of acyclovir, HSE related mortality rate had reduced but resistant strains emerged. Acyclovir resistant HSV incidence was reported as about 0.5 % and 3.5 %-10 % in immunocompetent and immunocompromised patients, respectively. Herein, a 12-year-old immunocompetent patient with HSV-1 encephalitis who was successfully treated with combined acyclovir and foscarnet therapy is described. In the case of deteriorating clinical condition under acyclovir treatment even if the absence of demonstration of increased CSF HSV viral load, the possibility of acyclovir resistant HSE and the addition of foscarnet to the acyclovir treatment might be considered.
Subject(s)
Humans , Male , Child , Acyclovir , Child , Foscarnet , Encephalitis, Herpes SimplexABSTRACT
A four and a half year old young boy with ADHD (attention-deficit hyperactivity disorder) was brought bysocial worker as a case of child abuse, as he was being sedated by his infirm grandfather, using alcohol, tocontrol hyperactivity. The child underwent deaddiction, treated for hyperactivity and enrolled into variousactivities. Grandfather was also extended therapeutic services. Caregiver was changed and case wasmonitored by social worker. Family was extensively given psycho education, especially regarding childabuse. Discussion of this unusual case is chiefly on ADHD, caregiver burnout, substance abuse and of coursechild abuse – its current state of under-recognition in India, detection and management.
ABSTRACT
Acute retinal necrosis (ARN) following herpes simplex encephalitis (HSE) in an immunocompetent patient is a rare condition. Quantitative real-time polymerase chain reaction (qPCR) has made it possible to identify and quantify viral genome. We report a case of ARN following HSE managed with the help of qPCR. A 45-year-old man developed ARN following HSE and was treated with intravenous acyclovir and intravitreal foscarnet. The retinitis did not respond initially and the qPCR demonstrated a rise in the number of copies of the HSV-1 viral genome. With continued treatment with intravenous acyclovir and intravitreal ganciclovir, the retinitis healed and the qPCR confirmed a reduction in the viral load. qPCR has a high sensitivity and specificity for HSV and is a useful tool for diagnosis and treatment of viral retinitis.
ABSTRACT
No abstract available.
Subject(s)
Astrocytoma , Encephalitis, Herpes Simplex , Herpes SimplexABSTRACT
Herpes simplex encephalitis (HSE) is a rare viral encephalitis in adults. A high (70%) mortality rate with serious complications has been reported even after active, appropriate management. The association between HSE and immune suppression is unclear, but there are case reports of cancer patients in which HSE concomitantly developed after whole brain radiation or high-dose steroid treatment. The clinical manifestations and laboratory findings of these patients are atypical compared to the general population. Although brain magnetic resonance images reveal typical HSE findings, cerebrospinal fluid (CSF) analysis might be normal in cancer patients. We report a case of HSE in a 48-year-old male diagnosed with nasopharyngeal cancer and treated with concurrent chemoradiation. This patient had a normal cell count in CSF, but HSE was finally diagnosed from positive polymerase chain reaction test results. After administration of acyclovir and systemic steroid treatment, the patient had a good clinical course with few neurologic sequelae.
Subject(s)
Adult , Humans , Male , Middle Aged , Acyclovir , Brain , Cell Count , Cerebrospinal Fluid , Chemoradiotherapy , Encephalitis, Herpes Simplex , Encephalitis, Viral , Mortality , Nasopharyngeal Neoplasms , Polymerase Chain ReactionABSTRACT
Objective To evaluate the factors influencing prognosis and to explore the pathological mechanism in which herpes simplex virus encephalitis(HSE) was one of the severe types of acute viral encephalitis in children and had poor prognosis.Methods Twenty-one children with HSE were diagnosed by the clinical syndrome of focal encephalitis and HSV DNA-PCR positive in cerebrospinal fluid(CSF) from Jan.2012 to Oct.2013,among whom,19 patients were treated with intravenous Acyclovir,30 mg/(kg · d) 48 hours after onset and were followed up for 6 to 24 months.Clinical data were collected including Glasgow Coma Score,the brain magnetic resonance imaging(MRI),and electroencephalography(EEG).All MRI examinations including plain scan and contrast enhancement were carried out at the beginning of admission and 1 month after the onset of symptoms.The clinical outcomes were divided into two levels accoming to the severity of the neurological deficit,then the data were analyzed by using Logistic regression and Fisher's exact probability method.The OR value was calculated.Results Eighteen children survived,of whom 5 cases had no neurological deficit(27.8％),3 cases were left with mild impairment(16.7％),and the above 8 cases were thought to have better outcome.Six cases had moderate impairment (33.3％) and 4 cases had severe impairment(22.2％) and 1 child died,and these 11 cases were thought to have worse outcome.Patients aged between 1 month and 10 years,average (2.03 ± 2.23) years old.The mean GCS score was (9.68 ± 2.65) scores,the GCS of the patients were more than 7except for one death child with 3 scores.The multiple factor analysis showed that EEG,age,GCS and the range and character in MRI were significantly correlative to the prognosis(P ＜ 0.05).The single factor analysis illustrated that age 1-4 years old(OR =30,95％ CI 2.066-366.510,P =0.002),GCS ≤ 10 scores(OR =27.518,95％ C1 2.066-366.510,P =0.004)and the wide necrosis existence involving diffuse white matter or deep nuclei of MRI findings (OR =12,95 ％ CI 1.294-111.323,P =0.017) indicated the worse outcome.Conclusions Age,GCS score,nature and damage degree of MRI lesions are the main important factors affecting the prognosis of children's HSE.HSE in children is apt to involve the cortex such as frontal lobe,parietal lobe even diffuse white matter or deep nuclei,which indicates the poor prognosis.
ABSTRACT
Aim: To see possible association between the chemotherapy, radiotherapy or both with the reactivation of Herpes simplex virus 1(HSV1) in brain which merits further dialogue in the field of current evidence based literature. Presentation of Case: We present a case of 46 years old male patient who developed herpes simplex encephalitis (HSE) while receiving radical chemo-radiation for locally advanced nasopharyngeal carcinoma. Full informed consent was obtained for publication of this case. He was treated with protracted course of anti-virals and is currently leading a healthy life. Study Design: The study is a case report of a rare but important side effect of a common chemoradiation procedure. Place and Duration of Study: The study took place at Comprehensive Cancer Center, King Fahad Medical City. It was reported during June 2013. Discussion: HSV1 causes several disseminated primary infections including herpes labialis, gingivostomatitis, and corneal infections. It is particularly notorious for causing potentially fatal encephalitis. Its reactivation is linked to several environmental factors including chemotherapy and radiotherapy. Conclusion: This case report emphasizes on the possible role of chemo-radiation as causation of this life threatening condition, its early detection, prompt and aggressive treatment.
ABSTRACT
Herpes simplex encephalitis (HSE) is rare, serious sporadic encephalitis associated with high mortality in untreated cases. Although cognitive impairment with fever could be the clue of diagnosis, various symptoms can make it difficult to be diagnosed. Dizziness is one of the most frequent symptoms ENT doctors can encounter. Authors experienced the HSE patient suffered rotatory sense of dizziness as a primary symptom and treated the patient successfully without major complication. We reported our experience and findings of vestibular function test of patient. It could be helpful to other ENT doctors who encounter similar patients.
Subject(s)
Humans , Dizziness , Encephalitis , Encephalitis, Herpes Simplex , Fever , Herpes Simplex , Methylmethacrylates , Polystyrenes , Vestibular Function TestsABSTRACT
Herpes simplex encephalitis is a diagnostic challenge and causes high morbidity and mortality in children. Early suspicion of the disease and a rapid, safe and useful diagnostic test are relevant because up to 70% of the cases may die. We report the case of a newborn girl aged 25 days, who presented with a clinical picture that was compatible with herpes simplex encephalitis where the confirmation of the etiological diagnosis was delayed. Only by repeated real-time polymerase chain reaction it was possible to confirm the presence of herpes simplex virus type 1 in the cerebrospinal fluid.
La encefalitis herpética genera un desafío diagnóstico y es causa de alta morbi-mortalidad en niños. Se requiere de una sospecha clínica precoz y una prueba diagnóstica útil, rápida y segura, ya que sin tratamiento oportuno y adecuado, hasta 70% de los casos puede fallecer. Comunicamos el caso de una recién nacida de 25 días de vida, que presenta un cuadro clínico compatible con encefalitis herpética, donde el diagnóstico etiológico tardó en ser confirmado y sólo la técnica de reacción de la polimerasa en cadena en tiempo real (RPC-TR) aplicada de forma repetida permitió certificar la presencia de virus herpes simplex tipo 1 en el LCR.
Subject(s)
Female , Humans , Infant, Newborn , Encephalitis, Herpes Simplex/diagnosis , Herpesvirus 1, Human , Herpes Simplex/diagnosis , Acyclovir/therapeutic use , Antiviral Agents/therapeutic use , Delayed Diagnosis , Encephalitis, Herpes Simplex/cerebrospinal fluid , Real-Time Polymerase Chain ReactionABSTRACT
A 58-year-old woman was admitted to hospital due to memory impairment and visuospatial dysfunction. Brain MRI revealed high signal lesions on both the temporal and inferior frontal lobes. She was diagnosed as having herpes simplex encephalitis based on her clinical and laboratory findings. Twelve months later she still presented with spatial disorientation, although her amnesia was improved. Neuropsychological testing revealed multiple cognitive impairments, and especially visuospatial dysfunction. This patient represents a case of herpes simplex encephalitis associated with spatial disorientation even when the amnesia had disappeared.
Subject(s)
Female , Humans , Middle Aged , Amnesia , Brain , Encephalitis, Herpes Simplex , Frontal Lobe , Hallucinations , Herpes Simplex , Memory , Methylmethacrylates , Neuropsychological Tests , PolystyrenesABSTRACT
No abstract available.
Subject(s)
Encephalitis, Herpes Simplex , Herpes Simplex , Methylmethacrylates , Neurosyphilis , PolystyrenesABSTRACT
This report presents the case of a patient treated with epiglottoplasty (Biller's laryngoplasty technique) for the pseudobulbar type of dysphagia associated with herpes simplex encephalitis (HSE). A 67-year-old man developed acute HSE with disturbance of consciousness and intractable aspiration. Oral intake was tried, but resulted in aspiration pneumonia and was therefore canceled at the patient's former institution. At 12 months following onset, the patient consulted our hospital and we judged that aspiration could not be controlled, and that surgical management would be needed. In order to both prevent aspiration and preserve phonation, epiglottoplasty was performed at 15 months following onset. Postoperatively, the patient was able to resume an unrestricted diet except for clear liquids. He also underwent voice rehabilitation with the support of his family and rehabilitation staff. These efforts finally enabled him to speak clearly. Epiglottoplasty is an effective treatment for intractable aspiration, but this procedure is not widely known to Japanese physiatrists. Careful patient screening and selection by the attending physiatrist is essential, as is providing adequate postoperative swallowing and voice rehabilitation.
ABSTRACT
We report a case of 70-year-old man with glioblastoma presenting as acute encephalitic illness. The patient exhibited sudden onset of cognitive impairment and headache for 2 days. Initial brain MRI showed left temporal lobe hyperintensity, and cerebrospinal fluid cytology revealed a mild pleocytosis. The patient had initially improved after medical treatment with a presumptive diagnosis of herpes simplex encephalitis (HSE). After 8 months, the patient complained of recurrent seizures. A follow-up brain MRI revealed marked increases in size and surrounding perilesional edema in the left temporal lesion on T2-weighted images and a new contrast-enhancing lesion on gadolinium-enhanced T1-weighted images. Stereotactic brain biopsy revealed a glioblastoma. The atypical encephalitic presentation of glioblastoma should be considered if definitive evidence for the diagnosis of HSE cannot be obtained.
Subject(s)
Aged , Humans , Biopsy , Brain , Edema , Encephalitis, Herpes Simplex , Follow-Up Studies , Glioblastoma , Headache , Herpes Simplex , Leukocytosis , Methylmethacrylates , Polystyrenes , Seizures , Temporal LobeABSTRACT
Herpes simplex encephalitis (HSE) is a leading cause of sporadic, nonepidemic viral encephalitis in children and adults. We report a very rare case of HSE with involvement of bilateral thalamus, putamen, upper pons and midbrain, with development of extrapyramidal symptoms which responded to corticosteroid therapy. A 15-mth-old female baby admitted with complaint of fever for 5 days and generalised tonic clonic seizure 10 hours before admission. On clinical examination patient was drowsy, temperature was 39.4 oC and vitals were stable with signs of increased intracranial tension. There were no signs of meningeal irritation. Patient gradually become unconscious in the next few hours and pupils were constricted bilaterally with development of atonia in all four limbs and neck muscles. Doll’s eye phenomenon was absent.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Antiviral Agents/therapeutic use , Basal Ganglia Diseases/diagnosis , Basal Ganglia Diseases/drug therapy , Basal Ganglia Diseases/etiology , Drug Therapy, Combination , Electroencephalography , Encephalitis, Herpes Simplex/complications , Encephalitis, Herpes Simplex/diagnosis , Encephalitis, Herpes Simplex/drug therapy , Female , Fever/diagnosis , Fever/etiology , Follow-Up Studies , Humans , Infant , Magnetic Resonance Imaging , Mannitol/therapeutic use , Phenytoin/therapeutic use , Risk Assessment , Seizures/diagnosis , Seizures/etiology , Severity of Illness Index , Treatment OutcomeABSTRACT
A encefalite herpética (EHS) é uma patologia grave, com alto índice de morbidade e letalidade. Esta doença se expressa por um quadro clínico agudo, tendo como principais manifestações:febre, cefaléia e alterações cognitivas e psíquicas. Desta forma, a suspeição clínica, associada a exames laboratoriaise de imagem são de fundamental importância para a detecção precoce e tratamento imediato desta patologia, a fim de impedir sua progressão rapidamente fatal. Neste relato, apresentamos um caso de EHS em uma paciente do sexo feminino, 48 anos, internada no Hospital dos Plantadores de Cana - Campos dos Goytacazes, RJ.(AU)
The herpes simplex encephalitis (HSE) is a serious pathology, with a high rate of morbidly and lethality. This diseasepresents a acute clinical condition, it had like principal symptons: fever, headache and cognitive and psychological alterations. In such a way, the clinical suspicion is associated to laboratorials examinations and of image. This are extremely important to early detect and fast treatment this pathology, on purpose to impede the quickly fatal progression of the illness. In this report, we present a case of Herpes Simplex Encephalitis in a forty-eight-years old female-patient, to taken into thePlantadores de Cana Hospital - Campos dos Goytacazes, RJ.(AU)
Subject(s)
Humans , Female , Middle Aged , Herpesvirus 1, Human , Encephalitis, Herpes Simplex/diagnosis , Encephalitis, Herpes Simplex/drug therapy , Aphasia/etiology , Seizures/etiology , Acyclovir/therapeutic use , Polymerase Chain Reaction/instrumentation , Fever/etiology , Headache/etiology , Nausea/etiologyABSTRACT
Herpes simplex encephalitis (HSE) is the most common form of encephalitis, with predilection for the temporal lobes and insular cortex. The presence of RBCs is a characteristic finding of CSF analysis and hemorrhagic transformation of the lesions on CT or MRI is not a rare, because the hemorrhagic necrosis is an important pathologic finding of HSE. However, intracerebral hematoma is rarely reported. We report a case of PCR proven HSE with hemotomas in both the medial temporal lobes, which has not been reported.
Subject(s)
Encephalitis , Encephalitis, Herpes Simplex , Hematoma , Herpesvirus 1, Human , Methylmethacrylates , Necrosis , Polymerase Chain Reaction , Polystyrenes , Temporal LobeABSTRACT
Herpes simplex encephalitis (HSE) is the most common type of viral encephalitis and a fourteen day administration of acyclovir is well-known as the treatment of choice for HSE. Occasionally HSE relapses, but rarely with acyclovir treatment. We report a case of relapsing HSE after treatment with acyclovir for 14 days. Our case suggests that patients with progressive high signal intensities in diffusion-weighted brain MRIs might need longer antiviral therapy over 14 days for preventing the relapse of herpes simplex encephalitis.
Subject(s)
Humans , Acyclovir , Brain , Encephalitis, Herpes Simplex , Encephalitis, Viral , Herpes Simplex , Magnetic Resonance Imaging , RecurrenceABSTRACT
The expression of the cytokines IL-2, IL-10, TNF-α and their roles in mice with herpes simplex viral encephalitis (HSE) were studied. By using semiquantitative reverse transcription polymerase chain reaction (RT-PCR), the expressions of IL-2, IL-10 and TNF-α mRNA in control group, HSE group and acyclovir (ACV)-treated group were detected and the pathological changes of brain were observed. It was found that after HSV1 infection, the cerebral lesions of haemorrhage and necrosis in mice were observed under the microscopy, and the levels of IL-2, IL-10 and TNF-α were increased remarkably. After treatment with ACV after HSV1 infection, the cerebral lesions in mice were improved, the level of IL-2 maintained stable, IL-10 was increased consistently, and TNF-α was decreased significantly as compared with those in HSE group. In acute HSE, many cytokines are upregulated, including IL-2, IL-10 and TNF-α to eliminate virus and TH1 type response is dominant. In convalescence, there is a shift in the cytokine expression profile from TH1 profile to TH2 profile and the shift can inhibit the overexpression of immune response in animals. ACV has remarkable effects in the treatment of HSE.
ABSTRACT
Herpes Simplex Encephalitis is associated with a high mortality rate and a high probability of neurological sequelae. Good results are obtained when Herpes Simplex Encephalitis is promptly diagnosed and treated with antiviral agents. We reported a case of Herpes Simplex Encephalitis in which Magnetic Resonance Imaging (MRI), Single Photon Emission Computed Tomography (SPECT) and Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) were performed sequentially. Imaging studies are valuable tools for early detection and diagnosis of Herpes Simplex Encephalitis. And particularly FDG-PET represents functional anatomy through diffuse decline of glucose metabolism better than other imaging studies.