Atypical herpes simplex virus encephalitis diagnosed by PCR amplification of viral DNA from CSF

Fodor, P. A.; Levin, Myron J.; Weinberg, Adriana; Sandberg, Elisabeth; Sylman, J.; Tyler, Ken

doi:10.1212/wnl.51.2.554

Cited by 142 publications

(96 citation statements)

References 19 publications

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“…Two adult patients were reported with 0 WBCs in CSF at presentation; however, both subjects were immunosuppressed (chronic steroid therapy, AIDS). 8 Our own series, although characterized by a very low number of cases, is consistent with these observations that HSV encephalitis in children is a rare and clearly recognizable clinical syndrome. Both cases of HSV encephalitis presented with fever, seizures, altered mental status, and CSF pleocytosis (90 and 1770 WBC/cm 3 respectively).…”

Section: Discussionsupporting

confidence: 88%

“…The introduction of CSF PCR led to the understanding that less-severe forms of HSV CNS disease do exist, although these cases typically lack only the classic severe focal encephalitis syndrome: fever (94% to 96% of cases) and altered mental status to some degree remain near universal findings in reports of "milder" disease. 8,9 In a series of 16 children, all cases presented with fever and all had clear evidence of CNS involvement. 10 Isolated cases of truly milder CNS disease in children have been reported only very rarely.…”

Section: Discussionmentioning

confidence: 99%

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Herpes PCR Testing and Empiric Acyclovir Use Beyond the Neonatal Period

et al. 2014

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BACKGROUND: Diagnostic strategies based on empirical testing and treatment to identify herpes simplex virus (HSV) infection in neonates may not be appropriate for older children in whom the most common presentation of severe infection is encephalitis, a rare and clinically recognizable condition. METHODS: Use of acyclovir in infants and children in 6 common non-HSV infection–related diagnosis-related groups was characterized between 1999 and 2012 at 15 US pediatric hospitals by using the Pediatric Health Information System database. Characteristics of non-neonatal patients at 1 institution tested for HSV encephalitis over a 6.5-year period were then analyzed to identify factors associated with potentially unnecessary testing and treatment. RESULTS: Acyclovir use increased from 7.6% to 15.6% (P < .001) from 1999 to 2012. Much of this increase came in infants 30 to 60 days of age (82.7% increase, P < .001) and in patients with milder disease severity (44.8% increase, P < .001). Length of stay was increased by 2 days for children treated with acyclovir (P < .001). At our institution, 1394 HSV cerebrospinal fluid polymerase chain reactions were performed in children >30 days old, with only 3 positive results (0.22%). Comparison of the 3 subjects with positive testing and 55 with negative testing revealed that all cases, but only 4% (95% confidence interval 1.2%–14.0%) of noncases had clinical characteristics typical of HSV encephalitis. CONCLUSIONS: Strategies for diagnosis and empirical treatment of suspected HSV encephalitis beyond the neonatal period have trended toward the approach common for neonates without evidence of an increase in disease incidence. This may result in increased medical costs and risk to patients.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Herpes PCR Testing and Empiric Acyclovir Use Beyond the Neonatal Period

et al. 2014

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“…In two cases the times were not documented. The median (range) duration of iv aciclovir treatment was three (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) days. The patient with PCR-confirmed herpes simplex encephalitis (HSE) received 14 days of iv aciclovir.…”

Section: Treatmentmentioning

confidence: 99%

“…1 The classic presentation of HSV encephalitis is of a fever, headache, altered consciousness, focal neurological signs and seizures. 2,3 Intravenous aciclovir is an effective treatment, reducing mortality and morbidity. 4,5 Several publications have shown that delays in initiating treatment are associated with a worse prognosis, 2,6 however, there has been little work to understand why the delays occur.…”

Section: Introductionmentioning

confidence: 99%

Management of suspected herpes simplex virus encephalitis in adults in a UK teaching hospital

et al. 2009

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-The outcome of herpes simplex virus (HSV) encephalitis is improved with prompt initiation of aciclovir treatment. Delays are common, but there is little understanding of why they occur. The case notes of 21 adults admitted with suspected HSV encephalitis over one year were reviewed. The median (range) duration of illness was 2.5 (1-99) days. Seventeen (81%) patients had a lumbar puncture (LP) performed, at a median (range) time of 24 (2-114) hours after encephalitis was suspected. Lumbar puncture was delayed for a computed tomography (CT) scan in 15 patients, but only one of these had contraindications to an immediate LP. The median (range) time from presentation to starting aciclovir was 48 (2-432) hours. HSV-PCR (polymerase chain reaction) was requested on cerebrospinal fluid from 12 patients, one of whom was positive. Five (24%) patients were given the wrong dose of aciclovir. Overall the management of suspected HSV encephalitis was often sub-optimal, with delays in LP occurring due to unnecessary CT scans, and the wrong aciclovir dose administered. Guidelines for the management of suspected encephalitis are needed.

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“…HSVE presents with an acute onset, localized CNS findings, and necrosis of brain parenchyma (classically of the temporal and/or frontal lobes) and may occur in patients of any age beyond the neonatal period. It is the most common cause of sporadic fatal encephalitis in the United States (10) and is predominantly caused by HSV1 (11)(12)(13). The traditional methods of laboratory diagnosis of HSV CNS infections are either extremely invasive (14) or insensitive (12) copy/ml) were detected in a 2.5 years old male and a 9-month-old female, respectively (table 2).…”

Section: Introductionmentioning

confidence: 99%

Detection of Herpes Simplex Virus Infection in Cerebrospinal Fluid

Ramroodi¹,

Kardi²,

Bouzari³

et al. 2016

mljgoums

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Background and Objective: Herpes simplex encephalitis is a life-threatening consequence of the central nervous system (CNS) infection with Herpes simplex virus (HSV). Although it is a rare disease, mortality rates reach 70% in the absence of therapy and only a minority of individuals can return to normal function. The aim of this study was to determine possible correlation between HSV infection and the incidence of encephalitis in patients with neurological signs.Methods: Overall, 152 CSF samples were tested from patients with neurological signs referred to Mahdieh Clinical Laboratory in Isfahan from 2010 to 2013. After cerebrospinal fluid (CSF) collection, DNA was extracted and real-time polymerase chain reaction (PCR) was performed for HSV detection.Results: Of 152 patients tested, 50 were diagnosed with encephalitis. HSV DNA was present in the CSF of 13 patients with encephalitis. HSV was significantly higher (p< 0.05) in patients with encephalitis, which shows the significance of infection as an etiological factor of this disease. About 60% of the encephalitis cases were in age range of 1-24 months.Conclusion: According to the findings of the present study, Cesarean section is recommended for HSV-positive mothers. A routine real-time PCR test is suggested for HSV detection in patients with encephalitis to avoid unnecessary antiviral treatments.

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Atypical herpes simplex virus encephalitis diagnosed by PCR amplification of viral DNA from CSF

Cited by 142 publications

References 19 publications

Herpes PCR Testing and Empiric Acyclovir Use Beyond the Neonatal Period

Herpes PCR Testing and Empiric Acyclovir Use Beyond the Neonatal Period

Management of suspected herpes simplex virus encephalitis in adults in a UK teaching hospital

Detection of Herpes Simplex Virus Infection in Cerebrospinal Fluid

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