HSV-1 Encephalitis: High Index of Clinical Suspicion, Prompt Diagnosis, and Early Therapeutic Intervention Are the Triptych of Success—Report of Two Cases and Comprehensive Review of the Literature

Abstract

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 comprehensive research of the relevant literature, we aim at showing the crucial role of medical history and physical examination, along with the high index of clinical suspicion, in order to make promptly the diagnosis and administer timely intravenous acyclovir, limiting the possibility of complications during the disease's course.

Application of Environment-Friendly Rhamnolipids against Transmission of Enveloped Viruses Like SARS-CoV2

“…Human herpesvirus type 1 (HSV-1) is a member of the Herpesviridae family that include a large number of enveloped DNA viruses common in both animal and humans. HSV-1 is the cause of cold sores or fever blisters in or around the mouth and encephalitis in newborns [ 20 , 21 ]. It is also the leading cause of corneal blindness in developing countries [ 22 , 23 ].…”

Modeling Herpes Simplex Virus 1 Infections in Human Central Nervous System Neuronal Cells Using Two- and Three-Dimensional Cultures Derived from Induced Pluripotent Stem Cells

“…These difficulties have also impeded models of the interactions of HSV-1 with the human central nervous system (CNS). HSV-1 infection of the CNS is the most common cause of encephalitis (herpes simplex encephalitis [HSE]), which has an incidence of 2 to 4/100,000 people annually, and is associated with rising rates of encephalitis in children (7–9). Even though antiviral therapy by acyclovir derivatives has significantly reduced the mortality to approximately 25%, patients who survive HSE often experience significant long-term neurological sequelae (10).…”

Chronic liver disease and hepatic encephalopathy patients with new-onset focal motor status epilepticus: Indicates herpetic encephalitis

“…Mortality of 7% is seen in herpetic encephalitis if early diagnosed and treated as compared to 70% if not treated. [ 4 ]…”

“…Mortality of 7% is seen in herpetic encephalitis if early diagnosed and treated as compared to 70% if not treated. [ 4 ] Herpes encephalitis as underlying etiology in two patients with chronic liver disease, who presented with focal SE is reported in this article. Permanent sequelae and mortality rates can be reduced if patients with chronic liver disease, presenting with refractory new-onset SE, are treated for HSE with appropriate antiviral medication.…”