Relapse of herpes simplex encephalitis after acyclovir therapy

Nicolaidou, Polyxeni; Iacovidou, Nikoletta; Youroukos, Sotiris; Liacopoulou-Tsitsipi, T.; Kattamis, C

doi:10.1007/bf01953988

Cited by 10 publications

(4 citation statements)

References 8 publications

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“…Also, this method was shown to be of potential utility for monitoring antiviral therapy in patients with HSE. Further studies should address the use of QC-PCR in anticipating the clinical relapse of encephalitis permitting the prompt reintroduction of antiviral therapy (19,25).…”

Section: Discussionmentioning

confidence: 99%

Application of Competitive PCR to Cerebrospinal Fluid Samples from Patients with Herpes Simplex Encephalitis

Domingues¹,

et al. 1998

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The purpose of the present study was to determine if the quantity of herpes simplex virus (HSV) DNA in the cerebrospinal fluid (CSF) of patients with herpes encephalitis would be useful in establishing the prognosis of the disease and to determine the effect of antiviral therapy on the clearance of viral DNA from the CSF. Quantitation of HSV DNA was done by constructing an internal standard (IS) from the glycoprotein B amplicon which had a 25-bp deletion between primer annealing sites. Each CSF specimen was coamplified with the IS and the ratio of the amount of HSV/amount of IS was compared to the ratios on a standard curve constructed with the same IS plus known amounts of HSV DNA. CSF specimens were available from 16 patients who were treated with intravenous acyclovir, and the amount of HSV DNA ranged from <25 to 18,000 copies per μl in CSF obtained before or within 4 days of the initiation of acyclovir therapy. Patients with >100 copies of HSV DNA per μl were older, were found by computed tomography to have lesions, and had poorer outcomes than patients with <100 copies. Follow-up CSF specimens were available from seven patients. In six of these seven patients, the HSV DNA levels decreased during therapy. One patient had a twofold increase in HSV DNA levels after 1 week of therapy and died on day 8. The application of this assay may be helpful in establishing the prognosis and in the monitoring of patients with herpes simplex encephalitis.

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Section: Discussionmentioning

confidence: 99%

Application of Competitive PCR to Cerebrospinal Fluid Samples from Patients with Herpes Simplex Encephalitis

Domingues¹,

et al. 1998

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“… a Based on review of the literature; cases considered by the authors as infectious HSVE relapses (n = 28; age available in n = 26; gender available in n = 23) [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15] and autoimmune mediated HSVE relapses (n = 33; age available in n = 23; gender available in n = 19) [2, 5, 13, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29]. …”

Section: Acknowledgmentsmentioning

confidence: 99%

“…The pathogenesis of these relapses is heterogeneous (Table 1): some cases represent true relapses of viral encephalitis, with positive HSV PCR in the CSF, new necrotic lesions in the MRI, and response to antiviral treatment. In these patients the relapsing symptoms represent a reactivation of the viral replication, or delayed symptoms of a persistent infection [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15]. In contrast, in a subset of relapsing patients the mechanisms that initiate the disorder are less clear.…”

Section: Introductionmentioning

confidence: 99%

Clinical Neuropathology practice guide 4-2013: post-herpes simplex encephalitis: N-methyl-Daspartate receptor antibodies are part of the problem

Höftberger¹,

Armangué²,

Leypoldt³

et al. 2013

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Classic herpes simplex virus encephalitis (HSVE) is an acute viral infection that usually follows a monophasic disease course; however some patients, mainly children, experience a relapse within weeks or months after the initial event. In a subset of these patients a viral reactivation is unlikely because the CSF PCR for HSV is negative, repeated MRI does not show new necrotic lesions, and the symptoms are refractory to antiviral therapy. These patients often develop choreoathetosis variably accompanied by behavioral changes and seizures, and a postinfectious immune-mechanism has been postulated. Recent studies demonstrated that 7% of patients with HSVE harbor NR1 N-methyl-D-aspartate receptor (NMDAR) IgG antibodies. Moreover, a child with post-HSVE choreoathetosis was found to have NMDAR antibodies; the patient did not improve with antiviral therapy but recovered after aggressive immunotherapy. Based on these findings, evidence is increasing that a subgroup of post-HSVE represents a separate disease entity, which in fact is anti-NMDAR encephalitis. Patients with relapsing HSVE or prolonged atypical symptoms, who have negative CSF PCR for HSV should routinely be tested for NMDAR IgG antibodies in CSF and serum. It is important to be aware of this differential diagnosis because patients respond to immunotherapy.

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“…Relapse of HSV encephalitis following acyclovir therapy has been reported in adults [9,21,39] and children [3,15,20,25,30,40]. Speculations on the pathogenic mechanism of the recurrence have included post-infectious encephalomyelitis, short duration of acyclovir treatment, acyclovir resistance of HSV, or persistence of HSV infection.…”

Section: Introductionmentioning

confidence: 99%

Relapse of Herpes Encephalitis after Acyclovir Therapy: Report of Two New Cases and Review of the Literature

et al. 2004

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Relapse of herpes simplex virus (HSV) encephalitis following acyclovir therapy has been reported infrequently in children beyond the neonatal period. The pathogenic mechanism of the recurrence is not fully understood. We report two new cases that support a mechanism of latent HSV infection with reactivation of the disease. Our patients were 2 years (#1) and 8 months (#2) old at initial infection. Both presented with fever, lethargy, focal seizures, and focal motor abnormalities. Serum HSV antibodies (Abs) were negative. The patients were treated with acyclovir for 14 and 21 days, respectively. They were readmitted at 1 month, and 4 days after discharge, respectively, with recurrent lethargy, seizures, and choreo-athetoid movements. Serum and CSF HSV Abs were significantly increased. CSF PCR was positive. In patient # 2 acyclovir-sensitive HSV was isolated from a brain biopsy. Both patients were re-treated with acyclovir, but progressed to a neurovegetative state. In our cases, latent HSV infection and reactivation is the most likely explanation for recurrent encephalitis. The immuno-pathogenic mechanisms of the infection recurrence are discussed. Based on the reported cases in the literature, patients younger than 2 years of age and with lower total dose of acyclovir treatments have a higher risk of recurrence.

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Relapse of herpes simplex encephalitis after acyclovir therapy

Cited by 10 publications

References 8 publications

Application of Competitive PCR to Cerebrospinal Fluid Samples from Patients with Herpes Simplex Encephalitis

Application of Competitive PCR to Cerebrospinal Fluid Samples from Patients with Herpes Simplex Encephalitis

Clinical Neuropathology practice guide 4-2013: post-herpes simplex encephalitis: N-methyl-Daspartate receptor antibodies are part of the problem

Relapse of Herpes Encephalitis after Acyclovir Therapy: Report of Two New Cases and Review of the Literature

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