Introduction. Herpes simplex virus (HSV) causes serious disease in neonatal period and early infancy with very high mortality and neurologic. Khandjeng Muslimmin studies Pressure ulcers, Surgery, and Home Care. IDIOPATHIC (30% OF CASES); SUPRASELLAR TUMOURS (30% OF CASES); INFECTIONS (ENCEPHALITIS, TB, etc); NON-INFECTIOUS GRANULOMA.
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Herpes simplex virus HSV causes serious disease in neonatal period and early infancy with very high mortality and neurologic sequelae. HSV infection in the neonates may have either a localised, disseminated or encephalitic pattern of presentation.
The outcome of the disease is largely dependent on a prompt diagnosis, which is often difficult to make and encephaligis adequate treatment, which is expensive. We are reporting the management of an infant with HSV encephalitis, which to our knowledge has not been reported earlier in this age group in Indian literature. A 3 month female infant was referred to this hospital as encephaliits case of pyogenic meningitis.
NEONATAL HERPES SIMPLEX ENCEPHALITIS
Baby was born to a encephalitks mother by Caesarean section. There were no genital lesions in the mother or prolonged rupture of membranes.
There was no history of recent immunization or exposure to patient with herpatic lesions. Baby was initially managed with antibiotics and diazepam. On arrival,baby was found to be obtunded and having multifocal clonic seizures involving mostly left encephalitks of the body. Vital parameters were normal.
Anterior fontanalle was normal in size and OFC was 37 cms.
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No mucocutaneous vesicles were noted. There was generalised hypotonia asksp decreased power in askeep left upper limb. Moro’s reflex was absent. There was no hepatomegaly. Maternal examination did not reveal any genital, oral or breast asjep. Culture was sterile for bacteria.
HSV-1 IgG antibodies were not positive. CT scan showed multicystic hemarrhagic necrosis in both temporal lobes. EEG showed low voltage activity in the right hemisphere. Child also received phenobarbitone. Clinically seizures ceased and power improved, ultimately becoming equal in all the four limbs. CSF analysis at the end of 3 weeks was normal. At follow up ABR was found to be abnormal in both the ears with decreased amplitude wskep wave 3 and increased latency of wave 5 and increased interpeak latency suggestive of poor conduction in auditory pathway at 10 months of age Fig 1.
Other neurological and development assessment was within normal limits during follow up till one year of age. Herpes simplex disease is caused by two distinct viruses i. Herpes simplex virus 1 HSV1 is predominant cause of encephalitis in children and adults, while HSV2 is the predominant cause in neonates and early infancy as it is almost always acquired from an infected maternal genital tract.
Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management
asiep Post natal transmission in this age group is rare. CSF is typically xanthochromic, consistent with release of blood into subarachnoid space secondary to necrotising nature of the disease. This typical picture was present in our case. The most definitive diagnosis of HSV infection is by recovery of the virus from scraping of vesicle, oropharynx, conjuctivae, urine, stool or CSF. However this requires the specimen to be frozen and shipped in dry ice or transported in Stuart’s medium [ 3 ].
Facilities for virus isolation are not routinely available in our country.
Detection of specific IgM antibodies to HSV is the most rapid and suggested means of establishing the diagnosis [ 4 ]. A four fold rise in the IgG titres is also diagnostic encephallitis was present in our case. Newer techniques for diagnosis of herpes simplex encephalitis include polymerase chain reaction assay of CSF [ 5 ].
Brain imaging techniques are characteristic though not pathognomonic of neonatal herpes simplex encephalitis. On computed tomography encephaliis temporal lobes are most commonly involved with multicystic haemorrhagic encephalomalacia as was seen in our case.
Contrast should be avoided as it may accumulate and cause toxicity [ 6 ]. Vidarabin adenine arabinoside was introduced earlier for the management of neonatal herpes with significant reduction in mortality [ 7 ]. Acyclovir acycloguanosine a selective inhibitor of viral replication, has minimal side effects and is currently the favoured drug in the treatment.
However studies have shown no significant differences in askeo final outcome with either drug [ 8 ]. Both are given for days [ 1 ]. Controlled studies enceephalitis shown that antiviral therapy leads to an impressive reduction in mortalilty and morbidity.
Non administration of therapy or delay in its institution is associated with high mortality and complications such as microcephaly, hydrocephaly, porencephalic cysts, spasticity, chorioretinitis, blindness, deafness, learning disabilities and seizures [ 9 ]. In view of low incidence of side-effects with acyclovir it is recommended that specific therapy be instituted in highly suggestive situation [ 10 ]. This recommendation is of particular value to us due to limited diagnostic facilities and high mortality associated with delay in treatment.
Postnatal transmission of HSV is rare but may occur from oral or breast herpetic lesions of the mother or from infected infants and adults including hospital personnel [ 11 ]. To conclude, herpes simplex encephalitis should be suspected in any infant with fever and focal neurological signs.
Though detection of virus is the most definite proof, treatment should be initiated early if the above clinical and CSF picture is present. National Center for Biotechnology InformationU. Med J Armed Forces India.
Published online Jun Author information Article notes Copyright and License information Disclaimer. Acyclovir, Herpes simplex encephalitis. Introduction Herpes simplex virus HSV causes serious disease in neonatal period and early infancy with very high mortality and neurologic sequelae. Case Report A 3 month female infant was referred to this hospital as a case of pyogenic meningitis.
Open in a separate window. Abnormal ABR suggestive of poor conduction in auditory pathway. Discussion Herpes simplex disease is caused by two distinct viruses i. Herpes simplex virus infection. Infectious disease in the fetus and newborn infant. WB Saunders Co; Philadelphia: Herpes simplex virus encephalitis in children; Analysis of CSF and progressive neurodevelopmental deterioration.
Transport of herpes simplex virus in Stuart’s medium. Br J Vener Dis. Newborn infections with herpes virus hominis type 1 and 2.
Rapid diagnosis of herpes simplex encephalitis by nested polymerase reaction of CSF. Prolonged brain retention of contrast agent in neonatal herpes simplex encephalitis.
Vidarabine therapy in neonatal herpes simplex virus infection. A controlled trial comparing vidarabine with acyclovir in neonatal encehpalitis simplex virus infection.
N Engl J Med. Viral infection of fetus and newborn. Schaffer and Averys-Disease of the Newborn. Editorial Herpes simplex encephalitis. Postnatal acquisition of herpes simplex virus by the newborn infant. A review of the literature.