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Clinical evolutive aspects and neuroimaging findings in a child with herpes simplex virus type I encephalitis

Luminos Monica, Draganescu Anca, Visan Angelica, Vasile Magdalena, Negulescu Cristina, Merisescu Madalina Maria, Kouris Camelia, Schiopu Sabina, Osman Endis, Bilasco Anuta
Abstract: Herpes simplex encephalitis (HSE) is a severe viral infection of the central nervous system and it’s one of the most common causes of life-threatening fulminate necrotizing viral encephalitis. Most frequently the patients’ presentation is a non-specific one, consisting of fever, headaches, vomiting, focal neurological signs, and seizures in association with an altered consciousness. The management of HSE has been improved in the last years through the availability of intravenous acyclovir therapy and PCR - based diagnostic assays, reducing mortality and morbidity rates and decreasing rates of neurological sequelae. The objective was to expose clinical data, laboratory test sequencing and management courses in HSE among children - a clinical case report. We present the case of a 15 month-old boy, admitted in the ICU of National Institute for Infectious diseases “Prof. Dr. Matei Bals” for fever, vomiting, diarrhoea, focal and generalized seizures, drowsiness, bulging anterior fontanel and altered mental status. The diagnosis of HSE was established corroborating data from the clinical findings with the neurological exam, and confirmed by detecting the HSV type I DNA in CSF using PCR; Brain MRI was highly suggestive for HSE.The patient was treated with i.v Acyclovir; anticonvulsant drugs , anti cerebral-edema therapy and i.v human immunoglobulin. The child was discharged after 25 days with a good clinical and neurological condition. HSE is the most common cause of sporadic fatal encephalitis worldwide and it’s a medical emergency that requires etiological treatment right away. Using PCR for detecting HSV -DNA from CSF remains the gold standard for diagnosing HSE. Mortality rates range dramatically depending on how early the antiviral treatment is initiated.

Keywords: herpes simplex type 1 encephalitis, polymerase chain reaction (PCR), cerebrospinal fluid, antiviral therapy


2015-03-01

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