Herpes simplex encephalitis

Herpes simplex encephalitis: Description, Causes and Risk Factors:Herpes simplex encephalitisThe most common acute encephalitis caused by HSV-1 and rarely HSV-2; affects persons of any age; preferentially involves the inferomedial portions of the temporal lobe and the orbital portions of the frontal lobes; pathologically, severe hemorrhagic necrosis is present along with, in the acute stages, intranuclear eosinophilic inclusion bodies in the neurons and glial cells.Herpes simplex encephalitis (HSE) remains the most common form of sporadic fatal encephalitis worldwide. HSE is a rare disease that is estimated to occur in 2-4 individuals per million population per year. More than 90% of the cases are caused by herpes simplex virus type 1 (HSV-1), and 7% are caused by herpes simplex virus type 2 (HSV-2). HSE is a devastating disease, and during its natural course, up to 70% of patients die. During the 1980s, 2 independent trials showed that Zovirax® was superior to vidarabine in the treatment of HSE and resulted in reduced mortality and morbidity. Despite treatment, the associated mortality rate is still high (20%), and permanent disability, particularly cognitive and memory impairment is common.Humans have become infected after exposure to infectious tissues and body fluids including ocular, oral, genital, CNS, and CSF tissues and fluids. Cell cultures from macaque kidneys are also potentially infectious. Exposure to peripheral blood from macaque monkeys has not been reported to cause infection in humans. However, exposures involving blood from macaque monkeys will be considered in the risk assessment for evaluation and treatment for this policy.The incidence of diabetes mellitus among patients with Herpes simplex encephalitis was normal during the period before HSE diagnosis but increased 5- to 10-fold after HSE, compared with the incidence among the general population. One reason for this may be that severe HSE disease and the frequent use of steroid treatment during the acute phase of Herpes simplex encephalitis can trigger latent diabetes.The high frequency of psychiatric admissions is not surprising, because personality changes are common in patients with HSE. The ?nding that 87% of surviving patients were re-admitted to the hospital during the study period illustrates the high incidence of morbidity after Herpes simplex encephalitis.Symptoms:Aphasia.
  • Epilepsy or myoclonic twitching.
  • Hallucinations.
  • Hemianopia
  • Focal paralysis.
  • Abnormal motor activity.
  • Abnormal behavior.
  • Coma.
  • Sometimes herpetic stomatitis.
  • Myalgia.
Diagnosis:The principal method of diagnosing Herpes simplex encephalitis is through thedetection of the viral genome by PCR of CSF samples.This method has been available for routine clinical use since1991. Previously, the diagnosis of HSE was veri?ed by detectionof intrathecal antibody production against HSV or by brainbiopsy. During the study period, specialized virologicaldiagnostics were performed at 6 laboratories in Sweden & Finland, all ofwhich were located at University Hospitals. The virological laboratories have kept computer-registered data of all results since1990.Treatment:The introduction of possible antiviral therapy in this herpetic group of viruses has emphasized the importance of early diagnosis in a disease in which previously diagnosis had been somewhat academic. The predilection of this particular virus for either one or both temporal lobes of the brain leads to confusion with a space-occupying lesion and many cases are sent to neurosurgical units.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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