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

1998 ◽  
Vol 36 (8) ◽  
pp. 2229-2234 ◽  
Author(s):  
R. B. Domingues ◽  
F. D. Lakeman ◽  
M. S. Mayo ◽  
R. J. Whitley
Keyword(s):  
Cerebrospinal Fluid ◽  
Herpes Simplex ◽  
Herpes Simplex Encephalitis ◽  
Internal Standard ◽  
Herpes Encephalitis ◽  
Standard Curve ◽  
Intravenous Acyclovir ◽  
Primer Annealing ◽  
Acyclovir Therapy ◽  
Simplex Virus

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.

Herpes encephalitis and hepatitis in pregnancy: A case report and literature review

2020 ◽  
pp. 1753495X2097803
Author(s):  
Claire M McCarthy ◽  
Caroline Conlon ◽  
Maria Kennelly ◽  
Richard Drew ◽  
Stephen Stewart ◽  
...  
Keyword(s):  
Herpes Simplex ◽  
Herpes Simplex Encephalitis ◽  
Male Infant ◽  
Herpes Encephalitis ◽  
Intravenous Acyclovir ◽  
Simplex Virus ◽  
Herpes Simplex Virus 2 ◽  
Elevated Transaminases ◽  
Work Up ◽  
In Pregnancy

We present the case of a healthy nulliparous woman who presented with persistent fever, proteinuria and elevated transaminases at 33 weeks’ gestation. Following initial treatment for suspected chorioamnionitis and potential pre-eclampsia, she had a caesarean section delivering a healthy male infant. However, on her third post-operative day, she developed neurological symptoms and accompanying severe sepsis, necessitating inotropic support and transfer to a higher level of care. A comprehensive work-up revealed Herpes Simplex Virus-2 (HSV-2) in serum and cerebrospinal fluid. Abdominal imaging was suggestive of accompanying hepatitis with micro-abscesses. This lady recovered well following intravenous acyclovir for 14 days. Her infant was not affected and was discharged home with his mother. Herpes simplex encephalitis and hepatitis associated with HSV-2 have been described three times previously in pregnancy. We delineate the diagnostic challenges that rare conditions such as this pose and emphasise the importance of multi-disciplinary care in managing complicated medical conditions in pregnancy.

Relapse of Herpes Simplex Encephalitis in Children

PEDIATRICS ◽  
1992 ◽  
Vol 89 (5) ◽  
pp. 891-894
Author(s):  
Hiroshi Kimura ◽  
Kosaburo Aso ◽  
Kiyotaka Kuzushima ◽  
Naoki Hanada ◽  
Motohiro Shibata ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Cerebrospinal Fluid ◽  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Polymerase Chain Reaction Assay ◽  
Herpes Simplex Encephalitis ◽  
Chain Reaction ◽  
Polymerase Chain ◽  
Acyclovir Therapy ◽  
Simplex Virus

The polymerase chain reaction method was used to diagnose herpes simplex encephalitis in children. Initial samples of cerebrospinal fluid from 15 patients with herpes simplex encephalitis were all positive for the herpes simplex virus DNA by polymerase chain reaction assay. In terms of early diagnosis, polymerase chain reaction assay became positive significantly earlier than the detection of intrathecally produced anti-herpes simplex virus antibody using the enzyme-linked immunosorbent assay (4.4 vs 8.9 days after onset; P &lt; .01). Serial examinations showed that the presence of virus DNA in cerebrospinal fluid continued for 3 to 18 days after the neurologic onset (mean 10.1 days). Four of the 15 patients had a relapse of encephalitis after completing acyclovir therapy. The mean duration of initial acyclovir therapy in the recurrent group was significantly shorter than that in the nonrecurrent group. In recurring cases, herpes simplex virus DNA reappeared temporarily in the cerebrospinal fluid of two patients. These results show that polymerase chain reaction assay is a useful diagnostic tool for the early and noninvasive diagnosis of herpes simplex encephalitis in children. Results also suggest that a comparatively short duration of acyclovir therapy may be related to a relapse of herpes simplex encephalitis in some children.

scholarly journals Herpes Simplex Encephalitis

2005 ◽  
Vol 32 (2) ◽  
pp. 246-247 ◽  
Author(s):  
Sean W. Taylor ◽  
Roger M. Smith ◽  
Giovanna Pari ◽  
Wendy Wobeser ◽  
John P. Rossiter ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Herpes Simplex ◽  
Brain Biopsy ◽  
Executive Dysfunction ◽  
Cortical Lesion ◽  
Low Density ◽  
Intravenous Acyclovir ◽  
History Of ◽  
Simplex Virus ◽  
The Right

A 28-year-old woman presented with a one day history of high fever and partial seizures with secondary generalization. This was preceded by a three week history of headache, ataxia, and fatigue. An initial computed tomogram head scan showed a low density mass lesion in the right frontal operculum without enhancement. On the next day, a repeat scan showed a new frontopolar, expansile, low density cortical lesion (Figure 1A) suggestive of encephalitis. Cerebrospinal fluid showed a pleocytosis of 311 mononuclear white blood cell count per μL and an elevated protein of 1.57 g/L. She received intravenous acyclovir and antibiotics. She remained febrile and became mute. A magnetic resonance (MR) scan under general anesthesia on her fourth hospital day showed frontal and perisylvian lesions with restricted diffusion (Figure 1B - D and Figure 2). A right frontal brain biopsy showed meningoencephalitis and immunohistochemical staining was positive for herpes simplex virus (HSV) antigen (Figure 3). Subsequently, HSV-1 DNA was demonstrated in both cerebrospinal fluid and brain tissue with polymerase chain amplification. She improved after a course of intravenous therapy with acyclovir with residual frontal lobe signs, including marked executive dysfunction, and her speech became normal.

Chronic granulomatous herpes encephalitis: a rare entity posing a diagnostic challenge

2011 ◽  
Vol 8 (4) ◽  
pp. 402-406 ◽  
Author(s):  
Matthew A. Adamo ◽  
Lisa Abraham ◽  
Ian F. Pollack
Keyword(s):  
Herpes Simplex ◽  
Herpes Simplex Encephalitis ◽  
Disease Process ◽  
Toll Like Receptor ◽  
Herpes Encephalitis ◽  
Diagnostic Challenge ◽  
Intractable Seizures ◽  
History Of ◽  
Simplex Virus ◽  
Chronic Disease State

Herpesviruses can cause an acute, subacute, or chronic disease state in both immunocompetent and immunocompromised individuals. Herpes simplex virus (HSV) encephalitis is most often an acute monophasic disease process. Rarely, however, it may progress to a chronic state, and more rarely still to a granulomatous encephalitis. Prior studies have suggested that antiviral immunity with Toll-like receptors determines susceptibility to herpesviruses. The authors report the case of a 14-year-old girl with a remote history of treated HSV encephalitis, who had intractable seizures and worsening MR imaging changes that were concerning for either a neoplastic or an inflammatory process. She was found to have granulomatous herpes simplex encephalitis and had a low cytokine response to Toll-like receptor 3 stimulation.

scholarly journals Use of Oral Valacyclovir Instead of IV Acyclovir in Treatment of Herpes Simplex Encephalitis (Hse) in Resources- Poor Country: A Review Article

2020 ◽  
Vol 14 (1) ◽  
pp. 41-43
Author(s):  
MM Bodiuzzaman
Keyword(s):  
Cerebrospinal Fluid ◽  
Herpes Simplex ◽  
Rural Areas ◽  
Herpes Simplex Encephalitis ◽  
Poor Country ◽  
Public Health Problem ◽  
Cost Effective ◽  
Main Concern ◽  
Recommended Treatment ◽  
Intravenous Acyclovir

Viral encephalitis remains a significant public health problem worldwide including Bangladesh. The recommended treatment for herpes simplex encephalitis (HSE) remains intravenous acyclovir. In resource-poor countries, however, intravenous formulations are usually unavailable or unaffordable. Efficacy of treatment depends upon cerebrospinal fluid (CSF) level of acyclovir. Main concern of use of valacyclovir is central nervous system penetration of drugs. This study reports the comparison of penetration of acyclovir into the cerebrospinal fluid (CSF) in patients with HSE, treated with the oral pro drug valacyclovir at a dose of 1,000 mg three times daily. The oral therapy achieved adequate acyclovir concentrations in the CSF and may be an acceptable early treatment for suspected HSE in resource-limited settings. In our country treatment of HSE by IV acyclovir is costly and needs about 45000 BDT per person to complete treatment and is not available in rural areas, on the other hand it is 10 times cost effective in treatment with oral Valacyclovir. Faridpur Med. Coll. J. Jan 2019;14(1): 41-43

scholarly journals Intracranial Hemorrhage Complicating Herpes Simplex Encephalitis on Antiviral Therapy: A Case Report and Review of the Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Ghada ElShimy ◽  
Christina Mariyam Joy ◽  
Fred Berlin ◽  
Waleed Lashin
Keyword(s):  
Case Report ◽  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Herpes Simplex Encephalitis ◽  
Review Of The Literature ◽  
Common Cause ◽  
The Usa ◽  
Acyclovir Therapy ◽  
Sporadic Encephalitis ◽  
Simplex Virus

Herpes simplex virus (HSV) encephalitis is the most common cause of nonendemic sporadic encephalitis in the USA. Decreased mortality with early treatment with acyclovir has been documented. Although common complications include cortical petechial hemorrhages, frank intracerebral hematomas are considered very rare. Only few cases have been reported in the literature. We report a case of HSV encephalitis complicated by intracerebral hemorrhage 12 days after initiation of acyclovir therapy.

scholarly journals Delays in Initiation of Acyclovir Therapy in Herpes Simplex Encephalitis

2012 ◽  
Vol 39 (5) ◽  
pp. 644-648 ◽  
Author(s):  
Peter S. Hughes ◽  
Alan C. Jackson
Keyword(s):  
Herpes Simplex ◽  
Herpes Simplex Encephalitis ◽  
Polymerase Chain Reaction Amplification ◽  
Clinical Findings ◽  
Imaging Results ◽  
Confirmatory Tests ◽  
Timely Fashion ◽  
Timing Of Initiation ◽  
Acyclovir Therapy ◽  
Simplex Virus

Background:Diagnosis of herpes simplex encephalitis (HSE) is based on clinical findings, MRI, and detection of herpes simplex virus (HSV) DNA in cerebrospinal fluid (CSF) using polymerase chain reaction amplification. Delays in starting treatment are associated with poorer clinical outcomes. We assessed the timing of initiation of acyclovir therapy in HSE.Methods:Inpatient databases from seven hospitals in Winnipeg, Manitoba were used to identify individuals diagnosed with encephalitis and HSE from 2004 to 2009. The time taken to initiate therapy with acyclovir and the reasons for delays were determined.Results:Seventy-seven patients were identified; 69 (90%) received acyclovir; in the others a non-HSV infection was strongly suspected. Thirteen patients were subsequently confirmed to have HSE. Acyclovir was initiated a median of 21 hours (3-407) after presentation in encephalitis cases, and a median of 11 hours (3-118) in HSE. The most common reason for delay was a failure to consider HSE in the differential diagnosis, despite suggestive clinical features. Where therapy was delayed in HSE patients, the decision to begin acyclovir was prompted by transfer of the patient to a different service (55%), recommendations by consultants (18%), imaging results (18%), and CSF pleocytosis (9%).Conclusions:Delays in initiating acyclovir for HSE are common, and are most often due to a failure to consider HSE in a timely fashion on presentation. In order to improve patient outcomes, physicians should be more vigilant for HSE, and begin acyclovir therapy expeditiously on the basis of clinical suspicion rather than waiting for confirmatory tests.

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