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Neonatal Herpes Encephalitis: A Case Series and Review of Clinical Presentation

  • Cory Toth (a1), Sheri Harder (a2) and Jerome Yager (a3)

Abstract

Objective:

To describe the clinical and laboratory findings in cases of neonatal herpes simplex virus (HSV) encephalitis.

Background:

Neonatal HSV encephalitis is a devastating infection which requires a high degree of clinical suspicion and rapid initiation of antiviral therapy.

Methods:

We performed a retrospective search for all cases of HSV encephalitis within the two Saskatchewan pediatric tertiary care centers for the period of 1985-2001. Only those patients with consistent clinical presentations along with direct evidence of presence of HSV, such as positive cerebrospinal fluid (CSF) viral cultures, positive polymerase chain reaction (PCR) for HSV from CSF, or positive immunoglobulin G against HSV from neonatal blood, were selected.

Results:

Five male and four female infant patients were identified. At a mean age of presentation of 24±20 days, seizures occurred in six neonates, lethargy in six neonates, temperature changes in five neonates, and apnea in three neonates. Examination of CSF demonstrated an initial monocytosis or lymphocytosis, elevated CSF protein and depressed CSF glucose in 100% of patients. Electroencephalography (EEG) was abnormal in 100% of patients. Initial computerized tomography was abnormal in 55% of patients. Clinical follow-up over an average of two years demonstrated developmental delay in four patients and upper motor neuron findings in four patients. No patients suffered from postencephalitic epilepsy or mortality.

Conclusions:

Neonatal HSV encephalitis most commonly presents with seizures, lethargy, and dysthermia. Cerebrospinal fluid testing and EEG have 100% sensitivity in cases with laboratory confirmation of HSV presence. Improvements in morbidity and mortality as compared to previous reports may relate to better recognition of this illness and acyclovir therapy. The lack of postinfection epilepsy in our series may also relate to better recognition and acyclovir therapy within this series of patients.

RÉSUMÉ: Objectif:

Décrire les observations cliniques et biochimiques chez les patients atteints d’encéphalite néonatale causée par le virus de l’herpès simplex (VHS).

Contexte:

Dans l’encéphalite néonatale à VHS, une infection dévastatrice, on doit faire preuve d’une grande acuité diagnostique et instituer promptement un traitement antiviral.

Méthodes:

Nous avons fait une recherche rétrospective de tous les cas d’encéphalite à VHS dans les deux centres pédiatriques de soins tertiaire de la Saskatchewan de 1985 à 2001. Seuls les patients dont le tableau clinique était conforme à celui de l’encéphalite à VHS et chez qui la présence du VHS avait été démontrée soit par une culture positive du liquide céphalo-rachidien (LCR), une amplification en chaîne par polymérase positive du LCR ou des immunoglobulines G anti-VHS positives dans le sang ont été sélectionnés.

Résultats:

Neuf bébés, soit cinq garçons et quatre filles, ont été identifiés. L’âge moyen de présentation était de 24 ± 20 jours et les symptômes initiaux ont été des convulsions chez six, de la léthargie chez six, des variations de température chez cinq et de l’apnée chez trois. L’examen du LCR a montré initialement une monocytose ou une lymphocytose, une élévation des protéines et une baisse du glucose chez tous les patients. L’électroencéphalogramme était anormal chez tous. La tomodensitométrie initiale était anormale chez 55% des patients. Le suivi clinique sur une période moyenne de deux ans a montré un retard de développement chez quatre patients et des anomalies du neurone moteur supérieur chez quatre patients. Aucun patient ne présentait de l’épilepsie postencéphalitique et il n’y a eu aucun décès.

Conclusions:

L’encéphalite néonatale à VHS se manifeste la plupart du temps par des convulsions, de la léthargie et de la dysthermie. L’examen du LCR et l’ÉEG ont une sensibilité de 100% chez les cas où il y a confirmation de la présence du VHS par le laboratoire. L’amélioration de la morbidité et de la mortalité par rapport aux observations antérieures est sans doute due à une meilleure identification de la maladie et au traitement par l’acyclovir. L’absence d’épilepsie postinfectieuse dans notre série de cas peut également être due à une meilleure identification de la maladie et au traitement par l’acyclovir chez ces patients.

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References

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Canadian Journal of Neurological Sciences
  • ISSN: 0317-1671
  • EISSN: 2057-0155
  • URL: /core/journals/canadian-journal-of-neurological-sciences
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