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Herpes simplex encephalitis in North West India.

A Panagariya1, R S Jain, S Gupta

  • 1Department of Neurology, SMS Medical College and Hospital, Jaipur 302004, India. pangaria@jp1.vsnl.net.in

Neurology India
|January 19, 2002
PubMed
Summary

Early diagnosis and treatment of herpes simplex encephalitis (HSE) are crucial. Prompt antiviral therapy with acyclovir significantly reduces mortality and neurological deficits in patients with HSE.

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Virology

Background:

  • Herpes simplex encephalitis (HSE) is a severe neurological condition often presenting with non-specific symptoms.
  • Differential diagnosis is critical to distinguish HSE from other encephalitic illnesses like cerebral malaria and tubercular meningitis.
  • Timely intervention with antiviral medications is essential for improving patient outcomes.

Purpose of the Study:

  • To investigate the clinical features, diagnostic methods, and treatment outcomes of herpes simplex encephalitis.
  • To emphasize the importance of early clinical suspicion and prompt initiation of antiviral therapy for HSE.
  • To evaluate the utility of electroencephalography (EEG), cerebrospinal fluid (CSF) analysis, CT, and MRI in diagnosing HSE.

Main Methods:

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  • A prospective study of patients with suspected encephalitic illness over 30 months.
  • Inclusion of CSF analysis, EEG, CT, MRI, and ELISA for herpes simplex virus (HSV) antibody detection.
  • Systematic exclusion of differential diagnoses mimicking HSE.

    • Main Results:

    • Twenty-eight patients were diagnosed with HSE based on EEG, serological, and/or neuroradiological findings.
    • Common clinical manifestations included altered sensorium (100%) and seizures (89%).
    • HSV antibody positivity in CSF/blood was observed in 14 patients; characteristic fronto-temporal lesions were noted on EEG and neuroimaging.

    Conclusions:

    • A high index of clinical suspicion for HSE is vital, supported by systematic exclusion of other causes.
    • Early diagnosis and treatment with acyclovir correlate with better outcomes, reduced mortality, and fewer neurological deficits.
    • Limitations include the non-availability of CSF-PCR and serial antibody estimations, underscoring the need for timely empirical treatment.