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Herpes simplex encephalitis.

B Sköldenberg1

  • 1Karolinska Institute, Department of Infectious Diseases, Danderyd Hospital, Sweden.

Scandinavian Journal of Infectious Diseases. Supplementum
|January 1, 1991
PubMed
Summary

Polymerase chain reaction (PCR) rapidly detects herpes simplex encephalitis (HSE) DNA in cerebrospinal fluid, enabling early diagnosis. Early acyclovir treatment significantly improves outcomes for HSE patients.

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Area of Science:

  • Neurology
  • Virology
  • Infectious Diseases

Background:

  • Herpes simplex encephalitis (HSE) management has seen advances, but early diagnosis remains challenging.
  • Current serological diagnostics for HSE are delayed (3-10 days post-symptom onset).
  • Understanding the inflammatory cascade in HSE is crucial for effective anti-inflammatory treatment.

Purpose of the Study:

  • To evaluate the efficacy of Polymerase Chain Reaction (PCR) for early herpes simplex virus (HSV) DNA detection in cerebrospinal fluid (CSF) for diagnosing HSE.
  • To assess the diagnostic utility of combining PCR with serological analysis for HSE.
  • To review the therapeutic impact of acyclovir and identify prognostic factors in HSE.

Main Methods:

  • CSF and serum samples from 43 consecutive HSE patients and 87 controls were analyzed.
  • A PCR assay with nested primer pairs was developed to amplify HSV DNA in CSF.
  • Serological analysis of intrathecal HSV antibody synthesis was performed.

Main Results:

  • PCR detected HSV DNA in 42 out of 43 HSE patients, remaining positive for up to 27 days.
  • A combination of PCR and serology allowed etiological diagnosis from early disease.
  • Acyclovir treatment significantly reduced mortality and morbidity compared to vidarabine.

Conclusions:

  • PCR offers a rapid and sensitive diagnostic method for HSE, complementing serological tests.
  • Early initiation of acyclovir treatment is critical for improving HSE patient prognosis.
  • Neuropsychological assessment is vital for determining long-term disability after HSE.

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