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Herpes simplex virus encephalitis: problems in diagnosis.

P D Cameron1, S J Wallace, J Munro

  • 1Department of Child Health, University Hospital of Wales, Heath Park, Cardiff.

Developmental Medicine and Child Neurology
|February 1, 1992
PubMed
Summary
This summary is machine-generated.

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Herpes simplex encephalitis (HSE) in children often presents atypically, leading to delayed diagnosis and poor outcomes. Early consideration and empirical acyclovir treatment are crucial, even with normal CT scans and absent fever.

Area of Science:

  • Pediatric Neurology
  • Infectious Diseases
  • Neurovirology

Background:

  • Herpes simplex encephalitis (HSE) is a severe neurological condition in children.
  • Prompt diagnosis and treatment are critical for improving patient outcomes.

Observation:

  • This study presents six pediatric cases of HSE with varied clinical presentations.
  • Delayed antiviral treatment (beyond six days) occurred in three cases, with initial misdiagnoses including epilepsy, meningitis, and febrile seizures.
  • Apyrexia and normal cranial CT findings were noted in two cases each, highlighting diagnostic challenges.

Findings:

  • Encephalitic changes on electroencephalograms (EEGs) were observed in five children.
  • Diagnosis was confirmed through serological titers, brain biopsy, vesicle culture, and cerebrospinal fluid (CSF) analysis.

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  • All six children experienced poor outcomes, underscoring the severity of delayed treatment.

    • Implications:

    • HSE should be suspected in children with focal seizures, irrespective of fever or normal CT scans.
    • Routine practice should include collecting CSF for viral diagnostics in suspected cases.
    • Empirical treatment with acyclovir is recommended prior to definitive virological confirmation to improve outcomes.