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Difference between herpes simplex virus type 1 and type 2 neonatal encephalitis in neurological outcome
L Corey1, R J Whitley, E F Stone
1Department of Laboratory Medicine, University of Washington, Seattle.
Insights
Neonatal herpes simplex virus (HSV) encephalitis outcomes differ by type. HSV-1 infection in infants leads to excellent neurological development, while HSV-2 causes significant long-term neurological and developmental deficits.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Virology
Background:
- Neonatal herpes simplex virus (HSV) encephalitis is a severe condition requiring prompt antiviral treatment.
- Understanding the long-term neurological and developmental sequelae is crucial for patient management and prognosis.
- Differentiation between HSV-1 and HSV-2 in neonatal encephalitis may impact outcomes.
Purpose of the Study:
- To assess and compare the neurological and developmental outcomes of infants treated for neonatal herpes simplex virus (HSV) encephalitis.
- To evaluate the long-term effects of acyclovir or vidarabine treatment based on HSV type (HSV-1 vs. HSV-2).
Main Methods:
- Retrospective follow-up of 24 infants treated for neonatal HSV encephalitis.
- Assessment of neurological and developmental status at 6 months to 3 years post-treatment.
- Comparison of outcomes between infants infected with HSV-1 and HSV-2.
Main Results:
- Infants with HSV-2 encephalitis showed more frequent seizures, higher cerebrospinal fluid abnormalities, and greater brain structural damage compared to HSV-1.
- All 9 infants with HSV-1 encephalitis had normal neurological outcomes at follow-up.
- Only 4 of 14 surviving infants with HSV-2 encephalitis (23%) had normal outcomes; significant morbidities included microcephaly, seizure disorders, ophthalmological defects, cerebral palsy, and mental retardation.
Conclusions:
- Systemic antiviral chemotherapy for neonatal HSV-1 encephalitis results in excellent neurological outcomes.
- Neonatal HSV-2 encephalitis is associated with high rates of severe neurological and developmental morbidity despite treatment.
- Type-specific differences in neonatal HSV encephalitis outcomes highlight the need for targeted management strategies.
Abstract:
24 infants consecutively treated with acyclovir or vidarabine for neonatal herpes simplex virus (HSV) encephalitis were followed up for 6 months to 3 years to assess neurological and developmental outcome. 15 patients had HSV-2 and 9 had HSV-1 encephalitis. Infants with HSV-2 encephalitis presented with a higher frequency of seizures, greater pleocytosis and protein concentrations in the cerebrospinal fluid, and more frequent evidence of structural damage on computerised tomographic scans of the brain than did those with HSV-1 encephalitis. 1 patient died. All 9 HSV-1 patients were normal at follow-up (mean 19.4 months) compared with only 4 (23%) of the 14 surviving HSV-2 infected infants (p = 0.003). Among infants with HSV-2 encephalitis, 50% became microcephalic; 57% had seizure disorders; 64% had ophthalmological defects; 64% had cerebral palsy; and 57% had mental retardation. Infants with neonatal HSV-1 encephalitis treated with systemic antiviral chemotherapy have excellent neurological outcomes; the neurological morbidity of those with HSV-2 encephalitis is still high.