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[Herpes Simplex Encephalitis].
1Department of Internal Medicine, Morita Hospital.
Brain and Nerve = Shinkei Kenkyu No Shinpo
|May 19, 2026
Summary
Herpes simplex encephalitis (HSE) is a severe brain infection. Early diagnosis and treatment with antiviral drugs like aciclovir (ACV) are crucial, with options for resistant cases or post-HSE autoimmune encephalitis.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Herpes simplex encephalitis (HSE) is the leading cause of sporadic viral encephalitis, carrying significant mortality and morbidity.
- No specific clinical signs definitively diagnose HSE, necessitating laboratory confirmation.
- Neurological relapses or worsening deficits affect nearly 30% of patients post-initial HSE episode.
Purpose of the Study:
- To outline diagnostic and treatment strategies for Herpes Simplex Encephalitis (HSE).
- To differentiate between primary HSE and autoimmune encephalitis (AE) post-HSE.
- To describe management approaches for both aciclovir-resistant HSE and AE post-HSE.
Main Methods:
- Diagnosis of HSE relies on herpes simplex virus (HSV) DNA polymerase chain reaction (PCR) testing of cerebrospinal fluid (CSF).
- Treatment involves intravenous aciclovir (ACV), with foscarnet considered for ACV-resistant cases.
- Post-HSE autoimmune encephalitis (AE) is diagnosed by testing for neuronal antibodies (e.g., anti-NMDAR) in serum or CSF.
Main Results:
- Optimal intravenous ACV treatment improves outcomes for HSE.
- Negative HSV PCR in CSF prompts consideration of AE post-HSE.
- AE post-HSE presents with distinct symptoms in children (choreoathetosis, seizures) and adults (altered consciousness, NMDAR-like symptoms).
Conclusions:
- Prompt diagnosis and treatment of HSE with ACV are critical.
- Management of HSE requires consideration of ACV resistance and potential secondary autoimmune processes.
- AE post-HSE typically responds to immunotherapy, with escalation options available for refractory cases.
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