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Relapse of herpes simplex encephalitis
M A Barthez-Carpentier1, F Rozenberg, E Dussaix
1Unité de Neurochirurgie-Neurologie, Centre de Pédiatrie Gatien de Clocheville, Tours, France.
Journal of Child Neurology
|September 1, 1995
Summary
Recurrent herpes simplex encephalitis in children may signal a post-infectious immune response, not active viral infection. This immune-mediated relapse causes severe neurological symptoms despite negative viral tests after initial treatment.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neuroimmunology
Background:
- Herpes simplex encephalitis (HSE) is a severe neurological condition often treated with acyclovir.
- Recurrences or delayed complications after initial HSE treatment are uncommon but can be severe.
- Understanding the mechanisms behind HSE relapse is crucial for effective management.
Purpose of the Study:
- To investigate the potential mechanisms behind recurrent central nervous system (CNS) signs in children previously treated for HSE.
- To differentiate between active viral reactivation and other causes of neurological deterioration post-HSE therapy.
Main Methods:
- Clinical case series of five children with recurrent CNS signs after acyclovir therapy for HSE.
- Detailed clinical characterization including movement disorders, fever, consciousness impairment, and seizures.
- Biologic analysis, magnetic resonance imaging (MRI), and neuropathology studies.
- Cerebrospinal fluid (CSF) analysis including viral cultures, herpes simplex virus (HSV) antigen detection, and polymerase chain reaction (PCR) for HSV DNA.
Main Results:
- All five children presented with severe ballismic movement disorder, fever, impaired consciousness, and seizures during relapse.
- Biologic analyses, MRI, and neuropathology were consistent with an inflammatory reaction.
- Viral cultures, HSV antigen, and HSV DNA in CSF were negative during relapse, ruling out active viral replication.
- Findings suggest a post-infectious, immune-mediated mechanism for the observed relapses.
Conclusions:
- Recurrent neurological deterioration after HSE treatment in these cases was not due to active herpes simplex virus infection.
- An immune-mediated inflammatory process, likely post-infectious, is implicated in these severe relapses.
- Further research into neuroinflammatory mechanisms following viral encephalitis is warranted.