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Related Experiment Videos

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
PubMed
Summary
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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.

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  • 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.