Abstract
Herpes simplex encephalitis (HSE) remains one of the most devastating infections of
the central nervous system in children despite available antiviral therapy. Our aim
was to determine the clinical epidemiology and long-term neuro-developmental outcome
of neonates and children admitted to our hospital with proven HSE. Patients with HSE
during November 1998 to December 2011 were identified from discharge and laboratory
records and data collection was done by retrospective review of their case notes.
HSE was proven by culture or polymerase chain reaction (PCR) or by a positive Herpes
simplex virus (HSV)–specific intrathecal antibody. We identified 13 patients during
the study period: nine neonates and four older children, all of whom were treated
with intravenous acyclovir. In the neonatal cohort, three (33%) presented with seizures
and only four (44%) had vesicles. The initial cerebrospinal fluid (CSF) HSV PCR was
positive in seven (78%) and HSV type 2 was the most common. Repeat CSF study showed
HSV positivity of 100%. Two (22%) neonates died and three (43%) had long-term neurodevelopmental
sequelae. Developmental delay, focal neurological deficit, and cognitive deficit were
among the most frequent neurological sequelae noted. In the pediatric cohort, three
children (75%) had positive CSF HSV PCR and seizures. One (25%) died and two of the
three survivors (67%) had neurodevelopmental sequelae. Early CSF studies may be negative
in HSE, so a repeat CSF analysis should be considered, particularly in neonates. Early
administration of acyclovir could prevent adverse outcomes in HSE.
Keywords
child - encephalitis - herpes simplex - newborn
