Herpes Simplex Virus Meningoencephalitis in Children
Basma Mohamed Ibrahim Elsyed Hassan;
Abstract
Summary
H
erpes simplex encephalitis (HSE) is an acute or subacute illness that causes both general and focal signs of cerebral dysfunction. It is sporadic and occurs without a seasonal pattern. Although the presence of fever, headache, behavioral changes, confusion, focal neurologic findings, and abnormal cerebrospinal fluid (CSF) findings are suggestive of HSE, no pathognomonic clinical findings reliably distinguish HSE from other neurologic disorders with similar presentations.
Childhood HSE presents with fever, altered mental state (encephalopathy), a deteriorating level of consciousness, focal seizures or focal neurological abnormalities. The infective source is usually elusive. Parents can describe encephalopathy as a change in behaviour, sleepiness or confusion. Children with normal behaviour at presentation may become confused later as the encephalitis progresses.
The present study is carried out to identify HSV as a causative agent in the etiology of viral meningo-encephalitis in patients attending Ain-Shams University Children hospital by using polymerase chain reaction PCR to detected HSV DNA in the CSF.
Our study was done on 50 patients with age above 6 months, presenting with altered mental status, and fever in a previously normal infant or child with normal developmental history. Any patient with electrolyte disturbance that might be implicated in altering the mental status, recent history of head trauma, receiving drugs that might affect the mental status, delayed development or those with MRI brain suggesting structural brain lesion e.g. ADEM, neurodegenerative disease, or brain tumor were excluded from this study.
For all patients full history taking, full clinical examination and (laboratory investigations; CBC, ESR, CRP, liver enzyne, CSF examination including HSV DNA detection by PCR) and neuraimaging were done.
Statistical analysis of our results showed that the mean age of enrolled patients was 3.70 ± 1.05 years ranged from 2 to 5.4 years with male predominance among enrolled patients (males (64.0%) and 18 (36.0%) females with male to female ratio: 1:1.8.
Most of enrolled patients in our study were presented with altered consciousness 49 cases (98%), while 42 cases presented with convulsion (84%), 32 cases presented with fever (64%), 31 cases presented with vomiting (62%), 11 cases presented with diarrhea (22%) and two cases were presented with headache (4.0%). to the preferential involvement of the frontal and temporal lobes.
Glasgow coma score (GCS) of enrolled patients was 11.72 ± 1.01 and ranged from 10 to 14.
Laboratory investigation results of our studied patients showed platelets number range between 180-820 103/cmm, total leukocytic count 2-15 103/cmm and hemoglobin % range between 8-12 g/dl. ALT and AST were elevated in 36% of patients, normal in 69% in patients, serum creatinine level was normal in all patients, and CRP was negative in all patients.
CSF examination of all enrolled cases in this study (100 %) showed WBC count of more than 100 cells/mm3 with all of these cells were lymphocytes. 86% of cases have mild to moderately elevated CSF protein levels, with normal glucose in 94%.
H
erpes simplex encephalitis (HSE) is an acute or subacute illness that causes both general and focal signs of cerebral dysfunction. It is sporadic and occurs without a seasonal pattern. Although the presence of fever, headache, behavioral changes, confusion, focal neurologic findings, and abnormal cerebrospinal fluid (CSF) findings are suggestive of HSE, no pathognomonic clinical findings reliably distinguish HSE from other neurologic disorders with similar presentations.
Childhood HSE presents with fever, altered mental state (encephalopathy), a deteriorating level of consciousness, focal seizures or focal neurological abnormalities. The infective source is usually elusive. Parents can describe encephalopathy as a change in behaviour, sleepiness or confusion. Children with normal behaviour at presentation may become confused later as the encephalitis progresses.
The present study is carried out to identify HSV as a causative agent in the etiology of viral meningo-encephalitis in patients attending Ain-Shams University Children hospital by using polymerase chain reaction PCR to detected HSV DNA in the CSF.
Our study was done on 50 patients with age above 6 months, presenting with altered mental status, and fever in a previously normal infant or child with normal developmental history. Any patient with electrolyte disturbance that might be implicated in altering the mental status, recent history of head trauma, receiving drugs that might affect the mental status, delayed development or those with MRI brain suggesting structural brain lesion e.g. ADEM, neurodegenerative disease, or brain tumor were excluded from this study.
For all patients full history taking, full clinical examination and (laboratory investigations; CBC, ESR, CRP, liver enzyne, CSF examination including HSV DNA detection by PCR) and neuraimaging were done.
Statistical analysis of our results showed that the mean age of enrolled patients was 3.70 ± 1.05 years ranged from 2 to 5.4 years with male predominance among enrolled patients (males (64.0%) and 18 (36.0%) females with male to female ratio: 1:1.8.
Most of enrolled patients in our study were presented with altered consciousness 49 cases (98%), while 42 cases presented with convulsion (84%), 32 cases presented with fever (64%), 31 cases presented with vomiting (62%), 11 cases presented with diarrhea (22%) and two cases were presented with headache (4.0%). to the preferential involvement of the frontal and temporal lobes.
Glasgow coma score (GCS) of enrolled patients was 11.72 ± 1.01 and ranged from 10 to 14.
Laboratory investigation results of our studied patients showed platelets number range between 180-820 103/cmm, total leukocytic count 2-15 103/cmm and hemoglobin % range between 8-12 g/dl. ALT and AST were elevated in 36% of patients, normal in 69% in patients, serum creatinine level was normal in all patients, and CRP was negative in all patients.
CSF examination of all enrolled cases in this study (100 %) showed WBC count of more than 100 cells/mm3 with all of these cells were lymphocytes. 86% of cases have mild to moderately elevated CSF protein levels, with normal glucose in 94%.
Other data
| Title | Herpes Simplex Virus Meningoencephalitis in Children | Other Titles | إلتهاب المخ والسحايا في الأطفال بواسطة فيرس الهربيس البسيط | Authors | Basma Mohamed Ibrahim Elsyed Hassan | Issue Date | 2017 |
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