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By ULY CLINIC

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Herpes simplex encephalitis

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Introduction

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The majority of cases in adults caused by HSV-1, a small number are caused by HSV-2 usually in immuno-suppression or in neonates. It causes inflammation and necrosis in the brain. 

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Diagnostic Criteria

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  • Early features are fever, headache & altered consciousness which may develop gradually over days or rapidly over hours

  • The most common manifestations are personality change, dysphasia, behavioural disturbance and occasional psychotic features

  • Focal or generalized seizures can occur

  • On lumbar puncture, CSF is under increased pressure and may appear normal or show a mild-moderate lymphocytosis, a mild-moderate increase in protein and normal or mildly decreased glucose.  

 

Note: The disease is easily missed in Tanzanian settings due to lack of diagnostic (HSV-1 and HSV-2 PCR) and should therefore be suspected in patients not responding to antibiotics/other treatment. 

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Supportive Therapy 

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Manage it as for unconscious patients (control seizures)

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Pharmacological Treatment

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  • Acyclovir IV/Oral (10–15 mg/kg every 8 hourly for 14–21 days  

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Updated on, 31.10.2020

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References

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1. STG 

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