Multicystic cerebral degeneration in neonatal herpes simplex virus encephalitis.

Typical herpetic papulovesicular skin lesions developed in an apparently normal infant at 12 days of age and were followed within 48 hours by signs and symptoms of acute encephalitis. Herpes simplex virus type 2 was cultured from the intact skin vesicles, and a fourfold increase in complement fixation titer to herpes simplex virus type 2 was found over the ensuing 24 days. The infant survived her acute illness, but was left with severe neurologic sequelae manifested as microcephaly with multicystic cerebral degeneration. The short-term and convalescent course is documented by serial, clinical, and EEG examinations, and the nature of the cerebral damage is demonstrated by computerized transaxial tomography.     

Herpes simplex virus type 2 acute retinal necrosis 9 years after neonatal herpes

Many cases of acute retinal necrosis caused by HSV-2 have been reported in children, teenagers, and young adults as a result of reactivation of congenital or neonatal infections, which may have been subclinical. Pediatricians should be aware of this entity and alert to recurrences that may be delayed by years.     

快速诊断单纯疱疹病毒脑炎

目的探讨快速诊断单纯疱疹病毒脑炎（ＨＳＥ），比较不同病毒学试验的诊断价值。方法用聚合酶链反应技术检测１７７例急性脑炎患儿的脑脊液（ＣＳＦ）标本中单纯疱疹病毒（ＨＳＶ）特异性ＤＮＡ；用酶联免疫吸附方法检测ＣＳＦ和血清标本中ＨＳＶ特异性ＩｇＭ和ＩｇＧ抗体。结果ＣＳＦ中ＨＳＶ特异性ＤＮＡ、ＩｇＭ和ＩｇＧ抗体阳性率分别为１．７％（３／１７７）、１０％（１／１００）和４７０％（４７／１００），血清ＨＳＶＩｇＭ、ＩｇＧ抗体阳性率分别为１２．５％（６／４８）、７２．９％（５１／７０）（因为标本量不足或缺如，未能对全部病例进行抗体检测）；３例患儿确诊为ＨＳＥ。结论用套式ＰＣＲ检测ＣＳＦ诊断ＨＳＥ较敏感、特异。     

Basal ganglia involvement in a child with herpes simplex encephalitis

Herpes simplex encephalitis (HSE) is a leading cause of sporadic, nonepidemic viral encephalitis in children and adults. We report a very rare case of HSE with involvement of bilateral thalamus, putamen, upper pons and midbrain, with development of extrapyramidal symptoms which responded to corticosteroid therapy. A 15-mth-old female baby admitted with complaint of fever for 5 days and generalised tonic clonic seizure 10 hours before admission. On clinical examination patient was drowsy, temperature was 39.4 °C and vitals were stable with signs of increased intracranial tension. There were no signs of meningeal irritation. Patient gradually become unconscious in the next few hours and pupils were constricted bilaterally with development of atonia in all four limbs and neck muscles. Doll’s eye phenomenon was absent.     

Brain stem encephalitis due to herpes simplex virus

Abstract A 6 year old child is described with infection due to herpes simplex virus type 1 causing brain stem encephalitis. The diagnosis was established by enzyme immunosorbent assays of the cerebrospinal fluid and serum which demonstrated antibody responses to herpes simplex virus. Recovery occurred and the importance of early use of acyclovir in achieving a good outcome is emphasized.     

Brain stem encephalitis due to herpes simplex virus

A 6 year old child is described with infection due to herpes simplex virus type 1 causing brain stem encephalitis. The diagnosis was established by enzyme immunosorbent assays of the cerebrospinal fluid and serum which demonstrated antibody responses to herpes simplex virus. Recovery occurred and the importance of early use of acyclovir in achieving a good outcome is emphasized.     

儿童单纯疱疹病毒性脑炎后抗AMPA2受体抗体脑炎1例

对郑州大学第一附属医院儿科收治的1例单纯疱疹病毒性脑炎后抗AMPA2受体抗体脑炎患儿的临床资料进行回顾性分析。患儿,女,9岁,以发热后精神行为异常起病,病初外院辅助检查示：脑脊液糖定性(＋),白细胞计数32×10 6/L,白蛋白(免疫比浊法)317.00 mg/L,免疫球蛋白IgG 45.80 mg/L。单纯...     

Relapse of neonatal herpes simplex virus infection

BACKGROUND: Neonatal herpes simplex virus (HSV) infection is a severe disease with high mortality and morbidity. Recurrence of skin vesicles is common. OBJECTIVE: To determine the features of relapse and identify the factors related to relapse. DESIGN: Thirty two surviving patients with neonatal herpes virus infections were enrolled. All patients received acyclovir treatment. Clinical and virological data were analysed and compared between relapsed and non-relapsed cases. RESULTS: Thirteen (41%) had either local skin or central nervous system relapse between 4 and 63 days after completing the initial antiviral treatment. Nine patients exhibited local skin relapses, and four developed central nervous system relapses. In one skin and two central nervous system relapse cases, neurological impairment later developed. Type 2 virus infection was significantly related to relapse (odds ratio 10.4, 95% confidence interval 1.1 to 99.0). Patients with relapse had worse outcomes than those without relapse. CONCLUSION: Neonates with HSV type 2 infections have a greater risk of relapse. Relapsed patients have poorer prognoses.     

Viremia in neonatal herpes simplex virus infections.

BACKGROUND: Polymerase chain reaction assays of the peripheral blood mononuclear cells (PBMC) and plasma may facilitate the diagnosis of neonatal herpes simplex virus (HSV). METHODS: Assays for HSV DNA were submitted from at least 1 specimen site (PBMC, plasma or cerebrospinal fluid) in 11 consecutive cases of neonatal HSV infection. RESULTS: HSV DNA was detected by PCR in the PBMC of 6 of 10 infants tested (60%), the plasma of 4 of 6 tested (67%) and the cerebrospinal fluid of 4 of 11 tested (36%). CONCLUSIONS: HSV viremia is more frequent than previously appreciated, and detection of HSV DNA in PBMC and plasma is a useful diagnostic tool, particularly in infants without skin lesions.     

单纯疱疹病毒性脑炎诊断方法与治疗观察

目的探讨单纯疱疹病毒性脑炎（ＨＳＶＥ）的诊断方法，了解对ＨＳＶＥ的治疗效果。方法应用聚合酶链反应（ＰＣＲ）技术和酶联免疫吸附测定（ＥＬＩＳＡ）方法，对２７例病毒性脑炎患儿的脑脊液进行单纯疱疹病毒（ＨＳＶ）ＤＮＡ和特异性ＩｇＭ抗体检测。结果ＨＳＶＤＮＡ阳性１１例；ＨＳＶＩｇＭ阳性４例，其中Ⅰ型３例，Ⅱ型１例；ＤＮＡ与ＩｇＭ同时阳性３例。将脑脊液检查ＨＳＶＤＮＡ阳性或ＨＳＶＩｇＭ抗体阳性者１２例诊断为ＨＳＶＥ，占４４％。对ＨＳＶＥ患儿予以静脉滴注无环鸟苷，连续用药一周，结果治愈８例，好转２例，自动出院及死亡各１例。结论ＰＣＲ与ＩｇＭ抗体检测两种方法相结合有助于ＨＳＶＥ病原学早期诊断，并指导ＨＳＶＥ的临床治疗     

Computed tomography in young children with herpes simplex virus encephalitis

Computed tomographic (CT) scans were obtained from eight infants and young children with herpes simplex virus encephalitis. In two cases the initial scan showed diffuse edematous changes as a mass effect without laterality. Unilateral localized low attenuation in the initial scan was evident 4 days after the onset in one patient, and high attenuation in the initial scan appeared on the 6th day in another patient, but in general, it was not possible to establish an early diagnosis of herpes simplex virus encephalitis from CT scan. In the longitudinal study the calcification with ventriculomegaly appeared in 3 of 5 survivors, and gyriform calcification in 2 of 3 patients, respectively. The appearance of multicystic encephalomalacia was evident in one patient 6 months after the onset of neonatal herpes simplex encephalitis. It is shown that the CT findings of neonates and young children with herpes simplex encephalitis are different from those of older children and adults, and the importance of longitudinal CT studies was stressed in clarifying the pathophysiology of the central nervous system involvement in survivors.     

Choreoathetosis after herpes simplex encephalitis with basal ganglia involvement on MRI

Children with herpes simplex virus encephalitis have a relapse in approximately 25% of cases, which rarely may present as a movement disorder, most often choreoathetosis. The anatomic basis for herpes simplex virus encephalitis-associated movement disorders has been poorly understood, because neuroimaging, to date, has not been able to show the direct involvement of the areas of the brain that typically govern such movements. We present a patient with abnormal involuntary movements after herpes simplex virus encephalitis, with new lesions on MRI between the time of initial presentation and the development of choreoathetosis. To our knowledge, this is the first patient with a post-herpes simplex virus encephalitis movement disorder with neuroradiographic evidence of thalamic involvement correlating with the onset of abnormal involuntary movements. We describe this patient and review the literature on movement disorders and herpes simplex virus encephalitis. Current understanding of the pathophysiology of post-herpes simplex virus encephalitis movement disorders proposes 2 possible mechanisms that may be responsible: reinfection with the resumption of viral replication, or a postinfectious, immune-mediated process.     

糖皮质激素对单纯疱疹病毒性脑炎发病及预后影响的动态观察

目的探讨单纯疱疹病毒性脑炎（HSE）的发病机制以及阿昔洛韦和地塞米松的作用机制。方法雄性小鼠共102只,随机分为对照组、病毒感染组、阿昔洛韦组和联合用药组。采用颅内注射单纯疱疹病毒-1型建立HSE小鼠模型;颅内注射后第1天,阿昔洛韦组和联合用药组小鼠给予阿昔洛韦灌胃,对照组和病毒感染组给予生理盐水灌胃;颅内注射后第3天,联合用药组给予地塞米松腹腔注射,余组给予生理盐水腹腔注射。分别于模型建立后第3、6、9天行神经症状评分,并用免疫组化法测定小鼠脑组织中IL-2、IL-10的表达, HE染色比较脑组织病理变化。结果病毒感染组生存率最低,阿昔洛韦组次之,联合用药组最高（P<0.05）。第3、6、9天的神经症状评分均以病毒感染组最高,阿昔洛韦组次之,联合用药组最低（P<0.05）。小鼠脑组织病理和HE染色也显示同样的情况。第3、6、9天,小鼠脑内IL-2呈现先升高后下降的趋势,而IL-10呈逐渐上升趋势;在各时间点,各组小鼠间IL-2、IL-10表达差异均有统计学意义（P<0.05）,其中均以病毒感染组高于阿昔洛韦组,阿昔洛韦组高于联合用药组（P均<0.05）;而联合用药组与对照组差异无统计学意义（P>0.05）。结论糖皮质激素联合抗病毒药物治疗HSE,较单纯阿昔洛韦治疗更能减少脑组织中IL-2、IL-10的分泌,减轻临床症状,提高生存率。     

儿童单纯疱疹病毒性脑炎的预后影响因素

目的 评价影响儿童单纯疱疹病毒性脑炎(HSE)的预后因素,探讨儿童HSE预后差的病理生理机制.方法 纳入广州市妇女儿童医疗中心2012年1月至2013年10月确诊的儿童HSE 21例,除2例自动出院外,余19例纳入本研究,所有病例脑脊液单纯疱疹病毒(HSV) DNA-PCR检测均阳性.所有病例发病48 h内均未予阿昔洛韦抗病毒治疗,对所有病例进行临床和影像学分析随访,随访时间6个月以上,临床及检查数据包括脑电图(EEG)、改良Glasgow Coma Scale(GCS)评分、脑磁共振成像(MRI)的结果,所有患儿均在住院时和起病1个月后进行至少2次MRI的平扫和增强扫描,然后对分析结果进行合理分组,进行多因素和单因素预后分析,以Logistic回归和Fisher's精确概率法统计分析,计算OR值.结果 本组病例年龄(2.03 ±2.23)岁,GCS评分(9.68±2.65)分,18例患儿存活,5例(27.8％)没有后遗症,3例(16.7％)轻度损害,这8例属于预后好.6例(33.3％)有中度神经系统损害,4例(22.2％)有严重的神经系统后遗症.8例预后好,11例预后差.多因素分析显示EEG、影像学病灶性质分布、年龄、GCS评分与预后相关(P＜0.05).单因素分析显示年龄1～4岁(OR=30,95％ CI 2.066～366.510,P=0.002),GCS评分≤10分(OR=27.518,95％ CI2.066～306.510,P=0.004),MRI显示广泛坏死性异常(OR=12,95％ CI1.294 ～ 111.323,P=0.017)是预后差的高危因素.结论 年龄、GCS评分、MRI的病变性质和损害程度是儿童HSE预后的重要影响因素.儿童HSE容易累及广泛甚至深部核团或白质,坏死性损害为主,是儿童HSE预后差的重要病理基础.     

Recurrent herpes simplex virus type 2 encephalitis in a preterm neonate. Favourable outcome after prolonged acyclovir treatment.

We describe a case of recurrent herpes simplex virus type 2 (HSV-2) central nervous system infection in a preterm neonate. On two occasions, encephalitis occurred together with eruption of vesicles on the right arm, and the patient was treated with acyclovir. New recurrences of vesicles followed each attempt to discontinue antiviral treatment, and prompted a continuous long-term acyclovir prophylaxis. At three years of age, the patient has developed normally. The use of immunoblotting for serologic diagnosis of neonatal HSV-2 infection is demonstrated.