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Recent issues in herpes simplex encephalitis

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Abstract

Herpes simplex encephalitis (HSE) remains the most important cause of fatal sporadic encephalitis in man. Caused by herpes simplex virus type 1 (HSV-1), and more rarely by HSV-2, it can have devastating clinical consequences for the patient, especially when the instigation of acyclovir therapy has been delayed by more than 2 days or more. Even with acyclovir treatment, nearly a third of patients may die or suffer significant morbidity. Both host and viral factors may interact to affect the clinical phenotype. Here we consider some of the recently published management guidelines for HSE and comment on various current issues of contention. The latter includes the timing and frequency of cerebrospinal fluid examinations for the polymerase chain reaction detection of HSV, decisions regarding acyclovir therapy including the consequences of delay in its initiation, and the use of corticosteroids in the disease.

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References

  • Baringer JR (2000) Herpes simplex virus encephalitis. In: Davis LE, Kennedy PGE (eds) Infectious diseases of the nervous system. Butterworth-Heinemann, Oxford, pp 139–164

    Google Scholar 

  • Casrouge A, Zhang SY, Eidenschenk C, Jouanguy E, Puel A, Yang K, Alcais A, Picard C, Mahfoufi N, Nicolas N, Lorenzo L, Plancoulaine S, Sénéchal B, Geissmann F, Tabeta K, Hoebe K, Du X, Miller RL, Héron B, Mignot C, de Villemeur TB, Lebon P, Dulac O, Rozenberg F, Beutler B, Tardieu M, Abel L, Casanova JL (2006) Herpes simplex virus encephalitis in human UNC-93B deficiency. Science 314:308–312

    Article  PubMed  CAS  Google Scholar 

  • Chaudhuri A, Kennedy PGE (2002) Diagnosis and treatment of viral encephalitis. Postgrad Med J 78:575–583

    Article  PubMed  CAS  Google Scholar 

  • Cinque P, Cleator GM, Weber T, Monteyne P, Sindic CJ, van Loon AM (1996) The role of laboratory investigation in the diagnosis and management of patients with suspected herpes simplex encephalitis: a consensus report. The EU concerted action on virus meningitis and encephalitis. J Neurol Neurosurg Psychiatry 61:339–345

    Article  PubMed  CAS  Google Scholar 

  • Davis LE, Johnson RT (1979) An explanation for the localization of herpes simplex encephalitis? Ann Neurol 5:2–5

    Article  PubMed  CAS  Google Scholar 

  • Field HJ, Vere Hodge RA (2013) Recent developments in anti-herpesvirus drugs. Br Med Bull 106(1):213–249

    Article  PubMed  CAS  Google Scholar 

  • Fodor PA, Levin MJ, Weinberg A, Sandberg E, Sylman J, Tyler KL (1998) Atypical herpes simplex virus encephalitis diagnosed by PCR amplification of viral DNA from CSF. Neurology 51:554–559

    Article  PubMed  CAS  Google Scholar 

  • Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D, Cunningham R, Zuckerman M, Mutton KJ, Solomon T, Ward KN, Lunn MP, Irani SR, Vincent A, Brown DW, Crowcroft NS, UK Health Protection Agency (HPA) Aetiology of Encephalitis Study Group (2010) Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis 10:835–844

    Article  PubMed  Google Scholar 

  • Herman M, Ciancanelli M, Ou YH, Lorenzo L, Klaudel-Dreszler M, Pauwels E, Sancho-Shimizu V, Pérez de Diego R, Abhyankar A, Israelsson E, Guo Y, Cardon A, Rozenberg F, Lebon P, Tardieu M, Heropolitanska-Pliszka E, Chaussabel D, White MA, Abel L, Zhang SY, Casanova JL (2012) Heterozygous TBK1 mutations impair TLR3 immunity and underlie herpes simplex encephalitis of childhood. J Exp Med 209:1567–1582

    Article  PubMed  CAS  Google Scholar 

  • Kamei S, Sekizawa T, Shiota H, Mizutani T, Itoyama Y, Takasu T, Morishima T, Hirayanagi K (2005) Evaluation of combination therapy using aciclovir and corticosteroid in adult patients with herpes simplex virus encephalitis. J Neurol Neurosurg Psychiatry 76:1544–1549

    Article  PubMed  CAS  Google Scholar 

  • Kennedy PGE (2004) Viral encephalitis: causes, differential diagnosis, and management. J Neurol Neurosurg Psychiatry 75(Suppl 1):i10–i15

    Article  PubMed  Google Scholar 

  • Kennedy PGE, Chaudhuri (2002) Herpes simplex encephalitis. J Neurol Neurosurg Psychiatry 73:237–238

    Article  PubMed  CAS  Google Scholar 

  • Lakeman FD, Whitley RJ (1995) Diagnosis of herpes simplex encephalitis: application of polymerase chain reaction to cerebrospinal fluid from brain-biopsied patients and correlation with disease. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. J Infect Dis 171:857–863

    Article  PubMed  CAS  Google Scholar 

  • Lafaille FG, Pessach IM, Zhang SY, Ciancanelli MJ, Herman M, Abhyankar A, Ying SW, Keros S, Goldstein PA, Mostoslavsky G, Ordovas-Montanes J, Jouanguy E, Plancoulaine S, Tu E, Elkabetz Y, Al-Muhsen S, Tardieu M, Schlaeger TM, Daley GQ, Abel L, Casanova JL, Studer L, Notarangelo LD (2012) Impaired intrinsic immunity to HSV-1 in human iPSC-derived TLR3-deficient CNS cells. Nature 491:769–773

    PubMed  CAS  Google Scholar 

  • Livorsi D, Anderson E, Qureshi S, Howard M, Wang YF, Franco-Paredes C (2010) Brainstem encephalitis: an unusual presentation of herpes simplex virus infection. J Neurol 257:1432–1437

    Article  PubMed  Google Scholar 

  • McGrath N, Anderson NE, Croxson MC, Powell KF (1997) Herpes simplex encephalitis treated with acyclovir: diagnosis and long term outcome. J Neurol Neurosurg Psychiatry 63:321–326

    Article  PubMed  CAS  Google Scholar 

  • Miller S, Mateen FJ, Aksamit AJ Jr (2013) Herpes simplex virus 2 meningitis: a retrospective cohort study. J Neurovirol 19:166–171

    Article  PubMed  CAS  Google Scholar 

  • Pérez de Diego R, Mulvey C, Crawford M, Trotter MW, Lorenzo L, Sancho-Shimizu V, Abel L, Zhang SY, Casanova JL, Godovac-Zimmermann J (2013) The proteome of Toll-like receptor 3-stimulated human immortalized fibroblasts: implications for susceptibility to herpes simplex virus encephalitis. J Allergy Clin Immunol 131:1157–1166

    Article  PubMed  Google Scholar 

  • Poissy J, Wolff M, Dewilde A, Rozenberg F, Raschilas F, Blas M, Georges H, Chaffaut C, Yazdanpanah Y (2009) Factors associated with delay to acyclovir administration in 184 patients with herpes simplex virus encephalitis. Clin Microbiol Infect 15:560–564

    Article  PubMed  CAS  Google Scholar 

  • Raschilas F, Wolff M, Delatour F, Chaffaut C, De Broucker T, Chevret S, Lebon P, Canton P, Rozenberg F (2002) Outcome of and prognostic factors for herpes simplex encephalitis in adult patients: results of a multicenter study. Clin Infect Dis 35:254–260

    Article  PubMed  Google Scholar 

  • Schulte EC, Sauerbrei A, Hoffmann D, Zimmer C, Hemmer B, Mühlau M (2010) Acyclovir resistance in herpes simplex encephalitis. Ann Neurol 67:830–833

    Article  PubMed  CAS  Google Scholar 

  • Solomon T, Michael BD, Smith PE, Sanderson F, Davies NW, Hart IJ, Holland M, Easton A, Buckley C, Kneen R, Beeching NJ, National Encephalitis Guidelines Development and Stakeholder Groups (2012) Management of suspected viral encephalitis in adults–Association of British Neurologists and British Infection Association National Guidelines. J Infect 64:347–373

    Article  PubMed  CAS  Google Scholar 

  • Steiner I (2011) Herpes simplex virus encephalitis: new infection or reactivation? Curr Opin Neurol 24:268–274

    Article  PubMed  Google Scholar 

  • Steiner I, Budka H, Chaudhuri A, Koskiniemi M, Sainio K, Salonen O, Kennedy PG (2005) Viral encephalitis: a review of diagnostic methods and guidelines for management. Eur J Neurol 12:331–343

    Article  PubMed  CAS  Google Scholar 

  • Steiner I, Budka H, Chaudhuri A, Koskiniemi M, Sainio K, Salonen O, Kennedy PG (2010) Viral meningoencephalitis: a review of diagnostic methods and guidelines for management. Eur J Neurol 17:999–e57

    Article  PubMed  CAS  Google Scholar 

  • Steiner I, Schmutzhard E, Sellner J, Chaudhuri A, Kennedy PG (2012) EFNS-ENS guidelines for the use of PCR technology for the diagnosis of infections of the nervous system. Eur J Neurol 19:1278–1291

    Article  PubMed  CAS  Google Scholar 

  • Sureka J, Jakkani RK (2012) Clinico-radiological spectrum of bilateral temporal lobe hyperintensity: a retrospective review. Br J Radiol 85:e782–e792

    Article  PubMed  CAS  Google Scholar 

  • Szpara ML, Parsons L, Enquist LW (2010) Sequence variability in clinical and laboratory isolates of herpes simplex virus 1 reveals new mutations. J Virol 84:5303–5313

    Article  PubMed  CAS  Google Scholar 

  • Thwaites GE (2012) The management of suspected encephalitis. BMJ 344:e3489

    Article  PubMed  Google Scholar 

  • Whitley RJ, Gnann JW (2002) Viral encephalitis: familiar infections and emerging pathogens. Lancet 359:507–513

    Article  PubMed  Google Scholar 

  • Whitley R, Lakeman AD, Nahmias A, Roizman B (1982) DNA restriction-enzyme analysis of herpes simplex virus isolates obtained from patients with encephalitis. N Engl J Med 307:1060–1062

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Peter G. E. Kennedy.

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Kennedy, P.G.E., Steiner, I. Recent issues in herpes simplex encephalitis. J. Neurovirol. 19, 346–350 (2013). https://doi.org/10.1007/s13365-013-0178-6

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  • DOI: https://doi.org/10.1007/s13365-013-0178-6

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