Document Detail

Infantile herpes simplex encephalitis: diagnostic features and differentiation from non-accidental injury.
MedLine Citation:
PMID:  12504603     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Neonatal herpes simplex virus (HSV) encephalitis is rare, but associated with considerable morbidity and mortality. After a baby, subsequently proven to have HSE, had initially been diagnosed as non-accidental injury (NAI), we reviewed the clinical features and radiology of infants with HSE recently diagnosed by our laboratory. METHODS: Screening of cerebrospinal fluid (CSF) samples sent to Oxford for HSV polymerase chain reaction (PCR) analysis, from wide range of British hospitals, identified HSV infected infants. After a diagnosis was made, the case notes and neuroradiology (where available) were reviewed and a limited follow-up was undertaken. RESULTS: Thirteen infants had HSV encephalitis (HSE), which in four followed a relapsing course. On subsequent assessment six infants had neurological sequelae, six appeared to be normal, and one was lost to follow-up. Neither a history of primary HSV infection in pregnancy, nor skin lesions in the baby, were helpful diagnostically. Magnetic resonance imaging indicated haemorrhage in the cortex, but no subdural haematomata, a hallmark of NAI, in 5/6 infants. CONCLUSIONS: The early clinical features of HSE and NAI may be indistinguishable. As early diagnosis is important, infants with an unidentified encephalopathic illness should be examined by neuroradiology and their CSF tested for HSV DNA. Together these examinations can confirm and differentiate between those two conditions. Relapsing HSE may mimic recurrent encephalopathy caused by multiple NAIs.
J Kurtz; P Anslow
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of infection     Volume:  46     ISSN:  0163-4453     ISO Abbreviation:  J. Infect.     Publication Date:  2003 Jan 
Date Detail:
Created Date:  2002-12-30     Completed Date:  2003-06-10     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7908424     Medline TA:  J Infect     Country:  England    
Other Details:
Languages:  eng     Pagination:  12-6     Citation Subset:  IM    
Department of Virology, John Radcliffe Hospital, Oxford OX3 9DU, UK.
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MeSH Terms
Child Abuse / diagnosis*
Craniocerebral Trauma / diagnosis*
Diagnosis, Differential
Encephalitis, Herpes Simplex / diagnosis*,  virology
Herpes Simplex / cerebrospinal fluid*,  genetics,  immunology
Infant, Newborn
Magnetic Resonance Imaging
Pregnancy Complications, Infectious / virology

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