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首页> 外文期刊>The Open Pediatric Medicine Journal >A Study on Herpes Simplex Encephalitis in 18 Children, Including 3 Relapses
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A Study on Herpes Simplex Encephalitis in 18 Children, Including 3 Relapses

机译：包括3次复发在内的18例儿童单纯疱疹性脑炎的研究

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Background: Herpes Simplex Virus (HSV) is the most common cause of acute sporadic focal encephalitis. Early Diagnosis is, therefore, crucial for predicting outcome. Improved laboratory technology and improved neuroimaging accessibility have enhanced our ability to diagnose this condition.Aims: To assess the reliability of different investigative tools in diagnosing and subsequent management of herpes simplex encephalitis (HSE); as well as the impact of infection and its relapse on the outcome of a cohort of 18 children evaluated during a period of 13 years.Methods: This combined prospective and retrospective study describes the clinical, laboratory, electroencephalographic and diagnostic imaging studies; and outcome in a cohort of 18 children with HSE over a period of 13 years. It also details the clinical and diagnostic features of 3 patients who relapsed.Results: The commonest initial presenting symptoms and signs were fever (100%), seizures (72%) irritability (50%) and weakness/hemiparesis (39%). Cerebrospinal fluid (CSF) pleocytosis was found in 62%, red blood cells (RBCs) >10x106/L in 81% and raised proteins (>0.59g/L) in 52%. Examination for herpes simplex virus (HSV) by polymerase chain reaction (PCR) was positive in 50% (6/12). Electroencephalographic changes were universally abnormal (17/17; 100%) and periodic lateralization discharges (PLEDS) were seen in 35% (6/17). During the acute stage (days 1-8 from symptom onset), magnetic resonance imaging (MRI) revealed abnormalities in 91% (10/11), cranial computed tomography (CT) in 50% (5/10) and single photon emission computed tomography (SPECT), within < 7 days, in 75% (6/8). All patients were treated with intravenous acyclovir. There were no deaths but 3 patients relapsed after periods ranging between 18 days and 66 months. Eleven (61%) patients had no or minor sequelae (good outcome) and 7 (39%) had moderate or severe sequelae (poor outcome). Delayed initiation of therapy (> 3days from onset of symptoms) had significant association with poor outcome (P = 0.002). Initial negative PCR results may become positive on subsequent CSF specimen.Conclusion: Diagnosis of HSE requires combined clinical, laboratory, electroencephalographic and neuroimaging studies. Negative results of PCR do not exclude the infection and should not interrupt the treatment. Early diagnosis and initiation of treatment minimize the devastating effect of HSE. Full course treatment with acyclovir for 21 days is also crucial for prognosis and prevention of subsequent relapse.
机译：背景：单纯疱疹病毒（HSV）是急性散发性局灶性脑炎的最常见原因。因此，早期诊断对于预测结果至关重要。改进的实验室技术和改进的神经影像学可及性提高了我们诊断这种情况的能力。目的：评估各种研究工具在单纯疱疹性脑炎（HSE）的诊断和后续治疗中的可靠性;方法：这项前瞻性和回顾性研究相结合，描述了临床，实验室，脑电图和诊断性影像学研究;以及在13年内评估的18个儿童队列的感染及其复发对其结果的影响。在18年的时间里，共有18名HSE儿童的研究结果。它还详细介绍了3例复发的患者的临床和诊断特征。结果：最常见的最初症状是发烧（100％），癫痫发作（72％）易怒（50％）和虚弱/偏瘫（39％）。 62％发现脑脊液（CSF）细胞增多，81％发现红细胞（RBC）> 10x106 / L，52％发现蛋白升高（> 0.59g / L）。通过聚合酶链反应（PCR）检查的单纯疱疹病毒（HSV）阳性率为50％（6/12）。脑电图变化普遍异常（17/17; 100％），周期性偏侧放电（PLEDS）占35％（6/17）。在急性期（从症状发作到第1至8天），磁共振成像（MRI）发现异常的比例为91％（10/11），颅骨计算机断层扫描（CT）的比例为50％（5/10），并且计算出单光子发射断层扫描（SPECT），在7天内（75％（6/8））。所有患者均接受静脉注射阿昔洛韦治疗。没有死亡，但是3名患者在18天至66个月之间的时间段后复发。 11例（61％）患者无后遗症或轻度后遗症（预后良好），7例（39％）有中度或重度后遗症（预后不良）。延迟开始治疗（症状发作后> 3天）与不良预后有显着相关性（P = 0.002）。结论：HSE的诊断需要临床，实验室，脑电图和神经影像学的综合研究。 PCR的阴性结果不能排除感染，因此不应中断治疗。早期诊断和开始治疗可将HSE的破坏性作用降至最低。用阿昔洛韦进行21天的全疗程治疗对于预后和预防随后的复发也至关重要。

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