Toth Cory, Harder Sheri, Yager Jerome
Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Can J Neurol Sci. 2003 Feb;30(1):36-40. doi: 10.1017/s0317167100002419.
To describe the clinical and laboratory findings in cases of neonatal herpes simplex virus (HSV) encephalitis.
Neonatal HSV encephalitis is a devastating infection which requires a high degree of clinical suspicion and rapid initiation of antiviral therapy.
We performed a retrospective search for all cases of HSV encephalitis within the two Saskatchewan pediatric tertiary care centers for the period of 1985-2001. Only those patients with consistent clinical presentations along with direct evidence of presence of HSV, such as positive cerebrospinal fluid (CSF) viral cultures, positive polymerase chain reaction (PCR) for HSV from CSF, or positive immunoglobulin G against HSV from neonatal blood, were selected.
Five male and four female infant patients were identified. At a mean age of presentation of 24 +/- 20 days, seizures occurred in six neonates, lethargy in six neonates, temperature changes in five neonates, and apnea in three neonates. Examination of CSF demonstrated an initial monocytosis or lymphocytosis, elevated CSF protein and depressed CSF glucose in 100% of patients. Electroencephalography (EEG) was abnormal in 100% of patients. Initial computerized tomography was abnormal in 55% of patients. Clinical follow-up over an average of two years demonstrated developmental delay in four patients and upper motor neuron findings in four patients. No patients suffered from postencephalitic epilepsy or mortality.
Neonatal HSV encephalitis most commonly presents with seizures, lethargy, and dysthermia. Cerebrospinal fluid testing and EEG have 100% sensitivity in cases with laboratory confirmation of HSV presence. Improvements in morbidity and mortality as compared to previous reports may relate to better recognition of this illness and acyclovir therapy. The lack of postinfection epilepsy in our series may also relate to better recognition and acyclovir therapy within this series of patients.
描述新生儿单纯疱疹病毒（HSV）脑炎病例的临床和实验室检查结果。
新生儿HSV脑炎是一种具有毁灭性的感染，需要高度的临床怀疑并迅速开始抗病毒治疗。
我们对1985年至2001年期间萨斯喀彻温省的两家儿科三级护理中心内所有HSV脑炎病例进行了回顾性检索。仅选择那些临床表现一致且有HSV存在直接证据的患者，例如脑脊液（CSF）病毒培养阳性、CSF中HSV的聚合酶链反应（PCR）阳性或新生儿血液中抗HSV免疫球蛋白G阳性。
确定了5名男婴和4名女婴患者。平均发病年龄为24±20天，6名新生儿出现惊厥，6名新生儿出现嗜睡，5名新生儿体温变化，3名新生儿出现呼吸暂停。CSF检查显示所有患者均有初始单核细胞增多或淋巴细胞增多、CSF蛋白升高和CSF葡萄糖降低。100%的患者脑电图（EEG）异常。初始计算机断层扫描55%的患者异常。平均两年的临床随访显示4名患者有发育迟缓，4名患者有上运动神经元表现。没有患者患有脑炎后癫痫或死亡。
新生儿HSV脑炎最常见的表现为惊厥、嗜睡和体温异常。在实验室确认存在HSV的病例中，脑脊液检测和EEG的敏感性为100%。与先前报告相比，发病率和死亡率的改善可能与对该疾病的更好识别和阿昔洛韦治疗有关。我们系列中缺乏感染后癫痫也可能与该系列患者中更好的识别和阿昔洛韦治疗有关。
