Case report: a pregnant woman with herpes simplex encephalitis successfully treated with dexamethasone

Mesker, A.J.; Bon, G.G.; Gans, Jan de; Kruijk, Jelle R. de

doi:10.1016/j.ejogrb.2010.10.014

Cited by 9 publications

(7 citation statements)

References 5 publications

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“…The mechanism of action of glucocorticoids, which are broad‐spectrum anti‐inflammatory agents, implies the promotion of anti‐inflammatory monocytes which seem to be actively involved in the resolution of immune reactions . Several human case reports and series have indicated a clinical improvement in patients suffering from HSE treated with corticosteroids combined with acyclovir . A retrospective analysis of a larger number of patients with HSE showed that administration of adjunctive glucocorticoids was an independent predictor of a better neurological outcome .…”

Section: Immunomodulatory Strategies Against Herpes Simplex Virus Encmentioning

confidence: 99%

Innate immune response during herpes simplex virus encephalitis and development of immunomodulatory strategies

Piret

Boivin

2015

Reviews in Medical Virology

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Herpes simplex viruses are large double-stranded DNA viruses. These viruses have the ability to establish a lifelong latency in sensory ganglia and to invade and replicate in the CNS. Apart from relatively benign mucosal infections, HSV is responsible for severe illnesses including HSV encephalitis (HSE). HSE is the most common cause of sporadic, potentially fatal viral encephalitis in Western countries. If left untreated, the mortality rate associated with HSE is approximately 70%. Despite antiviral therapy, the mortality is still higher than 30%, and almost 60% of surviving individuals develop neurological sequelae. It is suggested that direct virus-related and indirect immune-mediated mechanisms contribute to the damages occurring in the CNS during HSE. In this manuscript, we describe the innate immune response to HSV, the development of HSE in mice knock-out for proteins of the innate immune system as well as inherited deficiencies in key components of the signaling pathways involved in the production of type I interferon that could predispose individuals to develop HSE. Finally, we review several immunomodulatory strategies aimed at modulating the innate immune response at a critical time after infection that were evaluated in mouse models and could be combined with antiviral therapy to improve the prognosis of HSE. In conclusion, the cerebral innate immune response that develops during HSE is a "double-edged sword" as it is critical to control viral replication in the brain early after infection, but, if left uncontrolled, may also result in an exaggerated inflammatory response that could be detrimental to the host.

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Section: Immunomodulatory Strategies Against Herpes Simplex Virus Encmentioning

confidence: 99%

Innate immune response during herpes simplex virus encephalitis and development of immunomodulatory strategies

Piret

Boivin

2015

Reviews in Medical Virology

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“…Actually, adjunctive corticosteroid administration has been advantageous in the treatment of other infectious diseases with an exaggerated inflammatory response, such as bacterial meningitis [40], tuberculous meningitis [41] and herpetic keratitis [42]. In HSVE, animal models [30][31][32][33][34]39,43] ( Table 1 and Additional file 1) and human reports support the use of corticosteroids, either isolated [44,45] or combined with acyclovir [46][47][48][49] (Table 1 and Additional file 2). The ongoing GACHE trial will hopefully shed definitive light about the role of corticosteroids as adjunctive therapy to acyclovir [50].…”

Section: Data Supporting Steroidsmentioning

confidence: 99%

“…Interestingly, it seems that animal studies support delayed treatment with steroids on HSVE. This Viral replication [23,30,32] Viral load [23,30,33,37] CNS in ammatory response [31,34,38,39,43,51,52,58] Symptom severity [34,37] Radiological abnormalities [32,35,36] Possible ideal treatment [23,31,43,56,57] Actual treatment [21,[45][46][47][48][49] Day 0 (onset of infection) observation contrasts with the early use of steroids recommended in other CNS infections (for example, bacterial meningitis), highlighting the relevance that different temporal inflammatory patterns play in their pathophysiology and treatment. Notably, corticosteroids promote anti-inflammatory properties in monocytes [55].…”

Section: Is the Time Of Onset Of Steroid Therapy Important In Hsve?mentioning

confidence: 99%

A Systematic Review on the Role of Adjunctive Corticosteroids in Herpes Simplex Virus Encephalitis: Is Timing Critical for Safety and Efficacy?

2013

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“…Mother and child normal and healthy 15 months later. HSV-1 PCR Mesker AJ et al 2013 Dodd KC, et al [ 11 ] 30 37 1 Y NK Headache, fever, mental status change and reduced consciousness. WCC unknown HSV-1 PCR CT + MRI - Abnormalities in right temporal lobe Not done IV aciclovir 750 mg TDS (unknown course length) Caesarean section at 37 weeks – healthy child.…”

Section: Resultsmentioning

confidence: 99%

Herpes simplex virus encephalitis in pregnancy - a case report and review of reported patients in the literature

et al. 2015

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BackgroundHerpes simplex virus (HSV) encephalitis is the most common sporadic cause of encephalitis with significant morbidity and mortality that is drastically reduced by early antiviral treatment.Case presentationWe report a 37 year old woman, 33 weeks pregnant, who presented with seizures due to proven HSV-1 encephalitis, and who had had a previous episode of probable viral encephalitis aged 14 years. She was successfully treated with aciclovir on both occasions and, in the latter, went on to deliver a healthy infant. This case is compared with 17 cases of HSV encephalitis in pregnancy in the literature identifying a predominance in the late 2nd and 3rd trimesters, perhaps in part due to immunological changes in pregnancy. The clinical presentation is also compared with non-pregnant patients with HSV encephalitis in the largest prospective UK and European studies. We also present practical advice on management from recent national guidelines.ConclusionWhen pregnant women present with new seizures, headache, impaired consciousness or altered behaviour urgent investigation is required to identify common diagnoses, such as eclampsia, venous sinus thrombosis and metabolic disturbances. Nevertheless, viral encephalitis is a very treatable cause of this presentation with potentially serious complications if missed, and may be more common in latter stages of pregnancy. Encephalitis should not be discounted if the patient is afebrile, has a normal Glasgow coma score, or the cerebrospinal fluid white cell count is only slightly elevated, as these features are well recognised in viral encephalitis.

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Case report: a pregnant woman with herpes simplex encephalitis successfully treated with dexamethasone

Cited by 9 publications

References 5 publications

Innate immune response during herpes simplex virus encephalitis and development of immunomodulatory strategies

Innate immune response during herpes simplex virus encephalitis and development of immunomodulatory strategies

A Systematic Review on the Role of Adjunctive Corticosteroids in Herpes Simplex Virus Encephalitis: Is Timing Critical for Safety and Efficacy?

Herpes simplex virus encephalitis in pregnancy - a case report and review of reported patients in the literature

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