Herpes Simplex Meningo–encephalitis

Herpes simplex virus infections

“…In their twenty cases, diagnosis was confirmed either by isolation of the virus, detection of typical type A Cowdry intranuclear inclusions associated with perivascular mononuclear cell infiltration and areas of ischaemic necrosis, or by a rising titre of antibody. In three cases, Murray et al (1966) found neither a history nor clinical evidence of herpetic lesions, but signs of meningeal involvement about 7-8 days, and limb paresis and terminal coma between 8 and 12 days, after the occurrence of the first symptoms. In all three cases there was a lymphocyte-polymorphonuclear pleocytosis associated with a slight rise in protein.…”

“…It is generally agreed that, as suggested by Murray et al (1966), the clinical course is divisible into two distinct stages, namely, a prodromal irritative stage lasting from a few days to a week in which the patients prove totally unresponsive to antibiotic therapy; this is followed by a stage characterized by evidence of cerebral compression and its sequelae. Miller et al (1966) consider that suspicion 'should be aroused in any case presenting with headache and lethargy followed by confusion and stupor associated with evidence of cortical irritability'.…”