Mixed Infection - Hantavirus Haemorrhagic Fever With Renal Syndrome and Herpes Simplex Virus Encephalitis

Abstract

Introduction: This case report describes a patient treated at the Clinic of Infectious Diseases of University Hospital “St. George” Plovdiv, with two infections occurring at the same time – haemorrhagic fever with renal syndrome (HFRS) and herpes simplex virus (HSV) encephalitis. Results: A 53-year-old male presented with fever, flu-like syndrome and renal impairment with mild nitrogen elevation. The patient was treated at the Clinic of Nephrology for one week. Several hours after discharge he had three generalised tonic-clonic seizures and was admitted to the intensive care unit with status epilepticus and acute respiratory failure requiring intubation and mechanical ventilation for 4 days. Lumbar puncture results showed: white blood cells – 1.10 6 /l, glucose – 5.3 mmol/l, total protein – 1.6 g/l, increased immunoglobulin levels. The patient was transferred to the Clinic of Infectious Diseases with suspicion of viral encephalitis.
 HSV type 1 was detected in the cerebrospinal fluid by PCR. Due to suspected hantavirus infection, serum was examined and IgM and IgG antibodies against the HFRS virus were detected by ELISA. Specific treatment with acyclovir was started and there was a rapid improvement in the clinical condition. Convulsions did not recur. Nitrogen levels normalised and there was a short period of polyuria. Thrombocytopenia quickly resolved without occurrence of haemorrhagic syndrome. In the course of the disease, the patient developed mild diarrhoeal syndrome and left thrombophlebitis. He was discharged clinically well with negative PCR results for HSV.
 In conclusion, we can assume that as a result of immunosuppression due to HFRS, HSV type 1 reactivated and led to herpes encephalitis.