Recurrent herpes simplex encephalitis: Recovery of virus after Ara‐A treatment

Abstract

A 54-year-old man developed clinical findings consistent with herpes simplex virus (HSV) encephalitis. These signs included an abrupt onset of focal central nervous system disease, cerebrospinal fluid pleocytosis, localized electroencephalographic abnormalities, and a computerized tomographic scan showing right temporal lobe involvement. Treatment with adenine arabinoside (Ara-A) resulted in improvement. Two months later he again became confused, and a left hemiparesis developed. Although biopsy revealed extensive necrosis and inflammatory response, HSV antigens and herpesvirus particles were not detected. Culture of biopsy tissue yielded HSV type 1 only after 18 days. A second course of Ara-A was administered but the patient failed to improve and died four months later. Extensive inflammatory necrosis of both temporal lobes involving gray and white matter was found. Cultures were negative for HSV. The recovery of virus from our patient during the second encephalitic episode should raise concerns regarding the efficacy of Ara-A treatment and the role of the virus in recurrent disease. In addition, the importance of maintaining biopsy tissue in culture for prolonged periods is emphasized.

Predictors of a Prolonged Clinical Course in Adult Patients with Herpes Simplex Virus Encephalitis

“…prolonged group are also in accordance with the conventional predictors of poor outcome for HSVE (2,4,5 (3,(7)(8)(9)(10)(11)(12)(13)(14)(15). In the previous studies, the frequency of relapse after HSVE ranged from 5% to 26% (8)(9)(10) (15).…”

“…(2,(4)(5)(6). Management (7)(8)(9)(10) and adult patients (3,(11)(12)(13)(14)(15) 1 m 74 0 2 6 52 33 None 0 1 1 1 2 2 m 19 0 10 7 149 120 None 0 1 1 1 Extend ACV indicates extension of the duration of ACV administration. T a b l e 2 .…”

Intravenous Infusion of Cereport Increases Uptake and Efficacy of Acyclovir in Herpes Simplex Virus-Infected Rat Brains

“…Although therapy with either vidarabine or ACV (42,44) has proven to be effective in reducing mortality rates of HSV encephalitis, the long-term prognosis of the survivors is less than optimal. A few survivors suffer relapses, but many others have learning and memory abnormalities and impairment of general orientation and perceptive-motor skills (12,14,29). This current state of HSV encephalitis-associated mortality and morbidity suggests that alternative approaches to treatment need to be developed.…”

Relapse of herpes simplex encephalitis after acyclovir therapy

“…Relapses of H S E have been reported after vidarabine therapy [3]. A few cases of relapsing H S E after acyclovir treatment have also been reported and were attributed either to post-infectious encephalopathy of u n k n o w n mechanism [1,4] or to failure of the drug to eradicate the virus completely [4,5].…”

“…Controlled studies, however, have not defined the o p t i m a l d u r a t i o n of acyclovir therapy. R e l a p s e of H S E has b e e n r e p o r t e d after v i d a r a b i n e therapy [3]. F u r t h e r m o r e , in recent years a few cases of relapses following 8 [2] -1 0 [1,4,5] days of acyclovir therapy have also b e e n r e p o r t e d .…”