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

BMC Research Notes

Tom Solomon⁴  Anita Krishnan³  Ray Borrow²  Bode Williams¹  Besa Ziso³  Benedict D Michael⁴  Katherine C Dodd³ 

[1] Liverpool Women’s Hospital, Crown Street, Liverpool L8 7SS, UK;Vaccine Evaluation Unit, Public Health England, Oxford Road, Manchester M13 9WZ, UK;The Walton Centre Neurology NHS Foundation Trust, Lower Lane, Fazakerly, Liverpool L9 7JL, UK;Institute of Infection and Global Health, University of Liverpool, The Ronald Ross Building, West Derby Street, Liverpool L69 7BE, UK

关键词: Immunology;    Infectious;    Pregnancy complications;    Viral;    Encephalitis;    Herpes simplex;    Encephalitis;   

Others  :  1177930
DOI  :  10.1186/s13104-015-1071-6

 received in 2014-01-06, accepted in 2015-03-18,  发布年份 2015

【 摘 要 】

Background

Herpes 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 presentation

We 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.

Conclusion

When 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.

【 授权许可】

   
2015 Dodd et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Solomon T, Michael BD, Smith PE, Sanderson F, Davies NW, Hart IJ, et al.: Management of suspected viral encephalitis in adults – association of British Neurologists and British Infection Association National Guidelines. J Infect 2012, 64:347-73.
• [2]Whitley RJ, Gnann JW: Viral encephalitis: familiar infections and emerging pathogens. Lancet 2002, 359:507-13.
• [3]Michael BD, Sidhu M, Stoeter D, Roberts M, Beeching NJ, Bonington A, et al.: The epidemiology and management of adult suspected central nervous system infections - a retrospective cohort study in the NHS Northwest Region. Q J Med 2010, 103(10):749–5.
• [4]Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D, et al.: Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis 2010, 10:835-44.
• [5]Raschilas F, Wolff M, Delatour F, Chaffaut C, De Broucker T, Chevret S, et al.: Outcome of and prognostic factors for herpes simplex encephalitis in adult patients: results of a multicentre study. Clin Infect Dis 2013, 35(3):254-60.
• [6]King RL: Herpes simplex encephalitis in pregnancy. Am J Obstet Gynecol 1979, 135:1114-5.
• [7]Roman-Campos G, Navarro De Roman LI, Toro G, Vergara I: Herpes encephalitis in pregnancy. Am J Obstet Gynaecol 1979, 135:158-9.
• [8]Young EJ, Killam AP, Green FJ: Disseminated herpes virus infection. J Amer Med Assoc 1976, 235:2731-3.
• [9]Klein NA, Mabie WC, Shaver DC, Latham PS, Adamec TA, Pinstein ML, et al.: Herpes simplex virus hepatitis in pregnancy: two patients successfully treatment with aciclovir. Gastroenterology 1991, 100(1):239-44.
• [10]Pascal J, Perbet S, Bourdel N, Da Ines D, Tran X, Chartier C, et al.: Management of HSV-1 encephalitis due to reactivation of HSV-1 during later pregnancy. Int J Obstet Anesth 2012, 21:364-7. doi: 10.1016/j.ijoa.2012.05.004
• [11]Mesker AJ, Bon GG, de Gans J, de Krujik JR: Case report: a pregnant woman with herpes simplex encephalitis successfully treated with dexamethasone. Eur J Obstet Gynecol Reprod Biol 2011, 154:231-2.
• [12]Sellner J, Buonomano R, Nedeltchev K, Findling O, Schroth G, Surbek DV, et al.: A case of maternal herpes simplex virus encephalitis during later pregnancy. Nat Clin Pract Neurol 2009, 5:51-6.
• [13]Piskin N, Akduman D, Aydemir H, Celebi G, Oztoprak N: Herpes simplex virus encephalitis in pregnancy. J Matern Fetal Neonatal Med 2008, 21:421-3.
• [14]Gunduz A, Beskardes AF, Kutlu A, Ozkara C, Karaagac N, Yeni SN: Herpes encephalitis as a cause of nonconvulsive status epilepticus. Epileptic Disord 2006, 8:57-60.
• [15]Godet C, Beby-Defaux A, Agius G, Pourrat O, Robert R: Maternal herpes simplex virus type 2 encephalitis following cesarean section. J Infect 2003, 47:174-5.
• [16]Dupuis O, Audibert F, Fernandez H, Frydman R: Herpes simplex virus encephalitis in pregnancy. Obstet Gynecol 1999, 94:810-2.
• [17]Luby JP: Southwestern internal medicine conference: infections of the central nervous systems. Am J Med Sci 1992, 304:379-91.
• [18]Anteby E, Reches A, Lavy Y, Yagel S: Fetal serology in maternal HSV encephalitis. Prenat Diagn 1992, 12:855-6.
• [19]Frieden FJ, Ordorica SA, Goodgold AL, Hoskins IA, Silverman F, Young BK: Successful pregnancy with isolated herpes simplex virus encephalitis: case report and review of the literature. Obstet Gynecol 1990, 75:511-3.
• [20]Besser R, Vogt T, Thömke F: Successful treatment of HSV encephalitis during pregnancy. Neurology 1989, 39:748.
• [21]Hankey GJ, Bucens MR, Chambers JS: Herpes simplex encephalitis in third trimester of pregnancy: successful outcome for mother and child. Neurology 1987, 37:1534-7.
• [22]Berger SA, Weinberg M, Treves T, Sorkin P, Geller E, Yedwab G, et al.: Herpes encephalitis during pregnancy: failure of acyclovir and adenine arabinoside to prevent neonatal herpes. Isr J Med Sci 1986, 22:41-4.
• [23]Anderson JM, Nicholls MW: Herpes encephalitis in pregnancy. Br Med J 1972, 1:632.
• [24]Spiegel R, Miron D, Yodko H, Lumelsky D, Habib A, Horovitz Y: Late relapse of herpes simplex virus encephalitis in a child due to reactivation of latent virus: clinicopathological report and review. J Child Neurol 2008, 23:344-8.
• [25]Chen SJ, Liu YL, Sytwu HK: Immunologic regulation in pregnancy: from mechanism to therapeutic strategy for immunomodulation. Clin Dev Immunol 2012, 2012:258391.
• [26]Robinson DP, Klein SL: Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis. Horm Behav 2012, 62:263-71.
• [27]Kneen R, Michael BD, Menson E, Mehta B, Easton A, Hemingway C, et al.: Management of suspected viral encephalitis in children – association of British Neurologists and British infection association national guidelines. J Infect 2012, 64:449-77.
• [28]Rahuldeo J, Sushil K, Anupam A, Pragati T: Ventricular tachycardia and seizure in hyperemesis gravidarum. J Obstet Gynecol India 2010, 60(4):339-40.
• [29]Beach RL, Kaplan PW: Seizures in pregnancy: diagnosis and management. Int Rev Neurobiol 2008, 83:259-71. doi: 10.1016/S0074-7742(08)00015-9
• [30]Kang SH, Chua-Gocheco A, Bozzo P, Einarson A: Safety of antiviral medication for hte treatment of herpes during pregnancy. Can Fam Physician 2011, 57:427-8.
• [31]Tunkel AR, Glaser CA, Bloch KC, Sejvar JJ, Marra CM, Roos KL, et al.: The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2008, 47:303-27.
• [32]National Institute for Health and Clinical Excellence: The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care. Clinical guidelines, CG137. National Institute for Health and Clinical Excellence, London; 2012.
• [33]Michael BD, Solomon T: Seizures and encephalitis: clinical features, management, and potential pathophysiologic mechanisms. Epilepsia 2012, 53:63-71.
• [34]Pandey S, Rathore C, Michael BD. Antiepileptic drugs for the primary and secondary prevention of seizures in viral encephalitis. Cochrane Database Syst Rev. 2013:CD010247. doi:10.1002/14651858.