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We thank Dr Nadeem, for highlighting that the clinical features of drowsiness and infant focal seizures in our case report indicates that early treatment for viral/herpes encephalitis was an imperative.
We would like to reassure Dr Nadeem that our infant did indeed receive a combination of early intravenous antiviral treatment (acyclovir) and antibiotics (cefotaxime and amoxicillin) and this was continued until final viral/bacterial PCR and CSF culture results were obtained. The use of acyclovir and amoxicillin was omitted from the original report due to word count limitations.
Viral PCR tested was negative for a range of viruses including herpes simplex (HSV). Although PCR assay is an important diagnostic modality for viral encephalitis HSV, we would add that due to focal seizures, our infant case received investigations and treatment as per national (1) and local guidelines: immediate brain CT imaging was performed to exclude neurosurgical conditions, and a later cranial MRI scan did not show selective damage to the mesial temporal lobe structures or the hippocampus. In addition, an early electroencephalogram (EEG) was normal. The EEG severity and the presence of epileptic seizures at the initial presentation would be significant indicators for predicting the 6-month clinical outcome in patients with HSE.
The seriousness of HSV CNS infections suggests that clinicians maintain a high index of suspicion to initiate evaluation under s...
The seriousness of HSV CNS infections suggests that clinicians maintain a high index of suspicion to initiate evaluation under suitable circumstances. We are grateful to the Editors for now publishing Dr Nadeem’s response to our letter to highlight this to our readers.
(1) Meningitis Research Foundation (MRF). Management of Bacterial Meningitis in infants <3 months (Neonatal Algorithm) [PDF]. London, United Kingdom: Meningitis Research Foundation (MRF); 2017 [updated Nov 2017]. Available from: https://www.meningitis.org/getmedia/75ce0638-a815-4154-b504-b18c462320c8....