Elsevier

The Journal of Pediatrics

Volume 126, Issue 2, February 1995, Pages 234-241
The Journal of Pediatrics

Expanded spectrum of herpes simplex encephalitis in childhood☆,☆☆,★,★★

https://doi.org/10.1016/S0022-3476(95)70550-3Get rights and content

Abstract

We designed a polymerase chain reaction method to detect herpes simplex virus (HSV) DNA in spinal fluid from patients with encephalitis. The polymerase chain reaction amplified a 211 base-pair segment of the HSV DNA polymerase gene. Applying this method, we diagnosed HSV type 1 infection in three young children, aged 7 to 13 months, who had atypical forms of the illness. On the basis of magnetic resonance imaging, their disease was diffuse or multifocal in two cases and, in all three, lacked the temporal lobe involvement considered characteristic of HSV encephalitis beyond the neonatal period. Most of the diffuse or multifocal abnormalities detected by magnetic resonance imaging were not apparent by computed tomography. Restriction enzyme analysis of the polymerase chain reaction products from all three patients indicated that their disease was caused by HSV type 1. We conclude that in preschool-age children beyond the neonatal period, the spectrum of HSV encephalitis includes multifocal or diffuse involvement of the brain, which may be detected most efficiently by magnetic resonance imaging. The polymerase chain reaction method has the potential for providing an early diagnosis, but further studies are required to define the sensitivity and specificity of the polymerase chain reaction before it can be used for routine clinical decision making. (J PEDIATR 1995;126:234-41)

Section snippets

Polymerase chain reaction (DNA polymerase gene)

The PCR was performed on 10 μl untreated CSF. Two 18-base oligonucleotides were selected from regions of homology in the published sequences of the DNA polymerase genes of HSV types 1 and 2.16, 17, 18 The primer sequences were 5′GACTACCTGGAGATCGAG′3 and 5′TGAACCCGTACACCGAGT′3. These primers amplify a 211 base-pair segment corresponding to bases 56,057 through 56,250 (genomic number) in HSV-1 strain 17.17 Within this segment there is greater than 90% homology between HSV-1 and HSV-2 but no

RESULTS

Selected clinical and laboratory data from the three patients are summarized in Table I. Serologic data from patients 1 and 2 are summarized in Table II.

Patient 1

Patient 1 was a 13-month-old, previously healthy black female infant who had fever and generalized seizures. The CSF on the second day of illness had 4 · 106 erythrocytes/L (4 erythrocytes/mm3) and 5 · 106 leukocytes/L (5 leukocytes/mm3) with 75% neutrophils, protein 0.21 gm/L (21 mg/dl), and glucose 3.6 mmol/L (65 mg/dl) (Table I). Bacterial and viral cultures were negative. The seizure activity persisted, and the infant was admitted to an outside hospital; anticonvulsant therapy was started.

DISCUSSION

These patients illustrate the importance of two techniques, MRI and PCR, which together provide new insight into the clinical spectrum of HSV encephalitis in this age group. The MRI revealed diffuse or multifocal involvement of the brain in two patients and a frontoparietal lobe lesion in the third. These patients lacked the temporal lobe localization thought to be characteristic of the nonneonatal form of HSV encephalitis. Nevertheless, PCR revealed the presence of HSV DNA in the CSF of each

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    • Cited by (0)

    ☆

    From the Departments of Pediatrics, Neurology, Radiology, Medicine, and Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri

    ☆☆

    Supported in part (Dr. Schlesinger) by the American Physician Fellowship, Inc., for Medicine in Israel.

    ★

    Reprint requests: Gregory A. Storch, MD, Department of Pediatrics, Washington University School of Medicine at Children's Hospital, One Children's Place, St. Louis, MO 63110.

    ★★

    0022/3476/95/$3.00 + 0 9/20/46186

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