Expanded spectrum of herpes simplex encephalitis in childhood☆,☆☆,★,★★
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)
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From the Departments of Pediatrics, Neurology, Radiology, Medicine, and Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri
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Supported in part (Dr. Schlesinger) by the American Physician Fellowship, Inc., for Medicine in Israel.
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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.
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0022/3476/95/$3.00 + 0 9/20/46186