Neonatal herpetic encephalitis

Abstract

We present a newborn baby with in utero acquired herpes virus 1(HSV-1) encephalitis who recovered with no sequelae. A diagnosis based only on the clinical findings led to an early treatment with acyclovir from the first day of life. Confirmation was obtained with polimerase chain reaction (PCR) from the spinal fluid 48 hours after birth. The importance of early PCR determination to confirm the diagnosis is stressed, as well as the need for serial controls to demonstrate that the test returns to be negative and there is no viral reproduction. The limitations of other techniques such as cultures or serology with lower performance or delayed positive results are discussed. The limitations of PCR such as false negative or positive results are also mentioned. Since 90% of prenatal infections are caused by HSV-2, this HSV-1 infection is rather uncommon. The clear temporal lobe tropism of HSV-1 is mentioned as well as the clinical manifestations and the irritative encephalographic activity during viral replication in the CSF.