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A nine-week-old girl with fever and seizures.

Lefebvre MA, Malette B, Brukner I, Saint-Martin C, Papenburg J - Can J Infect Dis Med Microbiol (2015 Sep-Oct)

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Infectious Diseases, Departments of Pediatrics and Microbiology, Montreal Children's Hospital, McGill University Health Centre;

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Using a quantitative HSV PCR assay, we observed a 10-fold increase in HSV DNA in our patient’s CSF after 72 h on acyclovir... This highlights how HSV CSF titres may abruptly rise in the early stages of the disease and that the first week of antiviral therapy does not significantly reduce HSV PCR sensitivity... The prognostic utility of the initial level of CSF HSV DNA remains unclear... Domingues et al described the use of a quantitative CSF HSV PCR in 16 adult and pediatric patients with HSV encephalitis, and found that those with >100 copies of HSV DNA per microlitre, before or within four days of initiation of treatment, were more likely to display lesions on a computed tomography scan of the brain and poorer neurological outcomes... In cases with low/undetectable CSF HSV viral load, blood HSV PCR may serve as a useful adjunct to make an early presumptive diagnosis of HSV encephalitis, particularly in patients with a primary infection... In a retrospective cohort study involving 37 neonates with HSV disease, Kimura et al detected HSV DNA in the blood of 73% of patients with a central nervous system infection... They also found that newborns with disseminated disease had a higher serum viral load than those with central nervous system infections (10 copies/mL versus 10 copies/mL, respectively)... Moreover, death and neurological sequelae among survivors were significantly associated with higher serum HSV DNA copy numbers... Nevertheless, there is little information available regarding the added value of blood HSV PCR in cases of suspected encephalitis outside of the neonatal period, in which viremia is presumed to be less common... In a case series involving 24 non-neonatal pediatric HSV infections associated with a positive blood HSV PCR, Cantey et al detected HSV viremia in two immunocompetent adolescents with HSV-1 encephalitis secondary to viral reactivation, a mechanism more frequently implicated in older children... Similarly, because the negative predictive value of blood HSV PCR in children outside the neonatal period is not known, a negative test should not lead to stopping empirical antiviral therapy when there is ongoing clinical suspicion for HSV encephalitis... Nevertheless, CSF HSV PCR remains the preferred diagnostic modality, and repeating a lumbar puncture is crucial if the initial test is negative and HSV remains a possibility.

No MeSH data available.


Coronal and axial T2-weighted images revealing increased T2 signal in the bilateral thalami (more extensive on the right [AandB]), right precentral subcortical white matter and cortex (C)
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f1-cjidmm-26-247: Coronal and axial T2-weighted images revealing increased T2 signal in the bilateral thalami (more extensive on the right [AandB]), right precentral subcortical white matter and cortex (C)

Mentions: Laboratory investigations showed a normal complete blood cell count and transaminase levels. CSF examination revealed 55 white blood cells/μL (51% monocytes, 37% lymphocytes, 12% neutrophils), 7 red blood cells/μL, normal protein (0.35 g/L) and normal glucose (2.9 mmol/L). An electroencephalogram revealed active epileptiform activity over the right centroparietal regions. She was admitted to the pediatric ward and underwent magnetic resonance imaging of her head, which revealed multifocal nonenhancing lesions in the subcortical white matter of the right precentral gyrus, right cingular gyrus, right corticospinal tract, as well as the right internal capsule and thalamus (Figure 1). Bacterial cultures were without growth and antibiotics were discontinued after 48 h. CSF herpes simplex virus (HSV) 1 and HSV 2 polymerase chain reaction (PCR) (LightCycler 2.0 HSV 1/2 qualitative kit [Roche Diagnostics, Canada]) and enterovirus PCR were also negative. Repeat lumbar puncture and blood testing were performed on hospital day 3.


A nine-week-old girl with fever and seizures.

Lefebvre MA, Malette B, Brukner I, Saint-Martin C, Papenburg J - Can J Infect Dis Med Microbiol (2015 Sep-Oct)

Coronal and axial T2-weighted images revealing increased T2 signal in the bilateral thalami (more extensive on the right [AandB]), right precentral subcortical white matter and cortex (C)
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4644005&req=5

f1-cjidmm-26-247: Coronal and axial T2-weighted images revealing increased T2 signal in the bilateral thalami (more extensive on the right [AandB]), right precentral subcortical white matter and cortex (C)
Mentions: Laboratory investigations showed a normal complete blood cell count and transaminase levels. CSF examination revealed 55 white blood cells/μL (51% monocytes, 37% lymphocytes, 12% neutrophils), 7 red blood cells/μL, normal protein (0.35 g/L) and normal glucose (2.9 mmol/L). An electroencephalogram revealed active epileptiform activity over the right centroparietal regions. She was admitted to the pediatric ward and underwent magnetic resonance imaging of her head, which revealed multifocal nonenhancing lesions in the subcortical white matter of the right precentral gyrus, right cingular gyrus, right corticospinal tract, as well as the right internal capsule and thalamus (Figure 1). Bacterial cultures were without growth and antibiotics were discontinued after 48 h. CSF herpes simplex virus (HSV) 1 and HSV 2 polymerase chain reaction (PCR) (LightCycler 2.0 HSV 1/2 qualitative kit [Roche Diagnostics, Canada]) and enterovirus PCR were also negative. Repeat lumbar puncture and blood testing were performed on hospital day 3.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Infectious Diseases, Departments of Pediatrics and Microbiology, Montreal Children's Hospital, McGill University Health Centre;

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Using a quantitative HSV PCR assay, we observed a 10-fold increase in HSV DNA in our patient’s CSF after 72 h on acyclovir... This highlights how HSV CSF titres may abruptly rise in the early stages of the disease and that the first week of antiviral therapy does not significantly reduce HSV PCR sensitivity... The prognostic utility of the initial level of CSF HSV DNA remains unclear... Domingues et al described the use of a quantitative CSF HSV PCR in 16 adult and pediatric patients with HSV encephalitis, and found that those with >100 copies of HSV DNA per microlitre, before or within four days of initiation of treatment, were more likely to display lesions on a computed tomography scan of the brain and poorer neurological outcomes... In cases with low/undetectable CSF HSV viral load, blood HSV PCR may serve as a useful adjunct to make an early presumptive diagnosis of HSV encephalitis, particularly in patients with a primary infection... In a retrospective cohort study involving 37 neonates with HSV disease, Kimura et al detected HSV DNA in the blood of 73% of patients with a central nervous system infection... They also found that newborns with disseminated disease had a higher serum viral load than those with central nervous system infections (10 copies/mL versus 10 copies/mL, respectively)... Moreover, death and neurological sequelae among survivors were significantly associated with higher serum HSV DNA copy numbers... Nevertheless, there is little information available regarding the added value of blood HSV PCR in cases of suspected encephalitis outside of the neonatal period, in which viremia is presumed to be less common... In a case series involving 24 non-neonatal pediatric HSV infections associated with a positive blood HSV PCR, Cantey et al detected HSV viremia in two immunocompetent adolescents with HSV-1 encephalitis secondary to viral reactivation, a mechanism more frequently implicated in older children... Similarly, because the negative predictive value of blood HSV PCR in children outside the neonatal period is not known, a negative test should not lead to stopping empirical antiviral therapy when there is ongoing clinical suspicion for HSV encephalitis... Nevertheless, CSF HSV PCR remains the preferred diagnostic modality, and repeating a lumbar puncture is crucial if the initial test is negative and HSV remains a possibility.

No MeSH data available.