Clinical Manifestations, Laboratory Findings and Outcomes of Children with Herpetic Encephalitis in Amirkola Children Hospital, Northern Iran

Background: Herpes simplex encephalitis (HSE) is a fatal infection of the central nervous system. The early diagnosis of HSE is crucial because the early introduction of antiviral therapy can significantly decrease mortality and morbidity associated with this disease. This study was carried out to determine the clinical manifestations, laboratory findings and the outcome of the children admitted due to a presumptive diagnosis of HSE to Amirkola Children Hospital; a referral hospital in the north of Iran, during 2006-2007. Methods: This cross-sectional study was performed on patients with diagnosis of HSE in Amirkola Hospital, affiliated to the Babol University of Medial Sciences in the north of Iran. All of the children with a diagnosis of encephalitis were enrolled in this study. After admission, a special investigation including CSF analysis, electroencephalogram (EEG), Computerized tomography (CT scan) and/or magnetic resonance imaging (MRI) were performed. PCR (Polymerase Chain Reaction) analysis for herpes virus DNA was done on CSF sample in all patients. All the patients with a clinical diagnosis of herpetic encephalitis were treated with acyclovir at the time of admission but every patient with a positive PCR was assumed as a definite diagnosis of HSE. Clinical manifestations, laboratory findings and outcome of patients were collected. At the end of the study, frequency of HSE was reported according to the PCR for HSV DNA among the children admitted due to encephalitis. Results: The mean age of the patients was 5.58±3.46 years. The most common clinical manifestations were fever (70%), nausea, vomiting (54%) and headache (44%). Seizure was more common among girls, and was significantly more prevalent in younger patients. Abnormal EEG was presents in 42%, abnormal CT-scan in 38% and abnormal MRI in 48% of subjects. PCR was positive in 34% of our patients. All patients were discharged from the hospital after treatment with acyclovir. Conclusion: Herpetic encephalitis should be considered in each patient admitted with sudden change in the level of consciousness in a previously healthy child with fever and antecedent viral infection.