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Table 1 Previous HSV encephalitis in pregnancy case reports

From: Herpes simplex virus encephalitis in pregnancy - a case report and review of reported patients in the literature

Year and Author Age (yrs) Gestation (wks) Type Admission Investigations Treatment Outcome
Febrile GCS Symptoms CSF CT/MRI EEG
2015 Dodd KC (This case) 37 33 1 N 15 Headache, vomiting, photophobia, diarrhoea, visual hallucinations, confusion and seizures. WCC 10 MRI - Initially normal, then increased signal in the left temporal lobe with cytotoxic oedema Left fronto-temporal epileptiform changes IV aciclovir 10 mg/kg TDS stopped after 16 days when repeat HSV PCR negative Elective caesarean section at 39 weeks. Mother and child well at 5 months.
HSV-1 PCR
2012. Pascal J, et al. [10] 31 33 1 Y 13 Pyrexia, vomiting, headache, neck stiffness, photophobia, phonophobia, visual and auditory symptoms. WCC 345 MRI - Hyperintensity with oedema in the right temporal area and cerebral peduncle Not done IV aciclovir 10 mg/kg TDS stopped after 21 days and repeat HSV PCR negative Normal vaginal delivery at 39 weeks with epidural analgesia. Mother and child normal and healthy 15 months later.
HSV-1 PCR
Mesker AJ et al. 2013 Dodd KC, et al. [11] 30 37 1 Y NK Headache, fever, mental status change and reduced consciousness. WCC unknown HSV-1 PCR CT + MRI - Abnormalities in right temporal lobe Not done IV aciclovir 750 mg TDS (unknown course length) Caesarean section at 37 weeks – healthy child.
Dexamethasone 10 mg QDS 4 days Patient improved but deficit in spatial orientation on discharge.
2009. Sellner et al.[12] 25 32 1 Y NK Tonic-clonic seizure, drowsy, headaches, photophobia, vomiting, antero- and retro-grade amnesia. WCC 125 MRI - Right temporopolar and medial hyperintensity, with cytotoxic oedema Not done IV aciclovir 12.5 mg/kg TDS for 21 days. Stopped after repeat HSV PCR negative. Caesarean section at 33 weeks due to deterioration.
HSV-1 PCR Mother and child healthy 4 weeks after discharge.
2008 Piskin N, et al.[13] 26 25 1 Y NK Fever, headache, nausea, mental status changes. Tonic-clonic seizure during admission. WCC 70 MRI - Increased signal and oedema in the right temporal region. Diffuse slowing with epileptic activity right frontal region. IV aciclovir 750 mg TDS for 21 days Normal vaginal delivery at term.
HSV-1 PCR Dexamethasone – reducing regimen 28 days 2 months later – MRI shows clear regression and repeat EEG normal.
2006 Gunduz A, et al. [14] 24 7 NK Y (low grade) NK Headache, episodes of unresponsiveness, non-convulsive status epilepticus. WCC Normal (figure not given) MRI - Normal Ictal state – nonconvulsive status Aciclovir 30 mg/kg/day (unknown duration) Patient improved and seizure free at 10 months on carbamazepine.
HSV PCR Pregnancy terminated.
2003 Godet C, et al.[15] 29 38 (post-partum) 2 Y NK Post caesarean section developed fever and then impaired consciousness and amnesia. WCC 9 CT – normal Normal Intravenous aciclovir 10 mg/kg every 8 hours The fever and neurological disorder resolved after a few days on aciclovir.
HSV-2 PCR
1999 Dupuis O, et al.[16] 31 35 1 Y NK Headache, vomiting, and photophobia. Then confusion, aphasia, and auditory hallucinations. WCC 138 CT - Normal Epileptic foci in left temporal region Intravenous aciclovir (unknown dose and duration) Delivered a healthy child at term.
HSV-1 PCR MRI - Abnormal signal in the left temporal region Three months later, the mother exhibited moderate amnesia.
1999 Dupuis O, et al.[16] 35 27 1 Y 15 Generalised seizure, fever, headache, and photophobia. Then confusion, followed by coma, right paraparesis and facial palsy. WCC 156 CT - Normal Abnormal signal in left frontotemporal region. Aciclovir (unknown dose and duration) Vaginal delivery at term. Child healthy.
HSV-1 PCR MRI - Increased signal in left temporal region. Mother walking by day 23. Seizure recurrence at 12 weeks. At one year severe anterograde memory loss.
1992 Luby JP.[17] 15 35 1 Y 15 Fever, nausea, sore throat, and headache. WCC 398 CT - A low density area in the right temporal lobe Not done Aciclovir 10 mg/kg TDS for 14 days. Labour induced at 35 weeks. Discharged after 15 days – patient and infant healthy.
Developed nystagmus, focal seizures and confusion. Brain biopsy culture grew HSV-1
1992 Anteby E, et al.[18] 28 21 NK Y NK Fever and acute confusional state. Mild right hemiparesis. WCC −0 initially, CT – normal Diffuse slowing, pronounced over the left parieto-temporal regions. Aciclovir (2250 mg/day) for 10 days Discharged in good health after 10 days. Delivery of normal child at 39 weeks.
105 after 1 week. MRI - normal
CSF serology – anti-HSV seroconversion 1:8 to 1:512
1990 Frieden FJ, et al.[19] 37 26 1 + 2 Y 14 Headache, confusion, aphasia, right sided paraesthesias, and fever. WCC 623 Antibody titres positive for type 1 (>1:1600) and type 2 (>1:400) CT - Low density in the left temporal-parietal region Diffuse bilateral cerebral dysfunction more prominent on the left Aciclovir IV 500 mg TDS (unknown duration) The patient improved gradually with treatment and discharged well on day 11. Forceps delivery at term of a healthy infant.
MRI - Increased signal left temporal-parietal region Methylprednisolone 25 mg IV QDS
1989 Besser R et al.[20] 25 23 1 Y 15 Headache, vomiting and fever. Nuchal rigidity and somnolence developed. WCC 320 CT - A large low-density lesion in the right temporal lobe sparing the lenticulate nucleus Moderate slowing of background activity with delta waves in the right temporal region Aciclovir 10 mg/kg TDS for 10 days Premature labour required tocolysis.
HSV-1 IgM and IgG (ELISA) Improved rapidly and completely once aciclovir started. Delivered a healthy child 16 weeks later.
HSV complement fixing antibodies in CSF rose from 1:2 to 1:16
1987 Hankey GJ, et al.[21] 22 29 NK Y 15 Fever, headache and malaise. Developed seizures and reduced GCS. WCC 270 CT - Hypodense area in right temporal lobe with oedema Diffusely abnormal, right side worse than left Aciclovir 800 mg/day 22 days Slow recovery over 2 months. Vaginal delivery at 41 weeks, healthy child.
Serum HSV complement fixation antibody titres, and HSV-specific IgM in CSF. Dexamethasone 4 mg QDS in a reducing regimen to 22 days On-going secondary generalised seizures, but otherwise well.
1986 Berger SA, et al.[22] 41 32 2 Y NK Fever, confusion, seizures, and then stupor. WCC 15 leucocytes CT – diffuse cerebral oedema with bitemporal cerebral necrosis Seizure foci in both temporal lobes Aciclovir IV 10 mg/kg TDS on day 5 for 3 doses and then day 13 for 7 days. Infant delivered day 18 by caesarean section. The child had disseminated HSV infection treated successfully with IV aciclovir. The mother died 2 days later.
Adenine arabinoside IV 30 mg/kg 8 days.
Dexamethasone
ELISA of maternal and infant sera demonstrated antibody to HSV-2.
1979 Roman-Campos G, et al.[7] 22 16 NK N NK Spontaneous abortion, and 2 months of abnormal behaviour. Post mortem – bitemporal necrotising encephalitis with intranuclear inclusion bodies in neurons. Electron microscopy - herpevirus particles. Not done Not done None Patient had curettage following admission, then developed shock and low GCS. Died on day three.
1979 Roman-Campos G, et al.[7] 17 24 NK N NK Bizarre behaviour, a week later coma and then seizures. WCC 0 Carotid angiogram negative Generalised low voltage slow activity in the temporal regions. Dexamethasone Delivered a macerated foetus after one week. Patient died after 2 weeks.
Brain biopsy – brain oedema and necrotising encephalitis with multiple internuclear inclusion bodies. Electron microscopy - herpesvirus particles.
1972 Anderson JM, et al.[23] 19 ~39 NK Y 15 Pharingitis and fever, followed by dysphasia, right hemiparesis, paraesthesia, hemianopia and reduced conscious level. CSF WCC not stated. Technetium brain scan – a large left temporal space occupying lesion. Not stated Idoxuridine 2.5 g TDS started after 10 days The patient died after twelve days. She delivered a healthy live child five days before she died.
Culture – HSV.
Brain biopsy –positive fluorescent antibody study to HSV
  1. Abbreviations: CSF: Cerebrospinal fluid, IV: Intravenous, MRI: Magnetic resonance imaging, NK: Not known, WCC: White cell count.