title: Exacerbation of herpes simplex encephalitis after successful treatment with acyclovir.
abstract: Herpes simplex encephalitis (HSE) in children sometimes exacerbates after successful treatment; yet the frequency, etiology, and clinical features of exacerbation remain unclear. We report data for 27 children with HSE confirmed by polymerase chain reaction (PCR) analysis; all were successfully treated with acyclovir, but 7 (26%) had a relapse of encephalitic illness. In 2 of those 7, serial examination with a PCR assay showed that herpes simplex virus (HSV) DNA reappeared temporarily in the cerebrospinal fluid (CSF). For 5 of the 7 patients, a second course of acyclovir therapy was effective. Coxsackievirus A9 was isolated from CSF of 1 case patient during subsequent exacerbation. The total dose during initial acyclovir therapy was significantly lower in the relapse group than in the control group (P=.027). In conclusion, exacerbation of HSE in children may be more common than previously recognized. It is suggested that the replication of HSV or another viral pathogen caused a second encephalitic illness (HSE) in some cases.
authors.affiliation: Department of Pediatrics, Nagoya University School of Medicine, Nagoya 466-8550, Japan. yyito@med.nagoya-u.ac.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Ito
authors.forename: H
authors.initials: H
authors.lastname: Kimura
authors.forename: Y
authors.initials: Y
authors.lastname: Yabuta
authors.forename: Y
authors.initials: Y
authors.lastname: Ando
authors.forename: T
authors.initials: T
authors.lastname: Murakami
authors.forename: M
authors.initials: M
authors.lastname: Shiomi
authors.forename: T
authors.initials: T
authors.lastname: Morishima
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use*; D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D004279:DNA, Viral / Q000134:cerebrospinal fluid; D020803:Encephalitis, Herpes Simplex / Q000188:drug therapy* / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016133:Polymerase Chain Reaction; D012008:Recurrence; D018139:Simplexvirus / Q000502:physiology*
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D000212:Acyclovir