title: Central nervous system herpes simplex virus infection in afebrile children with seizures.
abstract: Central nervous system herpes simplex virus infection is suspected in patients presenting with acute-onset seizures and lethargy. The potential neurologic sequelae from untreated herpes infection can prompt empirical acyclovir therapy, even in afebrile subjects. The objectives of this study were to determine the frequency of central nervous system herpes simplex virus infection in children presenting with afebrile seizures and to assess the need for empirical acyclovir therapy. Clinical and laboratory data of children with acute-onset afebrile seizures and children with central nervous system herpes simplex virus infection were compared. Polymerase chain reaction and viral cultures of the cerebrospinal fluid for herpes simplex virus infection were negative in all subjects with afebrile seizures; 32.7% of these subjects were empirically treated with acyclovir. In conclusion, central nervous system herpes simplex virus infection is uncommon in children presenting with afebrile seizures, and acyclovir therapy is rarely necessary in subjects with normal neurologic examination and cerebrospinal fluid analysis.
authors.affiliation: Department of Pediatrics, Women and Children's Hospital of Buffalo and State University of New York, University at Buffalo, Buffalo, NY, USA. indmaj@yahoo.com
authors.forename: Indrajit
authors.initials: I
authors.lastname: Majumdar
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Hartley-McAndrew
authors.forename: Arie L
authors.initials: AL
authors.lastname: Weinstock
mesh_terms: D000293:Adolescent; D002494:Central Nervous System Infections / Q000150:complications* / Q000821:virology*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D006561:Herpes Simplex / Q000150:complications*; D006801:Humans; D007223:Infant; D008297:Male; D009460:Neurologic Examination; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology* / Q000821:virology*; D018139:Simplexvirus / Q000472:pathogenicity*