title: Herpes simplex virus encephalitis in Peru: a multicentre prospective study.
abstract: Herpes simplex virus (HSV) is one of the most commonly identified infectious aetiologies of encephalitis in North America and Europe. The epidemiology of encephalitis beyond these regions, however, is poorly defined. During 2009-2012 we enrolled 313 patients in a multicentre prospective study of encephalitis in Peru, 45 (14·4%) of whom had confirmed HSV infection. Of 38 patients with known HSV type, 84% had HSV-1 and 16% had HSV-2. Patients with HSV infection were significantly more likely to present in the summer months (44·4% vs. 20·0%, P = 0·003) and have nausea (60·0% vs. 39·8%, P = 0·01) and rash (15·6% vs. 5·3%, P = 0·01) compared to patients without HSV infection. These findings highlight differences in the epidemiology and clinical presentation of HSV encephalitis outside of the Northern Hemisphere that warrant further investigation. Furthermore, there is an urgent need for improved HSV diagnostic capacity and availability of intravenous acyclovir in Peru.
authors.affiliation: US Naval Medical Research Unit-6,Callao,Peru.
authors.forename: S M
authors.initials: SM
authors.lastname: Montano
authors.affiliation: Fogarty International Center,National Institutes of Health,Bethesda,MD,USA.
authors.forename: N
authors.initials: N
authors.lastname: Mori
authors.affiliation: Fogarty International Center,National Institutes of Health,Bethesda,MD,USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Nelson
authors.affiliation: Department of Neurology,School of Medicine,University of Washington,Seattle,WA,USA.
authors.forename: T G N
authors.initials: TG
authors.lastname: Ton
authors.affiliation: Hospital Belen,Trujillo,Peru.
authors.forename: V
authors.initials: V
authors.lastname: Celis
authors.affiliation: Hospital Dos de Mayo,Lima,Peru.
authors.forename: E
authors.initials: E
authors.lastname: Ticona
authors.affiliation: Hospital Cesar Garayar García,Loreto,Peru.
authors.forename: M
authors.initials: M
authors.lastname: Sihuincha
authors.affiliation: US Naval Medical Research Unit-6,Callao,Peru.
authors.forename: D H
authors.initials: DH
authors.lastname: Tilley
authors.affiliation: US Naval Medical Research Unit-6,Callao,Peru.
authors.forename: T
authors.initials: T
authors.lastname: Kochel
authors.affiliation: Department of Neurology,School of Medicine,University of Washington,Seattle,WA,USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Zunt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D020803:Encephalitis, Herpes Simplex / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010568:Peru / Q000453:epidemiology; D011446:Prospective Studies; D012621:Seasons; D018139:Simplexvirus / Q000145:classification / Q000302:isolation & purification*; D055815:Young Adult
keywords: Central nervous system infections; encephalitis; epidemiology; herpes simplex virus; virology