Infantile Herpes Encephalitis May Mimic Non-Accidental Injury

A DGReview of :"Infantile Herpes Simplex Encephalitis: Diagnostic Features and Differentiation from Non-accidental Injury."
Journal of Infection

01/15/2003
By David Loshak
 

It may not be possible to differentiate the early clinical features of neonatal herpes simplex encephalitis from non-accidental injury.

Relapsing herpes simplex encephalitis may also mimic recurrent encephalopathy caused by repeated non-accidental injuries.

As early diagnosis is clearly vital, infants with an unidentified encephalopathic illness should be examined by neuroradiology and their cerebrospinal fluid tested for herpes simplex virus DNA, say specialists at the John Radcliffe Hospital, Oxford, England. Together, these examinations could confirm and differentiate between the two conditions.

Although neonatal herpes simplex encephalitis is rare, it is associated with significant morbidity and mortality.

For this study, the researchers reviewed the clinical features and radiology of infants with herpes simplex encephalitis recently diagnosed by their laboratory after the infants had originally been diagnosed as having non-accidental injury but later found to have herpes simplex encephalitis.

Screening of cerebrospinal fluid samples sent to them from a wide range of British hospitals for herpes simplex virus polymerase chain reaction analysis identified those infants infected with herpes simplex virus.

After diagnosis was made, case notes and neuroradiology findings were reviewed. A limited follow-up was then undertaken, disclosing that 13 infants had herpes simplex encephalitis. In four cases, this followed a relapsing course.

Later assessments showed that six infants had neurological sequelae, while six appeared to be normal. One was lost to follow-up.

Neither a history of primary herpes simplex virus infection in pregnancy, nor skin lesions in the baby, assisted diagnosis. Magnetic resonance imaging indicated haemorrhage in the cortex, but no subdural haematomata, a hallmark of non-accidental injury, in five infants.
J of the Association for Research in Otolaryngology 2003;46(1):12-16. "Infantile Herpes Simplex Encephalitis: Diagnostic Features and Differentiation from Non-accidental Injury."

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