Post-COVID-19 HSV encephalitis: a review.

Abstract

BACKGROUND:

Herpes simplex virus encephalitis (HSVE) is one of the most common infectious causes of sporadic encephalitis. Coronavirus disease (COVID-19) has been associated with immune dysregulation of the host that might increase the risk of infections like HSVE following SARS-CoV-2 infection. There is paucity of literature on post COVID-19 HSVE. This study was conducted with the aim of analyzing the clinical presentation, brain imaging, and outcome of patients presenting with HSVE within 6 weeks of COVID-19 and providing a comprehensive review on the possible mechanisms of post-COVID-19 HSVE.

METHODS:

This observational study included patients who had laboratory-confirmed HSVE (type 1 or type 2) and a history of COVID-19 within the previous 6 weeks. Patients were followed up for 3 months.

RESULTS:

Eight patients were included and all of them had type 1 HSVE. The mean latency of onset of neurological symptoms from being diagnosed with COVID-19 is 23.87 days and a majority of the patients have received injectable steroids with a mean duration of 6.5 days. Behavioral abnormality was the commonest neurological presentation and typical brain imaging involved T2 FLAIR hyperintensities of the medial temporal lobes. All patients received intravenous acyclovir 10 mg/kg every eight hourly for atleast 14 days. One patient with concomitant rhinocerebral mucormycosis succumbed while the majority had a complete recovery.

CONCLUSION:

Possible immune dysregulation in COVID-19 may increase the susceptibility of HSVE in patients with a history of recent SARS-CoV-2 infection. The clinical manifestations and laboratory findings of HSVE in such patients are similar to typical HSVE.

• Authors: S Gupta, A Dutta, U Chakraborty, R Kumar, D Das, B K Ray
• Journal: QJM : monthly journal of the Association of Physicians (QJM) Vol. 115 Issue 4 Pg. 222-227 (Apr 20 2022) ISSN: 1460-2393 [Electronic] England
• PMID: 35199176 (Publication Type: Journal Article, Review)
• Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For permissions, please email: [email protected].

Chemical References

• Acyclovir

Topics

• Acyclovir (therapeutic use)
• COVID-19 (complications)
• Encephalitis, Herpes Simplex (complications, diagnosis, drug therapy)
• Herpes Simplex
• Humans
• Observational Studies as Topic
• SARS-CoV-2