HSV Encephalitis
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Clinic
- Prevalence: 500,000 individuals per year, 2-4 cases per 1 million population.
- 90% caused by HSV-1,10% due to HSV-2
- Fever and may have seizures esp in temporal lobe
- Common symptoms of HSE include
- Headaches, Drowsiness, Hyperactivity, General weakness
- Mostly have Impaired level of consciousness+ Altered mental state presenting as confusion.,.
- Symptoms similar with meningitis such as a Stiff neck, Altered reflexes, Confusion, Speech abnormalities.
- Skin lesions usually are not found in association with herpes simplex encephalitis. [1]
- HSE can trigger of NMDR encephalitis.
- The virus lies dormant in the ganglion of the trigeminal cranial nerve.
- Olfactory nerve may be involved, which explain its predilection for the temporal lobes.
- Recently included 420 adult patients with schizophrenia or bipolar spectrum and 481 healthy controls. The results of this cross-sectional study indicate that HSV-1 may be an environmental factor associated with brain structural abnormalities and cognitive impairment in severe mental illnesses such as Schizophrenia and bipolar disorder. [2]
- HSV-1 is the most common cause of sporadic necrotizing encephalitis in US, with a mortality rate of 30 -70%, and leaves various neurologic sequelae in the survivors. HSV-2 has been recognized as an etiologic agent in fatal infections in neonates and a mild meningitis in adults, but its role in encephalitis in adults is less well known. We suggest that some cases of acute psychosis may, like in our case, represent HSV-2 encephalitis.[3]
- HSE as a cause of psychosis is rare. It is suggested that herpes infection like other environmental stressors causes psychosis through inhibition of NMDA receptor and subsequent microglia activation in the hippocampus. [4]
- Seizures during the acute phase of HSE are the main risk for the development of postencephalitic epilepsy [5]
- Persistent infection with HSV and other brain infections is consistently associated with cognitive impairment. These infections can also affect sleep. Thus, sleep abnormalities could explain the cognitive dysfunction.[6]
- ↑ NORD
- ↑ Andreou, D., Jørgensen, K.N., Nerland, S. et al. Herpes simplex virus 1 infection on grey matter and general intelligence in severe mental illness. Transl Psychiatry 12, 276 (2022). https://doi.org/10.1038/s41398-022-02044-3
- ↑ Herpes simplex type 2 virus encephalitis presenting as psychosis, VOLUME 73, ISSUE 3, P445-448, SEPTEMBER 01, 1982
- ↑ Klein H. C., Doorduin J., de Witte L., de Vries E. F. Immunology and Psychiatry. Vol. 8. Switzerland: Springer; 2015. Microglia activation, herpes infection, and NMDA receptor inhibition: common pathways to psychosis? pp. 243–254. (Current Topics in Neurotoxicity).
- ↑ Sellner J, Trinka E. Seizures and epilepsy in herpes simplex virus encephalitis: current concepts and future directions of pathogenesis and management. J Neurol. 2012 Oct;259(10):2019-30. doi: 10.1007/s00415-012-6494-6. Epub 2012 Apr 18. PMID: 22527234.
- ↑ Meshreky KM, Wood J, Chowdari KV, Hall MH, Wilckens KA, Yolken R, Buysse DJ, Nimgaonkar VL. Infection with Herpes Simplex virus type 1 (HSV-1) and sleep: The dog that did not bark. Psychiatry Res. 2019 Oct;280:112502. doi: 10.1016/j.psychres.2019.112502. Epub 2019 Jul 31. PMID: 31382180; PMCID: PMC7265549.