Herpes simplex virus encephalitis
Release time : 12/13/2024 15:18:49
Herpes simplex virus encephalitis, found worldwide, has no seasonal tendency, can occur at any age, and there is no gender difference. The condition is severe and the mortality rate is high.
Herpes Simplex Virus Encephalitis (HSE), abbreviated as HSE.
Also known as acute necrotizing encephalitis or acute inclusion body encephalitis.
This disease is sporadic, found around the world, with no seasonal tendency, and can occur at any age without gender differences. The condition is severe and the mortality rate is high.
This condition falls under the classification of traditional Chinese medicine's syndromes such as fever diseases, febrile toxin, headache, and mania. It results from the invasion of damp-heat pathogenic qi, transforming into fire and invading the nutritive energy, disturbing the clear orifices, and instigating liver wind.
Due to the absence of lymphoid tissue, macrophages, and potential immune active cells in the central nervous system (CNS), its own immune response ability is low, and peripheral anti-inflammatory cells or antibodies are not easily able to act through the blood-brain barrier. Therefore, less virulent pathogens can also cause severe infections of the CNS.
There are approximately 100 types of viruses worldwide that can cause CNS infections. Herpes simplex virus encephalitis is a brain inflammation caused by the herpes simplex virus (HSV) and is the most common type of non epidemic encephalitis both domestically and internationally, accounting for 20% to 68% of known viral encephalitis.
In 1941, the pathogen was first isolated and identified from the patient's brain.
Herpes simplex virus most commonly affects the temporal lobe, frontal lobe, and limbic system of the brain, causing hemorrhagic necrosis of brain tissue. Therefore, herpes simplex virus encephalitis is also known as acute necrotizing encephalitis or hemorrhagic encephalitis.
Symptoms of Herpes Simplex Virus Encephalitis: The condition is most commonly caused by herpes simplex virus type I (HSV-I) infection, primarily seen in adults.
What symptoms do people exhibit when they are infected? 1. General condition: The disease can occur at any time of the year, with the incubation period for primary infection ranging from 2 to 26 days, averaging 6 to 8 days. Premonitory symptoms may include upper respiratory infections, fever, headache, dizziness, sore throat, muscle pain, abdominal pain, diarrhea, fatigue, and lethargy.
The majority of cases present acutely, with a minority manifesting as subacute, chronic, or recurrent cases. Approximately one-fourth of patients have a history of oral and facial mucosal vesicular lesions. Most patients experience fever within days of onset, with the highest recorded temperature reaching 40 °C to 41°C.
The duration of the disease varies, ranging from several days to several months.
2. Psychiatric Symptoms: Early on, the predominant symptoms were those of psychiatric disorders, with an incidence rate of approximately 69% to 85%, primarily characterized by personality changes, decreased responsiveness, distractibility, reduced speech, incoherent or irrelevant responses, restlessness, poor social interaction, agitation, auditory hallucinations, visual hallucinations, elation, delusions, and deranged thinking. These symptoms are likely associated with damage to the temporal lobes and the limbic system, with some patients presenting to psychiatry solely due to psychopathological behavior as their primary or sole symptom.
3. Neurological symptoms may manifest as intellectual disfunction, poor time and spatial orientation, recent memory deficits, limb paralysis, and various forms of epileptic seizures (such as generalized tonic-clonic seizures and partial seizures).
4. Signs: These include hemianopia, nystagmus, pupillary inequality, oculomotor paralysis, increased muscle tone, hemiplegia, ataxia, altered reflexes, pyramidal signs, and signs of meningeal irritation such as diffuse or focal brain damage manifestations.
Severe cases may present varying degrees of consciousness impairment, or even coma; in severe cases, widespread cerebral necrosis and cerebral edema can lead to increased intracranial pressure and even cerebral herniation, resulting in death.
If not treated, about 70% to 80% of patients die from HSV encephalitis, and most survivors have severe sequelae.
Early diagnosis and treatment are key to reducing the mortality rate of this disease. This mainly includes specific antiviral therapy, concurrent immunosuppressive therapy, and symptomatic supportive treatment.
1. Antiviral Chemotherapeutic Agents: - Acyclovir (Acyclovir): A second-generation antiviral medication, derived from guanosine. It inhibits the activity of DNA polymerase through its ability to prevent the replication of viral DNA, thereby impeding the synthesis of virus structural proteins (gamma peptides), thus exerting its antiviral effect. It possesses strong anti-HSV capabilities.
The commonly used dosage is: for infants (over 6 months old), HSE is 500mg/m2, intravenous drip, once every 8 hours, with a treatment course of 10 days.
Adult 30mg/kg/day, divided into 3 intravenous infusions, used continuously for 14-21 days. Recurrence is common if it is less than 10 days.
The recommended treatment period is 21 days, and if the condition is severe, the treatment time may be extended or a second course of treatment may be administered.
2. Ganciclovir, which has been more recently introduced: its efficacy against herpes simplex virus (HSV) is 25-100 times that of acyclovir, and it offers broader antiviral activity and lower side effects.
The dosage is 5-10mg/kg/day, intravenous drip, the course of treatment is 10-14 days.
2. Immunosuppressant therapy:
Muscle cells can produce sufficient endogenous interferons in the human body.
2) Transfer factor: It can sensitize normal lymphocytes and convert them into immune lymphocytes, which can be injected subcutaneously 1-2 times a week, with 1 tube per injection.
3) Adrenocortical Steroids: For patients with severe conditions, those with hemorrhagic necrosis in the brain CT scan, and a significant increase in cerebrospinal fluid red blood cells and white blood cells, they may be used appropriately.
3. Supportive treatment for all aspects is crucial for patients with severe conditions and coma, ensuring nutritional balance and maintaining fluid and electrolyte homeostasis while preserving the patency of the respiratory tract.
Provide intravenous hypernutrition when necessary, enhance life care, prevent bedsores and respiratory infections and other complications.
4. Symptomatic treatment includes physical cooling, anticonvulsants, sedation, dehydration, and intracranial pressure reduction for patients with high fever.
Nursing care for herpes simplex encephalitis. The course of the disease lasts from several weeks to several months, with a mortality rate of 19% -70%. In some cases (about 5%-10%) there is a recurrence after one to three months of treatment.
Among the survivors, about 2/3 have residual symptoms such as epilepsy, mental abnormalities or cognitive dysfunctions. In a very few cases, these may even lead to a state of coma.
We should take good care of patients, keep the environment quiet, strengthen nutrition, and provide high protein and vitamin diet.
Actively assist in rehabilitation treatment and prevent the occurrence of sequelae.
Patients in a comatose state require enteral nutrition via the nasal route to prevent pressure sores.
Maintain airway patency.
Pay attention to water, electrolyte, and acid-base balance, and provide oxygen at low flow rates.
The medical section mentioned in this article is for reference only.
In the event of discomfort, it is recommended to seek medical attention immediately for a definitive diagnosis and treatment.