Herpetic encephalitis is a common form of neuroinfection caused by herpes viruses.
Herpetic encephalitis occurs in all age groups with a frequency of 8% -10% of the total number of viral encephalitis. The disease causes herpes virus type 1 and type 2.Newborn children are more often diagnosed with herpetic encephalitis, which is caused by the herpes simplex virus type 2.The source of herpes simplex for a child is a woman with an active stage of the disease, when there are eruptions on the genitals. Infection occurs when the mother's birth canal passes. In other cases, the cause of encephalitis is more often the herpes viruses of type 1, which latently persist in the body and can become active, or the primary infection with airborne droplets( contact).As a rule, the disease is severe and occurs more often than other viral encephalitis, has no seasonality.
Recent studies have shown that immunodeficiency states do not increase the risk of encephalitis.
The virus penetrates the gray matter of the brain, causing necrosis of nerve cells. Most often, the temporal lobes are affected, and, more rarely, lobes. Cysts are formed on the site of necrosis.
Symptoms of
Herpetic encephalitis, like any other, proceeds with severe headache. The disease begins acutely with fever to febrile figures( 39C-40C).There is a severe headache, vomiting, nausea, a pronounced general weakness. Drastically reduced or completely absent appetite. In some people, an increase in body temperature may be negligible. The febrile period lasts an average of several days to several weeks, sometimes it can be of a two-wave nature. After the first wave of fever, there is a light period when the patient feels well, headaches and fever disappear. The second wave of fever coincides with the appearance of neurological symptoms, which can grow acutely or gradually. With single-wave encephalitis, symptoms from the nervous system may appear already from 2 to 3 days after the onset of the disease.
Tropism of herpes viruses to the temporal and frontal lobes determines neurological symptoms. A person is disturbed by the sense of smell until a complete absence( anosmia), olfactory hallucinations may occur, which are manifested by the sensation of non-existent odors in the surrounding space. Violation of understanding and / or reproduction of speech( sensory aphasia and sensorimotor aphasia).Sensory aphasia is manifested by the lack of understanding of speech, but the reproduction of sounds is not disturbed. A person does not understand what he is told, utters individual sounds, syllables or words that do not carry a semantic load( "verbal okroshka").Sensory motor aphasia is manifested not only by the lack of understanding of the speech of others, but also by the violation of the reproduction of sounds and pronunciation of words( up to the complete loss of the ability to speak).
Another symptom of herpetic encephalitis is epileptic seizures. Attacks can be simple( consciousness is not lost) and complex( consciousness is lost).Complex seizures represent a loss of consciousness and the development of generalized seizures. Even in the early stages of the disease there is a high risk of the transition of the stage of oppressed consciousness to the stage of development of coma.
During partial seizures, a person ceases to come into contact with others, react to external stimuli, smells, or experiences visual hallucinations. There may be a feeling of crawling, numbness of parts of the body.
Some patients develop hemiparesis - weakness in the limbs on the one hand, hemianopsia - loss of visual fields on one side.
In the absence of treatment, a lethal outcome occurs in 50-70% of cases as a result of developing complications: edema and wedging of the brain into the large occipital foramen, oppression of the respiratory center, leading to a stopping of breathing, damage to the brainstem.
Treatment of
A patient with herpetic encephalitis is hospitalized in the intensive care unit. A person with herpes encephalitis is subject to mandatory admission to the intensive care unit or to the intensive care unit. This is necessary so that at any time of the disease there is a possibility to stop respiratory and cardiovascular complications.
In the acute period, the following groups of drugs are used:
- An etiotropic treatment directed to the herpes virus is prescribed. The drug of choice is acyclovir or valavir.
- Human immunoglobulins and interferons( laferobion) are used.
- Pathogenetic therapy is aimed at maintaining water-electrolyte balance, respiratory function, cardiovascular system work, reduction of intracranial pressure. For this purpose, use an albumin solution, crystalloids, blood plasma transfusion, glucose and electrolyte solution, glucocorticosteroids( prednisolone).
- In the development of respiratory failure, a person is transferred to mechanical ventilation.
- Nootropics( pantogam, pyracetam), vitamins( pyridoxine, riboflavin), vascular preparations( cavinton), antioxidants( mexiletine) are prescribed to improve the work of nerve cells, to maintain metabolism in the brain tissues.
- Antibiotic therapy is necessary to prevent the stratification of bacterial infection( cephalosporins, macrolides).
During the period of remission, a person may need drug support to reduce residual effects.
The outcome of the disease, as a rule, depends on the timely prescribed antiviral therapy. Early access to a doctor and diagnosis of herpetic encephalitis significantly reduce the risk of death.
