Post COVID-19 HSV encephalitis: a review

Link to article at PubMed

QJM. 2022 Feb 23:hcac060. doi: 10.1093/qjmed/hcac060. Online ahead of print.


BACKGROUND: Herpes simplex virus encephalitis (HSVE) is one of the most common infectious cause of sporadic encephalitis. COVID-19 has been associated with immune dysregulation of the host which 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 analysing the clinical presentation, brain imaging, and outcome of patients presenting with HSVE within six 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 six 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 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 10mg/kg every eight hourly for atleast 14 days. One patient with concomitant rhinocerebral mucormycosis succumbed while majority had complete recovery.

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

PMID:35199176 | DOI:10.1093/qjmed/hcac060

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