Oleh :

dr. Rahmad Ramadhani

Program Pendidikan Dokter Spesialis Ilmu Kesehatan Anak

Fakultas Kedokteran Universitas Lambung Mangkurat
2019
Alsweed A, Alsuhibani M, Casanova J. International Journal of Pediatrics and Approach to
recurrent Herpes Simplex Encephalitis in children. Int J Pediatr Adolesc Med [Internet].
2018;5(2):35–8. Available from: https://doi.org/10.1016/j.ijpam.2018.05.004
Duarte LF, Farías MA, Álvarez DM, Bueno SM, Riedel CA, González PA. Herpes Simplex Virus
Type 1 Infection of the Central Nervous System : Insights Into Proposed Interrelationships
With Neurodegenerative Disorders. 2019;13(February):1–23.
• Herpes simplex encephalitis (HSE) annual incidence is 1 in
every 250-500 thousand in the developed countries
• Encephalitis caused by HSV-1 accounts for most of the
cases, and it typically affects older children
• In the United States, the incidence of viral encephalitis, in
general, is 20,000 per year and roughly up to 20% of them
are caused by HSV-1, and one in every three patients is a
child

Alsweed A, Alsuhibani M, Casanova J. International Journal of Pediatrics and Approach to

recurrent Herpes Simplex Encephalitis in children. Int J Pediatr Adolesc Med [Internet].
2018;5(2):35–8. Available from: https://doi.org/10.1016/j.ijpam.2018.05.004
• Regarding how HSV-1 reaches the CNS to develop HSE,
several routes and mechanisms have been proposed
both, as a consequence of primary infection or due to
viral reactivations
• How HSV damage neuron :
a) Modulates apoptosis-related pathway
b) Modulates autophagy
c) Modulates mitochondria oxidative stress

Duarte LF, Farías MA, Álvarez DM, Bueno SM, Riedel CA, González PA. Herpes Simplex Virus
Type 1 Infection of the Central Nervous System : Insights Into Proposed Interrelationships
With Neurodegenerative Disorders. 2019;13(February):1–23.
Sabah M, Mulcahy J, Zeman A. Herpes simplex encephalitis. 2016;(June 2012).
• Lumbar puncture (LP) should be done for all patients
with suspension for HSE provide no contraindication such
as an elevated intracranial pressure.
• Elevated protein and pleocytosis with predominance of
lymphocyte are the commonest finding in HSE.
• CSF glucose is usually normal
• CSF RBCs are usually normal unless the patient has
advance HSE (necrosis) or hemorrhagic encephalitis
which will increase RBCs in CSF.
• Normal CSF values has been reported in HSE 5-10%.
Alsweed A, Alsuhibani M, Casanova J. International Journal of Pediatrics and Approach to
recurrent Herpes Simplex Encephalitis in children. Int J Pediatr Adolesc Med [Internet].
2018;5(2):35–8. Available from: https://doi.org/10.1016/j.ijpam.2018.05.004
• The gold standard test for diagnosis of HSE is HSV DNA
PCR which is highly sensitive and specific (reach up to
96% in both).
• HSV DNA PCR can yield negative result if the CSF sample
tested early in the disease course and it can persist
positive for 7-10 days despite acyclovir therapy.

Alsweed A, Alsuhibani M, Casanova J. International Journal of Pediatrics and Approach to

recurrent Herpes Simplex Encephalitis in children. Int J Pediatr Adolesc Med [Internet].
2018;5(2):35–8. Available from: https://doi.org/10.1016/j.ijpam.2018.05.004
• The neuroimaging of choice for HSE diagnosis is MRI
brain which is more sensitive and specific than CT scan
• Edema, hemorrhage, and necrosis in the inferomedial
temporal lobe is the common imagining abnormality.
• The brain involvement could be unilateral or bilateral

Alsweed A, Alsuhibani M, Casanova J. International Journal of Pediatrics and Approach to

recurrent Herpes Simplex Encephalitis in children. Int J Pediatr Adolesc Med [Internet].
2018;5(2):35–8. Available from: https://doi.org/10.1016/j.ijpam.2018.05.004
• EEG finding is abnormal in the majority of patient.
• Periodic lateralization epileptiform discharge is
characteristic for HSE.

Alsweed A, Alsuhibani M, Casanova J. International Journal of Pediatrics and Approach to

recurrent Herpes Simplex Encephalitis in children. Int J Pediatr Adolesc Med [Internet].
2018;5(2):35–8. Available from: https://doi.org/10.1016/j.ijpam.2018.05.004
• High index of suspicion, early diagnosis and prompt start
of antiviral is crucial.
• Intravenous Acyclovir is the mainstay of treatment in
addition to supportive management and good hydration.
• The current recommended dose is 45 mg/kg per day in 3
divided doses in children and 60 mg/kg per day in 3
divided doses for neonate.
• Acyclovir resistant to HSV which mostly due to mutation
of the viral thymidine-kinase gene is rare in
immunocompetent patient.
Alsweed A, Alsuhibani M, Casanova J. International Journal of Pediatrics and Approach to
recurrent Herpes Simplex Encephalitis in children. Int J Pediatr Adolesc Med [Internet].
2018;5(2):35–8. Available from: https://doi.org/10.1016/j.ijpam.2018.05.004
• Foscarnet is an alternative antiviral for the treatment of
acyclovir-resistant HSV.
• There is controversy about adjuvant corticosteroids
therapy for HSE, and it is not routinely recommended
• Corticosteroid may be indicated in HSE complicated by
vasogenic brain edema.

Alsweed A, Alsuhibani M, Casanova J. International Journal of Pediatrics and Approach to

recurrent Herpes Simplex Encephalitis in children. Int J Pediatr Adolesc Med [Internet].
2018;5(2):35–8. Available from: https://doi.org/10.1016/j.ijpam.2018.05.004
TERIMA KASIH