Infantile Herpes Simplex Virus Meningitis: A Case Report

Herpes simplex virus (HSV) is one of the main causes of neonatal meningitis; nonetheless, it usually goes unreported. A lumbar puncture is needed to accurately differentiate between viral and bacterial meningitis. The cerebrospinal fluid can be analyzed to exclude bacterial meningitis; nevertheless, the identification of the specific viral cause may be beneficial. Viral diagnosis determines prognosis, improves the care of the patient, decreases hospitalization duration, and reduces unnecessary use of antibiotics. In young infants, the herpes simplex virus infection is responsible for serious complications leading to morbidity, mortality, and permanent sequelae in survivors. The clinical findings of this infection usually include tremors, seizures, lethargy, irritability, poor feeding, temperature instability, and a bulging anterior fontanel, which are common in almost all forms of meningitis. These similarities make the differential diagnosis rather difficult.

Case report: 

We report and discuss the case of an an11-day-old neonate girl who presented with fever and negative test results, as well as our challenges that finally led to the diagnosis of HSV-related meningitis and its management.

It could be managed to reach a firm diagnosis confirming the initial differential diagnosis through additional and repetitive testing. Therefore, it is concluded that clinical judgments may be more reliable than paraclinical results in the individual approach for each patient. Furthermore, HSV infection should also be considered for patients with a persistent fever of unknown origin. It is also recommended to adopt separate procedures for the suspicion of HSV type 1 and HSV type 2.