Suspicious Encephalitis: Herpes Simplex vs. Other Diagnosis

Herpes simplex encephalitis (HSE) is the most common cause of encephalitis worldwide and is a potentially fatal infection of the central nervous system. Therefore, early and accurate treatment of this disease is vital. Clinical manifestations and paraclinical findings can help physicians in precious diagnosis and treatment.

The present study aimed to assess the clinical/paraclinical findings and outcomes of patients suspected to HSE.

In a descriptive-analytical study, 70 patients suspected to HSE were prospectively enrolled and divided into three groups: confirmed HSE, other-diagnosis, and without-diagnosis groups. The clinical/paraclinical findings and outcomes of the three groups were gathered using demographic and HSE checklists. The data were analyzed using the Kruskal-Wallis and ANOVA tests.

There was a significant difference in the mean age (P = 0.016), sex (P = 0.027), and seizure (P = 0.001) between the three groups so that the HSE group patients were younger, mostly female, with seizure observed in more than half of these patients. The treatment period was significantly longer in the HSE group (P < 0.001). The mean of ESR was lower in the HSE group (P = 0.034), and CRP was higher in the other-diagnosis group (P = 0.0231); they were significantly different lab tests between the three groups. The diagnostic results of HSE in magnetic resonance imaging (MRI) showed a significant difference between the three groups (P < 0.001). Neurological sequels were significantly higher in the HSE group (P = 0.029). Differences in other findings were not statistically significant.

Seizure as a clinical finding and brain MRI as a paraclinical investigation is helpful for the differentiation of HSE from other similar diseases. The early use of acyclovir for suspected patients plays a pivotal role in the improvement of the clinical prognosis of HSE. We suggest that physicians prescribe acyclovir as soon as HSE is clinically suspected.