Management of HSV-1 encephalitis due to reactivation of HSV-1 during late pregnancy

Abstract A previously healthy 31-year-old G4P2 woman at 33 weeks of gestation was admitted as an emergency with a pyrexia of 39°C, vomiting, headache and neck stiffness associated with photophobia, phonophobia and visual and auditory symptoms. There were no heraldic signs of eclampsia. Polymerase ch...

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Bibliographic Details
Published in:International journal of obstetric anesthesia 2012-10, Vol.21 (4), p.364-367
Main Authors: Pascal, J, Perbet, S, Bourdel, N, Da Ines, D, Tran, X, Chartier, C, Bonnin, M, Mage, G, Bazin, J.-E, Constantin, J.-M
Format: Article
Language:English
Subjects:
Acyclovir - therapeutic use
Adult
Anesthesia & Perioperative Care
Antiviral Agents - therapeutic use
Brain - virology
Diagnosis, Differential
Encephalitis
Encephalitis, Herpes Simplex - cerebrospinal fluid
Encephalitis, Herpes Simplex - diagnosis
Encephalitis, Herpes Simplex - drug therapy
Encephalitis, Herpes Simplex - virology
Epidural analgesia
Female
Follow-Up Studies
Herpes simplex virus type 1
Herpesvirus 1, Human - physiology
Humans
Magnetic resonance imaging
Magnetic Resonance Imaging - methods
Obstetrics and Gynecology
Polymerase Chain Reaction - methods
Pregnancy
Pregnancy Complications, Infectious - cerebrospinal fluid
Pregnancy Complications, Infectious - diagnosis
Pregnancy Complications, Infectious - drug therapy
Pregnancy Complications, Infectious - virology
Pregnancy Trimester, Third
Virus Activation
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Summary:Abstract A previously healthy 31-year-old G4P2 woman at 33 weeks of gestation was admitted as an emergency with a pyrexia of 39°C, vomiting, headache and neck stiffness associated with photophobia, phonophobia and visual and auditory symptoms. There were no heraldic signs of eclampsia. Polymerase chain reaction and testing for herpes simplex virus in the cerebrospinal fluid diagnosed herpes simplex-1 meningoencephalitis. Following acyclovir, the clinical course improved. Spontaneous vaginal delivery occurred at 39 weeks of gestation with epidural analgesia using ropivacaine. Mother and child were neurologically normal and healthy 15 months later. Early administration of acyclovir is essential to reduce the risk of neurological complications. After treatment and a negative polymerase chain reaction for herpes simplex virus in the cerebrospinal fluid, epidural analgesia with local anesthetic and sufentanil is possible.
ISSN:0959-289X
1532-3374
DOI:10.1016/j.ijoa.2012.05.004