Analysis of clinical manifestations and prognostic factors of herpes simplex virus type 1 encephalitis

Abstract

Objective To analyze the clinical features and prognostic factors of herpes simplex virus type 1 (HSV‐1) encephalitis. Methods A total of 51 patients with HSV‐1 encephalitis hospitalized in He'nan Provincial People's Hospital from January 2018 to September 2023 were selected, and their clinical data, laboratory and imaging examination results were recorded. The modified Rankin Scale (mRS) was used to evaluate the prognosis of patients and the recovery of neurological function after brain injury. Univariate and multivariate stepwise Logistic regression analyses were screened for risk factors of adverse prognosis of HSV‐1 encephalitis. Results The main symptoms of 51 cases were fever and headache. The serological examination results showed increased white blood cell count (14 cases), increased neutrophil count (14 cases), decreased lymphocyte count (8 cases), and decreased serum sodium level (17 cases). Cerebrospinal fluid (CSF) examination by lumbar puncture showed increased CSF pressure (18 cases), increased white blood cell count (28 cases), increased protein (32 cases), and increased glucose (15 cases). There were 48 patients who underwent head MRI examination, and 43 patients (89.58%) showed obvious brain region involvement on head MRI, among which 35 patients (72.92%) with positive MRI showed typical unilateral or bilateral temporal and frontal lobe involvement, and 8 cases (16.67%) with increased cerebral pia mater enhancement. 66.67% (34/51) of the patients recovered completely within 6 months after discharge, 21.57% (11/51) of the patients had sequelae, and the fatality rate was 11.76% (6/51). There were 34 (66.67%) patients with good prognosis and 17 (33.33%) patients with adverse prognosis. Multivariate Logistic regression analysis showed age increased (OR = 1.090, 95%CI: 1.020-1.200; P = 0.023) and increased CSF glucose level (OR = 23.800, 95%CI: 23.800-1250.000; P = 0.030) were risk factors for adverse prognosis in HSV‐1 encephalitis patients. Conclusions Increased aging and CSF glucose level are risk factors for the adverse prognosis in HSV ‐ 1 encephalitis patients. In clinical practice, it is necessary to master the clinical characteristics of patients with HSV‐1 encephalitis, so as to achieve early detection, diagnosis and treatment.

DOI: 10.3969/j.issn.1672‐6731.2024.04.005