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Diseases That Mimic Herpes Simplex EncephalitisDiagnosis, Presentation, and Outcome
Richard J. Whitley, MD;
C. Glenn Cobbs, MD;
Charles A. Alford, Jr, MD;
Seng-Jaw Soong, PhD;
Martin S. Hirsch, MD;
James D. Connor, MD;
Larry Corey, MD;
Daniel F. Hanley, MD;
Myron Levin, MD;
Dwight A. Powell, MD;
NIAID Collaborative Antiviral Study Group
JAMA. 1989;262(2):234-239.
Abstract
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A total of 432 patients underwent brain biopsy for presumptive herpes simplex encephalitis. Three patient groups were identified. The first group, 195 patients (45%), had herpes simplex encephalitis confirmed by the isolation of herpes simplex virus from brain tissue at biopsy (193 patients) or autopsy (2 patients). The second group, 95 patients (22%), had diseases that were identified but that were not caused by herpes simplex virus. Three subgroups were recognized: (1) 38 patients (9%) with treatable disease, (2) 40 patients (9%) with nontreatable but diagnosed viral infection, and (3) 17 patients (4%) with identified diseases neither of viral etiology nor treatable. The third group, 142 patients (33%), remained without a diagnosis. Clinical presentation of patients in the second group was similar to that of those with herpes simplex encephalitis and those without a diagnosis. Patients in the subgroup with nontreatable but diagnosed viral infections had the greatest likelihood of returning to normal.
(JAMA. 1989;262:234-239)
Author Affiliations
From the Departments of Pediatrics, Microbiology, Biostatistics, and Medicine, University of Alabama at Birmingham (Drs Whitley, Cobbs, Alford, and Soong); the Department of Medicine, Massachusetts General Hospital, Boston (Dr Hirsch); the Department of Pediatrics, University of California at San Diego (Dr Connor); the Department of Medicine, University of Washington, Seattle (Dr Corey); the Department of Neurology, The Johns Hopkins University, Baltimore, Md (Dr Hanley); the Departments of Pediatrics and Medicine, University of Colorado, Denver (Dr Levin); and the Department of Pediatrics, Ohio State University, Columbus (Dr Powell).
Footnotes
Reprint requests to Department of Pediatrics, University of Alabama School of Medicine, Childrens' Hospital Tower, Suite 653, Birmingham, AL 35294 (Dr Whitley).
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