What is the prevalence of relapse following treatment of herpes simplex encephalitis (HSE)?

Updated: Jul 17, 2018
  • Author: Wayne E Anderson, DO, FAHS, FAAN; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Relapses after HSE have been reported to occur in 5-26% of patients, with most relapses occurring within the first 3 months after completion of treatment. Relapses are more frequent in children than adults. It is unclear whether such relapses represent recurrence of viral infection or an immune-mediated inflammatory process. Some of the relapses reported in earlier studies may have been due to inadequate duration of treatment rather than true recurrences of HSE.

A long-term follow-up study of patients with HSE suggested that the pathogenic mechanisms present during relapses differ from those present during the initial infection. [29] Serial measurements of inflammatory markers as well as HSV viral load in the CSF of relapsing patients demonstrated increased inflammatory markers without detectable HSV during relapses. These findings suggest that immune-mediated events, rather than direct viral-mediated neuronal toxicity, may predominate in relapses.


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