Herpes simplex virus-1 herpetic meningoencephalitis in Adults: Three cases in Casablanca, Morocco

Abstract

Herpes simplex virus type 1 is the first cause of acute focal encephalitis with necrosis of the cerebral parenchyma in children and adults, with high morbidity. Herpes simplex virus type 2 is the main cause of herpetic meningitis in adults, with a good evolution. Herpetic meningoencephalitis is rarely caused by HSV-1. We report three observations of PCR-confirmed HSV-1 meningoencephalitis in cerebrospinal fluid in young immunocompetent adults aged 27, 53, and 58. They presented with a meningoencephalitis picture consisting of a meningeal syndrome and encephalic involvement. Lumbar puncture confirmed lymphocytic clear-fluid meningitis, with a median white blood cell count of 97, red blood cell count of 69, proteinorachia of 0.78, and glycorachia of 0.62. Cerebral magnetic resonance imaging is the gold-standard neuroimaging technique in the management of herpetic meningoencephalitis. Early initiation of acyclovir has contributed significantly to improved patient outcomes and prognosis. Herpetic meningoencephalitis is a diagnostic and therapeutic emergency, with a very poor functional prognosis, particularly in terms of complications.