KẾT QUẢ ĐIỀU TRỊ VIÊM NÃO DO VIRUS HERPES SIMPLEX Ở TRẺ EM TẠI BỆNH VIỆN NHI TRUNG ƯƠNG NĂM 2019-2025

Abstract

Objectives: To describe the treatment outcomes and associated factors in pediatric patients with Herpes simplex virus (HSV) encephalitis at Vietnam National Children’s Hospital. Subjects and Methods: A cross-sectional descriptive study on fifty-four children with Herpes simplex encephalitis were hospitalized from January 2019 to June 2025 at Vietnam National Children's Hospital. Results: In our study, the median age was 19 months (interquartile range [IQR], 10.5 - 48 months), and the male-to-female ratio was 1.16: 1. The most common symptom was fever (96.3%), followed by seizures (87%), nausea and vomiting (59.3%), headache (24.1%), constipation (31.5%), and diarrhea (48.1%). In 75.9% of cases, there was cerebrospinal fluid (CSF) pleocytosis with a median of 17 cells/mm³ (interquartile range [IQR], 5.5 - 61.3 cells/ mm³), predominantly lymphocytic (73%). All patients had normal CSF protein levels and normal CSF glucose concentrations. Cerebral magnetic resonance imaging revealed that the temporal lobes were the most frequently injured regions (70.4%), followed by the frontal lobes (50%), thalamus (35.2%), and parietal lobes (18.5%). All patients received acyclovir therapy; the mean time from symptom onset to initiation of acyclovir was 4 days (range, 2 – 12 days). After two weeks of treatment, 94.3% of patients had CSF negative for HSV by PCR. At discharge: The rate of patients who completely recovered is 31.5%; sequelae is 66.6%, and 1.9% requested discharge due to severe disease; there were no in-hospital deaths. Interestingly, patients treated early, within 3 days of symptom onset, had better outcomes than those treated after 3 days (p<0.001). Conclusions: The rate of sequelae after HSV encephalitis remains significant, early initiation of treatment is associated with improved therapeutic efficacy. To mitigate this burden, acyclovir should be started as early as possible in patients with suspected acute encephalitis in order to minimize neurological sequelae.