MIXED INFECTION - HANTAVIRUS HAEMORRHAGIC FEVER WITH RENAL SYNDROME AND HERPES SIMPLEX VIRUS ENCEPHALITIS

P. Argirova, I. Boev, M. Stoycheva
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Abstract

Introduction: This case report describes a patient treated at the Clinic of Infectious Diseases of University Hospital “St. George” Plovdiv, with two infections occurring at the same time – haemorrhagic fever with renal syndrome (HFRS) and herpes simplex virus (HSV) encephalitis. Results: A 53-year-old male presented with fever, flu-like syndrome and renal impairment with mild nitrogen elevation. The patient was treated at the Clinic of Nephrology for one week. Several hours after discharge he had three generalised tonic-clonic seizures and was admitted to the intensive care unit with status epilepticus and acute respiratory failure requiring intubation and mechanical ventilation for 4 days. Lumbar puncture results showed: white blood cells – 1.10 6 /l, glucose – 5.3 mmol/l, total protein – 1.6 g/l, increased immunoglobulin levels. The patient was transferred to the Clinic of Infectious Diseases with suspicion of viral encephalitis. HSV type 1 was detected in the cerebrospinal fluid by PCR. Due to suspected hantavirus infection, serum was examined and IgM and IgG antibodies against the HFRS virus were detected by ELISA. Specific treatment with acyclovir was started and there was a rapid improvement in the clinical condition. Convulsions did not recur. Nitrogen levels normalised and there was a short period of polyuria. Thrombocytopenia quickly resolved without occurrence of haemorrhagic syndrome. In the course of the disease, the patient developed mild diarrhoeal syndrome and left thrombophlebitis. He was discharged clinically well with negative PCR results for HSV. In conclusion, we can assume that as a result of immunosuppression due to HFRS, HSV type 1 reactivated and led to herpes encephalitis.
混合感染-汉坦病毒出血热伴肾综合征和单纯疱疹病毒脑炎
本病例报告描述了在“圣乔治”普罗夫迪夫大学医院传染病诊所治疗的一名患者,同时发生两种感染-肾综合征出血热(HFRS)和单纯疱疹病毒(HSV)脑炎。结果:男性53岁,表现为发热、流感样综合征和肾功能损害,伴有轻度氮升高。病人在肾内科门诊治疗了一个星期。出院后数小时,患者出现三次全身性强直阵挛性发作,并因癫痫持续状态和急性呼吸衰竭入住重症监护病房,需要插管和机械通气4天。腰椎穿刺结果显示:白细胞- 1.10 6 /l,葡萄糖- 5.3 mmol/l,总蛋白- 1.6 g/l,免疫球蛋白水平升高。病人怀疑为病毒性脑炎,转至传染病科。用PCR检测脑脊液中HSV 1型。对疑似汉坦病毒感染的患者进行血清检测,ELISA检测HFRS病毒IgM和IgG抗体。开始用阿昔洛韦进行特异性治疗,临床情况迅速改善。抽搐没有再发生。氮水平恢复正常,有短时间的多尿。血小板减少症迅速消失,无出血综合征发生。在发病过程中,患者出现轻度腹泻综合征和左血栓性静脉炎。患者临床出院,PCR检测结果为HSV阴性。总之,我们可以假设由于HFRS引起的免疫抑制,HSV 1型重新激活并导致疱疹脑炎。
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