Métodos diagnósticos complementarios: ¿Cuál es su utilidad clínica real en las encefalitis herpéticas?

Objectives: Depict the form of the clinical manifestation of the herpetic encephalitis and prove the utility of the different complementary explorations in its use. Material and methods: Retrospective revision of the herpetic encephalitis cases diagnosed through quantitative PCR which required to be admitted in UCIP (Intensive Care and Pediatric Urgencies). There was a collection of data regarding the clinical evolution and the sensitivity of the different complementary diagnostic methods. In the 7 cases the LCR was reevaluated through DNA quantification by means of PCR and the viral load was correlated with the different clinical data. Results: 16 cases altogether. Their ages ranged between 19 days and 12 years (mean age: 34 months). The clinical manifestation was undistinguishable of the presented by other encephalitis. Main symptoms were fever (81% of the cases), convulsions (68%), vomiting (62%) and diminished level of consciousness (50%). Imaging tests and neurophysiological studies sensitivity were less than 80% (being less than 50% in the first 24 hours since the symptoms onset). Quantitative PCR is the gold standard for the detection of viral load. Viral load was positively correlated with age, number of leukocytes in CSF and time since beginning of the clinical manifestation. There was no correlation between viral load and disease prognosis. Conclusions: Neither the clinical presentation or neuroimaging or neurophysiological studies have enough sensitivity for helping diagnosis. On the contrary, we have found that real-time quantitative PCR is useful for the diagnosis of herpetic encephalitis. There was no association between viral load and illness prognosis. The viral load has not been correlated with the clinical picture. However, more studies are needed to evaluate the clinical utility of this technique.