Yoğun Bakım Ünitesinde Herpes Simpleks Virüs Meningoensefaliti Yönetimi
Özet
Herpes simplex virüs meningoensefaliti (HSV ME), HSV-1 veya HSV-2 virüslerinin neden olduğu, merkezi sinir sistemini etkileyen, yüksek mortalite ve morbidite oranına sahip ciddi bir enfeksiyondur. Genellikle prodromal belirtilerle başlayan hastalık, hızla ilerleyerek nörolojik semptomlara ve bilinç değişikliklerine yol açar. Bu olgu sunumunda, 35 yaşında, bilinen bir hastalığı olmayan bir depremzede hastanın HSV ME tanısıyla yoğun bakım ünitesindeki yönetimi ele alınmaktadır. Hasta, baş ağrısı, bilinç bulanıklığı, tonik-klonik kasılmalar ve ateş şikayetleriyle başvurmuş, yapılan beyin omurilik sıvısı (BOS) analizi sonucunda HSV-1 DNA pozitifliği saptanarak tanı doğrulanmıştır. Erken dönemde başlanan ampirik antiviral tedavi ve multidisipliner yaklaşımla hastanın metabolik asidoz durumu hızla düzelmiş, bilinç durumu iyileşmiştir. Bu vaka, sosyo-ekonomik koşulların da etkisiyle komplike olan nadir bir HSV ME örneğini sunmakta ve erken tanı ile tedaviye hızla başlanmasının hastalık prognozunu önemli ölçüde iyileştirdiğini göstermektedir.
Herpes simplex virus meningoencephalitis (HSV ME) is a severe infection of the central nervous system caused by HSV-1 or HSV-2, characterized by high mortality and morbidity rates. The disease typically begins with prodromal symptoms and rapidly progresses to neurological symptoms and altered consciousness. This case report discusses the management of a 35-year-old earthquake survivor with no prior medical history who was diagnosed with HSV ME in the intensive care unit. The patient presented with headache, altered consciousness, tonic-clonic seizures, and fever, and the diagnosis was confirmed by detecting HSV-1 DNA in the cerebrospinal fluid (CSF) analysis. Early empirical antiviral treatment and a multidisciplinary approach led to a rapid improvement in the patient's metabolic acidosis and consciousness levels. This case highlights a rare instance of HSV ME complicated by socio-economic factors and underscores the importance of early diagnosis and prompt initiation of treatment in significantly improving the disease prognosis.
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