Helen Payne (United Kingdom)

Imperial College London Room 235 Medical Student Building
Helen is a Clinical Lecturer in Paediatric Infectious Diseases at Imperial College London. Her research interests are in congenital infection and immune ontogeny, and in understanding the role of immune activation in driving or inhibiting infections in young and immunosuppressed children. Her PhD examined the influence of HIV and ART-strategies on thymic and naïve B-cell output, HIV-specific antibody responses and peripheral HIV-1 proviral DNA reservoirs using stored samples from the Children with Early Antiretroviral Therapy (CHER) trial in South Africa. On-going work in this area builds on understanding immunological health in perinatally-acquired HIV, and the role of subclinical co-infection with viruses such as EBV and CMV, and associated increased morbidity and mortality in this vulnerable population. The theme of Helen’s Lectureship is exploring the host-immune response to cytomegalovirus in infants and immunosuppressed children and adolescents. Projects include developing improved diagnostics for congenital CMV, and understanding transcriptomic biomarkers associated with poor neurodevelopmental outcomes.

Presenter of 2 Presentations

 Conference Calendar

Live discussion (ID 1857)

Session Name
1640 - WALTER MARGET EDUCATIONAL WORKSHOP (ID 271)
Lecture Time
13:57 - 14:04
Room
Hall 02
Presenter

RECURRENT ENCEPHALITIS (ID 1586)

Session Name
1640 - WALTER MARGET EDUCATIONAL WORKSHOP (ID 271)
Lecture Time
13:49 - 13:57
Room
Hall 02
Presenter

Abstract

Title of Case(s)

Recurrent Encephalitis

Background

Herpes simplex (HSV-1) encephalitis is the most common cause of viral encephalitis in infants and children, a potentially devastating disease that can present with non-specific features. Recurrence of HSV-1 encephalitis has been reported in 50% of paediatric cases despite treatment with aciclovir.

Case Presentation Summary

This is a presentation of a 3 year old child with 3 discreet episodes of encephalitis. The initial presentation was at 2 months of age with febrile focal seizures requiring phenytoin. Her CSF had no significant white cells, culture and viral PCR negative. She had normal MRI but her electroencephalogram showed epileptiform discharges over mid-parietal area. Her ceftriaxone and aciclovir were discontinued at 48 hours. Her second presentation was at 2 years with fever and vomiting, progressing to lethargy, irritability and upgoing plantars on examination. She had an urgent MRI that showed a left frontal parenchyma haematoma and a subdural bleed. She was commenced on ceftriaxone, aciclovir and clarithromycin and transferred to a tertiary centre where she had a LP which was positive for Herpes Simplex Type 1 (HSV-1). She was treated with 3 weeks of aciclovir and post-treatment CSF was negative for HSV-1. However, she presented again at 3 years with fever, headache and vomiting. MRI showed encephalomalacia and interval development of multiple areas of vasogenic oedema. Her LP had high opening pressure and protein but no significant white cell count and was negative for bacterial culture, HSV-1 and all other viruses tested. She had a brain biopsy that showed florid granulomatous and necrotising inflammation with high levels of HSV-1 and considered to be post-HSV-1 granulomatous disease of the brain, a post-infectious inflammatory reaction. She was managed with prolonged high-dose aciclovir and steroids, physiotherapy and occupational therapy, and her clinical outcome is to be observed.

Key Learning Points

If HSV-1 encephalitis recurs – don’t assume is it straight-forward relapse.

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