Original Article

Prevalence of herpes simplex viruses types 1 and 2 infections among suspected children of encephalitis in Kermanshah, Iran


Background and Objectives: Various infectious and non-infectious factors can cause encephalitis in the central nervous system (CNS), the most important of which are viruses. Herpes viruses are one of the most important causes of encephalitis worldwide. PCR detected the virus on the cerebrospinal fluid (CSF) sample. The aim of this study was to set up an in-house PCR to identify herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) and determine the prevalence of these viruses in suspected children of encephalitis.
Materials and Methods: This cross-sectional study was conducted on 160 suspected children with encephalitis cases referred to Dr. Kermanshahi Children Hospital, Kermanshah, Iran, from April to March 2021. CSF samples were extracted using a viral extraction kit, and a PCR was performed. The level of glucose and total protein of the samples was measured.
Results: The total prevalence of HSV was 16.25%. 17 samples were positive for HSV-1 (10.6%), and 9 samples for HSV-2 (5.6%). There was a significant correlation between glucose, total protein, and HSV PCR positive, but no significant correlation between age and HSV PCR positive results.
Conclusion: Rapid diagnosis of a virus may reduce the hospitalization rate and the use of unnecessary therapies and crease mortality, morbidity, and disability in children. Results in this study show that the distribution of HSV types in children with encephalitis predominantly was type 1 compared with type 2.

1. Roos K (2005). Principles of neurologic infectious diseases. McGraw-Hill Professional.
2. Kennedy PGE. Viral encephalitis: causes, differential diagnosis, and management. J Neurol Neurosurg Psychiatry 2004; 75 Suppl 1(Suppl 1): i10-15.
3. Kermanian M, Soleimanjahi H, Arefian E, Bamdad T. Enrichment of cerebrospinal fluid samples on cell culture for enhancement of sensitivity of mumps and enterovirus detection by multiplex RT-PCR. Diagn Microbiol Infect Dis 2008; 60: 375-379.
4. CostaB.KD, Sato DK. Viral encephalitis: a practical review on diagnostic approach and treatment. J Pediatr (Rio J) 2020; 96 Suppl 1(Suppl 1): 12-19.
5. Venkatesan A, Murphy OC. Viral encephalitis. Neurol Clin 2018; 36: 705-724.
6. Conrady CD, Drevets AD, Carr DJ. Herpes simplex type I (HSV-1) infection of the nervous system: is an immune response a good thing? J Neuroimmunol 2010; 220: 1-9.
7. Pires de Mello CP, Bloom DC, Paixão IC. Herpes simplex virus type-1: replication, latency, reactivation and its antiviral targets. Antivir Ther 2016; 21: 277-286.
8. Whitley RJ, Roizman B. Herpes simplex virus infections. Lancet 2001; 357: 1513-1518.
9. Miller CS, Danaher RJ. Asymptomatic shedding of herpes simplex virus (HSV) in the oral cavity. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105: 43-50.
10. Fatahzadeh M, Schwartz RA. Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. J Am Acad Dermatol 2007; 57: 737-763; quiz 764-766.
11. Piret J. Boivin G. Immunomodulatory strategies in herpes simplex virus encephalitis. Clin Microbiol Rev 2020; 33: e00105-19.
12. Whitley RJ. Herpes simplex encephalitis: adolescents and adults. Antiviral Res 2006; 71: 141-148.
13. Bale Jr JF. Virus and immune-mediated encephalitides: epidemiology, diagnosis, treatment, and prevention. Pediatr Neurol 2015; 53: 3-12.
14. McPherson RA, Pincus MR. Henry's clinical diagnosis and management by laboratory methods E-book. Elsevier Health Sci 2021.
15. Dehghan Manshadi SA, Teimourian S, Seifi A, Alinejadi Z, Sarahian N, Salehi M. Herpes Simplex Virus Type 1 Encephalitis: A Descriptive, Cross Sectional Study, 2011-2016, Iran. Arch Neurosci 2018; 5(2): e62348.
16. Kaeley N, Bansal S, Bhatia R, Ahmad S. Herpes simplex encephalitis: an uncommon presentation. J Clin Diagn Res 2016; 10: OD25-26.
17. Jain S, Patel B, Bhatt GC. Enteroviral encephalitis in children: clinical features, pathophysiology, and treatment advances. Pathog Glob Health 2014; 108: 216-222.
18. Gnann JW Jr, Whitley RJ. Herpes simplex encephalitis: an update. Curr Infect Dis Rep 2017; 19: 13.
19. Miri R, Ahmadi Ghezeldasht S, Mohamadinezhad V, Mosavat A, Shamsian SA, Sabet F, et al. Herpes simplex virus and tuberculosis-associated encephalitis in northeast of Iran. Jundishapur J Microbiol 2019; 12(2): e83452.
20. Ibrahim AI, Obeid MT, Jouma MJ, Roemer K, Mueller-Lantzsch N, Gärtner BC. Prevalence of herpes simplex virus (types 1 and 2), varicella-zoster virus, cytomegalovirus, and human herpesvirus 6 and 7 DNA in cerebrospinal fluid of Middle Eastern patients with encephalitis. J Clin Microbiol 2005; 43: 4172-4174.
21. Meligy B, Kadry D, Draz IH, Marzouk H, El Baroudy NR, El Rifay AS. Epidemiological profile of acute viral encephalitis in a sample of Egyptian Children. Open Access Maced J Med Sci 2018; 6: 423-429.
22. Ghannad MS, Solgi G, Hashemi SH, Zebarjady-Bagherpour J, Hemmatzadeh A, Hajilooi M. Herpes simplex virus encephalitis in hamadan, iran. Iran J Microbiol 2013; 5: 272-277.
23. Babaei A, Shatizadeh Malekshahi S, Pirbonyeh N, Moattari A. Prevalence and clinical manifestations of herpes simplex virus infection among suspected patients of herpes simplex encephalitis in Shiraz, Iran. Virusdisease 2021; 32: 266-271.
24. Azadfar S, Cheraghali F, Moradi A, Javid N, Tabarraei A. Herpes simplex virus meningitis in children in South East of caspian sea, iran. Jundishapur J Microbiol 2014; 7(1): e8599.
25. Tavakolian S, Goudarzi H, Eslami G, Darazam IA, Dehghan G, Faghihloo E. Detection of Enterovirus, Herpes Simplex, Varicella Zoster, Epstein‐Barr and Cytomegalovirus in cerebrospinal fluid in meningitis patients in Iran. J Clin Lab Anal 2021; 35(7): e23836.
IssueVol 15 No 1 (2023) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijm.v15i1.11931
Encephalitis; Herpes simplex virus; Cerebrospinal fluid

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Fakhredini K, Soleimanjahi H, Bamdad T. Prevalence of herpes simplex viruses types 1 and 2 infections among suspected children of encephalitis in Kermanshah, Iran. Iran J Microbiol. 2023;15(1):149-154.