Children’s Hospital

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ABSTRAK
Tujuan dari tinjauan ini:
Untuk memberikan pembaruan
pemikiran saat ini
mengenaiherpe simplex
encephalitis, menekankan
informasi baru tentang
pathogenesis, diagnosis, dan
respon imun
 PENGANTAR
Virus Herpes Simpleks tipe 1 dan 2 (HSV-1 dan
HSV-2) adalah anggota dari Alphaherpes virus.
Dengan siklus replikasi pendek, penghancuran sel
inang cepat, kemampuan latensi pada ganglia
sensoris. Encephalitis HSV (HSE) adalah
penyakit langka dengan insiden di seluruh dunia
diperkirakan 1: 250.000-500.000 individu per
tahun.
 EPIDEMIOLOGI

Ensephalitis di AS tahun
Sepertiga kasus pada pasien usia
2000-2010 teeridentifikasi
238.567 pasien. 6 bulan -20 tahun.

Setengah kasus yang lebih tua

Patogen paling sering dari 50 tahun
diidentifikasi adalah
HSV

Pria = Wanita
 Areas We Cover

Infeksi HSV-1 Primer orofaring

dengan SSP
Invasi melalui saluran trigeminal atau
penciuman. Percobaan pada hewan Infeksi HSV-1 primer dengan
menunjukkan baik penciuman atau saraf infeksi SSP dari penyebaran
trigeminal dapat memberi akses viral ke SSP. Hematogen

Invasi SSP Setelah episode berulang Infeksi SSP tanpa infeksi HSv-1
orofasial perifer yg Jelas

Mungkin diakibatkan reaktivasi virus

Infeksi HSV-1 ,mewakili reaktivasi virus laten dalam CNS.
perifer dengan penyebaran akson
berikutnya.
 HISTOPATOLOGIS:
HSE ditandai dengan nekrotikan melibatkan
lobus temporal, infero frontal dan atau
korteks insular hemisfer serebri. Penyakit
awal biasanya pada unilateral.

PATOLOGI SSP pada

HSE
Merupakan kombinasi replikasi virus sitolitik dan
mekanisme mediasi imun.
Pada model murine Limfosit T sitolitik khusus
melisiskan sel yg terinfeksi HSV dan membuat lesi
fokus. Produksi sitokin inflamasi dimediasi oleh
reseptor Toll-Like (TLR) 2. Pada pasien HSE sitokin
dan reseptor sitokin terlarut dapat dideteksi dslam
serum dan CSF. Respon imun awal yang berat dapat
menekan replikasi virus pada awal perjalanan
infeksi.
PRESENTASI KLINIS
 POPULASI KHUSUS

Immunocompromis Prosedur bedah

ed saraf dan terapi
radiasi SSP
Pasien yang
menerima obat
imunosupresif jenis
tertentu
ex: Natalizubam,
inhibitor alpha
faktor nekrosis
tumor
 Predisposisi Genetik
Reseptor Toll memainkan peran penting dalam respon imun bawaan.
TLR3 diekspresikan dalam CNS untuk menghambat penyebaran
HSV melalui interferon. Peneliti menemukan defisiensi resesif
autosom pada UNC-93B mengakibatkan gangguan respon interferon
seluler.Beberapa kesalahan gen tunggal dalam TLR3-jalur interferon
tipe I dan III telah dijelaskan pada anak-anak menghasilkan
peningkatan kerentanan terhadap HSE. Pengamatan ini
menunjukkan bahwa produksi interferon yang bergantung pada
TLR3- UNC93B sangat penting untuk memberikan kekebalan
protektif terhadap HSV-1 di CNS selama infeksi primer pada masa
kanak-kanak.

LABORATORIUM
-Pungsi lumbal (LP) kelainan
bila:
• Protein 50– 200 mg /dL atau
lebih.
• Leukositosis CSF 5 - 500 sel /
mm 3 atau lebih.
• Dominasi limfosit (60 - 98%)
• Sel darah merah (sering pada
pasien HSE dengan nekrosis
jaringan yang signifikan)
• Glukosa sering normal.
• Kultur (sangat tidak
sensitifitas)
DIAGNOSA
Imaging
- Polymerase Chain
Magnetic resonance imaging
Reaction (PCR) (MRI) adalah teknik
pencitraan yang lebih disukai
Sensitivitas PCR untuk pasien dengan dugaan
diperkirakan 98%
HSE. Computed tomography
dengan spesifisitas 94 - (CT) relatif tidak sensitif
99% untuk HSE
untuk mendeteksi perubahan
disebabkan oleh HSV-1. awal HSE. Dalam satu studi,
PCR menunjukkan HSE
pemindaian MRI
pada CSF (+) untuk mengungkapkan kelainan pada
HSV-2 jarang, lebih
21% pasien HSE dengan
umum HSV-2 pemindaian CT normal.
Meningitis.
 DIAGNOSA

Elektroensefalogram (EEG)

> 80% pasien dengan HSE,

biasanya menampilkan
gelombang lambat dengan
amplitudo tinggi, tetapi
perubahannya tidak spesifik. Pola
EEG yang paling khas dari HSE
adalah pelepasan epileptiformis
lateralis periodik (PLEDs) yang
berasal dari lobus temporal yang
terlibat.
 DIAGNOSA BANDING
Etiologi infeksi potensial lainnya termasuk meningitis, abses otak, atau
empiema yang disebabkan oleh bakteri atau jamur patogen. HSE harus
dibedakan dari meningitis HSV. Pasien dengan HSVmeningitis biasanya
memiliki sakit kepala parah, demam, dan kekakuan nuchal, tetapi
biasanya tidak menunjukkan perubahan status mental, temuan neurologis
fokal, atau kejang.
 TERAPI
Antiviral
Acyclovir saat ini satu-satunya obat
antivirus yang disetujui FDA untuk
pengobatan HSE.
Hasil suboptimal bahkan pada
pasien yang menerima terapi
asiklovir yang tepat, dosis asiklovir
yang lebih tinggi (36 - 45 mg / kg /
hari) untuk jangka waktu lebih lama
(14 - 21 hari) telah
direkomendasikan oleh banyak ahli.
 Table of Contents

01 02
Our Center Key Numbers
Here you could describe the Here you could describe the
topic of the section topic of the section

03 04
Patient Care Key Accomplishments
Here you could describe the Here you could describe the
topic of the section topic of the section
Introduction
It could be the part of the presentation where you
can introduce your healthcare center. Keep it short
and go straight to the point. Your audience will
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Our Center
Venus has a beautiful name and is the second planet
from the Sun. It’s terribly hot—even hotter than
Mercury—and its atmosphere is extremely poisonous.
It’s the second-brightest natural object in the night
sky after the Moon
 Our Philosophy

Mission
Mercury is the closest planet to the Sun and
the smallest one in the Solar System—it’s
only a bit larger than our Moon. The planet’s
name has nothing to do with the liquid metal,
since it was named after the Roman
messenger god, Mercury
Vision
Venus has a beautiful name and is the
second planet from the Sun. It’s terribly
hot—even hotter than Mercury—and its
atmosphere is extremely poisonous. It’s
the second-brightest natural object in
the night sky after the Moon
 Key Numbers

5,000 50,000 20,000

This is the number This is the number This is the number

of transplants of total visitors we of patients we had
performed so far had last month last month
 Our Graphics

Mercury is the closest planet to

the Sun

Despite being red, Mars is

actually a cold place

Venus has a beautiful name,

but it’s terribly hot

If you want to modify this graph, click on it, follow the link,
change the data and replace it
 A Brief Story
Mercury is the closest planet to the Sun and
the smallest one in the Solar System—it’s
only a bit larger than our Moon. The planet’s
name has nothing to do with the liquid metal,
since it was named after the Roman
messenger god, Mercury
 Milestones Reached

2001 - 2003 2007 - 2012 2013 - 2019

Saturn is composed of Despite being red, Mars Mercury is the closest
hydrogen and helium is a cold place planet to the Sun

2003 - 2007 2012 - 2013

Neptune is the farthest Venus has a beautiful
planet from the Sun name, but it’s hot
Our Process

Saturn is composed of
01. hydrogen and helium

Venus has a beautiful

02. name, but it’s hot

Despite being red, Mars

03. is a cold place

Neptune is the farthest

04. planet from the Sun
Patient
Care
Mercury is the closest planet to the
Sun and the smallest one in the
Solar System—it’s only a bit larger
than our Moon. The planet’s name
has nothing to do with the liquid
metal, since it was named after the
Roman messenger god
Patogenesis
Saturn is composed mostly of
Saturn
hydrogen and helium

Despite being red, Mars is

Mars
actually a cold place

Jupiter is the biggest planet in

Jupiter
our Solar System

Venus has a beautiful name, but

Venus
it’s terribly hot
 Key Accomplishments

Year Area Accomplishment

Saturn is composed mostly of

2001 Saturn
hydrogen and helium

2009 Venus Venus has a beautiful name, but it’s hot

Despite being red, Mars is actually a

2018 Mars
cold place

Jupiter is the biggest planet in our

2019 Jupiter
Solar System
 Patient Satisfaction

Mercury

Factor 1 Mercury is the closest planet to the Sun and

the smallest one in the Solar System—it’s
Factor 2 only a bit larger than our Moon. The planet’s
Factor 3 name has nothing to do with the liquid metal,
since it was named after the Roman
Factor 4 messenger god, Mercury

If you want to modify this graph, click on it,

follow the link, change the data and replace it
 Innovations

Jupiter Neptune
Jupiter is the Neptune is the
biggest planet in farthest planet
our Solar System from the Sun

Mars Venus
Despite being red, Venus has a
Mars is actually a beautiful name,
cold place but it’s terribly hot
 Testimonials

Jenna Doe, 6 Helena Patterson, 7

“Neptune is the fourth-largest “Despite being red, Mars is
planet by diameter in our Solar actually a cold place. It’s full of
System” iron oxide dust”

John James, 8 Cindy Tubbs, 9

“Mercury is the closest planet “Saturn is the ringed one. It’s a
to the Sun and the smallest one gas giant, composed mostly of
in our Solar System” hydrogen and helium”
 Awards

2015 2019 2012

Mercury is the closest planet Venus has a beautiful name, Saturn is composed mostly
to the Sun but it’s very hot of hydrogen and helium
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 Our Team

Nurse
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bit about this person
Surgeon
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Doctor
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Thanks!
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