Systemic and topical use of Poly I.C. in treatment of generalized neonatal herpes simplex infection with severe ocular involvement

Herpes virus hominis known also as Herpes Simplex Virus is a common cause of fatal encephalitis in adults and neonates. Its two stereotypes are completely different in their clinical and pathologic manifestations. Type I in adults causes lesions in the mouth, cornea, skin, and central nervous system (CNS). Type II is transmitted exclusively by genital contact, and usually causes only genital and cutaneous lesions, but may cause a diffuse disease. Many reports of ocular involvement such as conjunctivitis, chorioretinitis, uveitis, and also encephalitis in neonates with disseminated HSV infection have recently been reported. In a 3-wk-old female infant a case of Neonatal Herpes Simplex Virus (RSV) Encephalitis with severe ocular manifestation treated by topical systemic and intrathecal Interferon inducer, Poly IC (Polyriboinosinic acid-Polyribocytidylic acid) is reported. Prior to the administration of Poly IC, no Interferon could be detected neither in blood nor in CSF and vesicular fluid from conjunctiva. Intravenous administration of the drug initiated measurable levels in blood and tears, but not in CSF. However, intrathecal injection induced persistent high levels of Interferon in CSF. Virus clearance from conjunctiva tears and vesicular fluid occurred after three days of topical application of Poly IC. The mechanism of action of Poly IC, the laboratory results and the therapeutic conclusions are discussed in detail. This is the first report of intrathecal administration of Poly IC in a case of HSV Encephalitis. The authors believe that Poly IC should be given to any suspected or proved case of viral encephalitis, as soon as suspicion is raised in order to prevent irreversible neuronal damage. In order to initiate rapid rise of Interferon in the CSF, we believe that Poly IC should be injected intrathecally.