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Goldhardt R, Al-Khersan H, Davis JL, Smiddy WE, Komotar RJ, Ivan ME, Pasol J. Bilateral Acute Retinal Necrosis Secondary to Herpes Simplex Virus Encephalitis After Craniotomy for Tuberculum Meningioma Resection. J Neuroophthalmol 2024:00041327-990000000-00666. [PMID: 38913949 DOI: 10.1097/wno.0000000000002197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Affiliation(s)
- Raquel Goldhardt
- Bascom Palmer Eye Institute (RG, HA-K, JLD, WES, JP), University of Miami Miller School of Medicine, Miami, FL; and Department of Neurosurgery (RJK, MEI), University of Miami Miller School of Medicine, Miami, FL
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2
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Platz IL, Tetens MM, Dessau R, Ellermann-Eriksen S, Andersen NS, Jensen VVS, Østergaard C, Bodilsen J, Søgaard KK, Bangsborg J, Nielsen ACY, Møller JK, Lebech AM, Omland LH, Obel N. Characteristics and long-term prognosis of Danish residents with a positive intrathecal antibody index test for herpes simplex virus or varicella-zoster virus compared with individuals with a positive cerebrospinal fluid PCR: a nationwide cohort study. Clin Microbiol Infect 2024; 30:240-246. [PMID: 37967615 DOI: 10.1016/j.cmi.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES We compared characteristics and outcomes of individuals who in the cerebrospinal fluid (CSF) were positive for herpes simplex virus (HSV) or varicella-zoster virus (VZV)-intrathecal antibody index test ([AI]-positive) vs. individuals who were PCR-positive for HSV type 1 (HSV1), type 2 (HSV2), and for VZV. METHODS Nationwide cohort study of all Danish residents with positive CSF-AI or -PCR for HSV or VZV (1995-2021). We calculated short- and long-term risks as age-, sex-, and comorbidity-adjusted odds ratios (aOR), adjusted hazard ratios (aHR), and absolute risk differences with 95% CIs. RESULTS Compared with individuals with positive PCR for HSV1 (n = 321), HSV2 (n = 497), and VZV (n = 1054), individuals with a positive AI for HSV (n = 177) and VZV (n = 219) had CSF pleocytosis less frequently (leucocyte count >10/μL: HSV-AI: 39%, VZV-AI: 52%, HSV1-PCR: 81%, HSV2-PCR: 92%, VZV-PCR: 83%), and were less frequently diagnosed with central nervous system infection ([aOR {95%CI}]: HSV-AI vs. HSV1-PCR: [0.1 {0.1, 0.2}], HSV-AI vs. HSV2-PCR: [0.1 {0.0, 0.1}], VZV-AI vs. VZV-PCR: [0.2 {0.2, 0.3}]). Individuals with a positive HSV-AI or VZV-AI had increased risk of demyelinating disease ([aOR {95%CI}; aHR {95%CI}]: HSV-AI vs. HSV1-PCR: [4.6 {0.9, 24.5}; aHR not applicable], HSV-AI vs. HSV2-PCR: [10.4 {2.3, 45.9}; 12.4 {2.3, 66.0}], VZV-AI vs. VZV-PCR: [aOR not applicable; 10.3 {1.8, 58.8}]). Disability pension was less frequent among HSV-AI than HSV1-PCR cohort members (5-year risk difference: -23.6%, 95%CI: -35.2, -11.8), and more frequent among VZV-AI than VZV-PCR cohort members (5-year risk difference: 16.8%, 95%CI: 5.0, 28.7). DISCUSSION AI-positive individuals differ from PCR-positive individuals in several aspects. AI appears unspecific for current central nervous system infections.
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Affiliation(s)
- Isabella L Platz
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Malte M Tetens
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ram Dessau
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Nanna S Andersen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Microbiology, University of Southern Denmark, Odense, Denmark
| | | | - Christian Østergaard
- Department of Clinical Microbiology, Copenhagen University Hospital - Hvidovre Hospital, Copenhagen, Denmark
| | - Jacob Bodilsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Kirstine Kobberøe Søgaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jette Bangsborg
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
| | - Alex Christian Yde Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jens Kjølseth Møller
- Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Petersen PT, Bodilsen J, Jepsen MPG, Larsen L, Storgaard M, Hansen BR, Helweg-Larsen J, Wiese L, Lüttichau HR, Andersen CØ, Nielsen H, Brandt CT. Clinical features and prognostic factors in adults with viral meningitis. Brain 2023; 146:3816-3825. [PMID: 36929167 PMCID: PMC10473559 DOI: 10.1093/brain/awad089] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/08/2023] [Accepted: 02/25/2023] [Indexed: 03/18/2023] Open
Abstract
Clinical features applicable to the entire spectrum of viral meningitis are limited, and prognostic factors for adverse outcomes are undetermined. This nationwide population-based prospective cohort study included all adults with presumed and microbiologically confirmed viral meningitis in Denmark from 2015 until 2020. Prognostic factors for an unfavourable outcome (Glasgow Outcome Scale score of 1-4) 30 days after discharge were examined by modified Poisson regression. In total, 1066 episodes of viral meningitis were included, yielding a mean annual incidence of 4.7 episodes per 100 000 persons. Pathogens were enteroviruses in 419/1066 (39%), herpes simplex virus type 2 in 171/1066 (16%), varicella-zoster virus in 162/1066 (15%), miscellaneous viruses in 31/1066 (3%) and remained unidentified in 283/1066 (27%). The median age was 33 years (IQR 27-44), and 576/1066 (54%) were females. In herpes simplex virus type 2 meningitis, 131/171 (77%) were females. Immunosuppression [32/162 (20%)] and shingles [90/149 (60%)] were frequent in varicella-zoster virus meningitis. The triad of headache, neck stiffness and hyperacusis or photophobia was present in 264/960 (28%). The median time until lumbar puncture was 3.0 h (IQR 1.3-7.1), and the median CSF leucocyte count was 160 cells/µl (IQR 60-358). The outcome was unfavourable in 216/1055 (20%) 30 days after discharge. Using unidentified pathogen as the reference, the adjusted relative risk of an unfavourable outcome was 1.34 (95% CI 0.95-1.88) for enteroviruses, 1.55 (95% CI 1.00-2.41) for herpes simplex virus type 2, 1.51 (95% CI 0.98-2.33) for varicella-zoster virus and 1.37 (95% CI 0.61-3.05) for miscellaneous viruses. The adjusted relative risk of an unfavourable outcome was 1.34 (95% CI 1.03-1.75) for females. Timing of acyclovir or valacyclovir was not associated with the outcome in meningitis caused by herpes simplex virus type 2 or varicella-zoster virus. In summary, the outcome of viral meningitis was similar among patients with different aetiologies, including those with presumed viral meningitis but without an identified pathogen. Females had an increased risk of an unfavourable outcome. Early antiviral treatment was not associated with an improved outcome in meningitis caused by herpes simplex virus type 2 or varicella-zoster virus.
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Affiliation(s)
- Pelle Trier Petersen
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, 3400 Hillerød, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | | | - Lykke Larsen
- Department of Infectious Diseases, Odense University Hospital, 5000 Odense, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus, Denmark
| | | | | | - Lothar Wiese
- Department of Medicine, Sjællands University Hospital, 4000 Roskilde, Denmark
| | | | | | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
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Bodilsen J, Tattevin P, Tong SYC, Naucler P, Nielsen H. Treatment of Herpes Simplex Virus Type 2 Meningitis: A Survey Among Infectious Diseases Specialists in France, Sweden, Australia, and Denmark. Open Forum Infect Dis 2022; 9:ofac644. [PMID: 36570969 PMCID: PMC9772874 DOI: 10.1093/ofid/ofac644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background We aimed to describe attitudes toward treatment of herpes simplex virus type 2 (HSV-2) meningitis and prioritize future trials. Methods This was a self-administered online survey of HSV-2 meningitis treatment among infectious diseases (ID) specialists in France, Sweden, Australia, and Denmark. Results A total of 223 ID specialists (45% female) from France (36%), Denmark (24%), Sweden (21%), and Australia (19%) participated in the survey, primarily from university hospitals (64%). The estimated overall response rate was 11% and ranged from 6% (Australia) to 64% (Denmark). Intravenous (IV) acyclovir followed by oral valacyclovir was the favored treatment in 110 of 179 (61%), whereas monotherapy with either IV acyclovir or oral valacyclovir was used by 35 of 179 (20%) and 34 of 179 (19%), respectively. The median total duration was reported to be 7 days (interquartile range, 7-10 days) regardless of antiviral regimen. Immunocompromise influenced decisions on antiviral treatment in 110 of 189 (58%) of respondents, mainly by prolonged total duration of treatment (36/110 [33%]), prolonged IV administration (31/110 [28%]), and mandatory antiviral treatment (25/110 [23%]). Treatment with acyclovir/valacyclovir versus placebo and comparison of acyclovir versus valacyclovir were assigned the highest prioritization scores for future randomized controlled trials on HSV-2 meningitis. Conclusions Perceptions of indications for as well as type and duration of antiviral treatment varied substantially among ID specialists.
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Affiliation(s)
- Jacob Bodilsen
- Correspondence: Jacob Bodilsen, Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark ()
| | - Pierre Tattevin
- European Society of Clinical Microbiology and Infectious Diseases Study Group for Infectious Diseases of the Brain, Basel, Switzerland,Department of Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France,Réseau National de Recherche Clinique en Infectiologie, Paris, France
| | - Steven Y C Tong
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia,Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Pontus Naucler
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden,Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Chen JH, Wu J, Yang XY, Li J, Huang NQ, Shi SP, Feng F, Li Q, Yu CY, Luo Y. Diagnostic Value of the Electroencephalogram and Cerebrospinal Fluid in Viral Encephalitis. Neurologist 2022; 27:225-229. [PMID: 35184121 DOI: 10.1097/nrl.0000000000000395] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Electroencephalogram (EEG) and cerebrospinal fluid (CSF) are widely used in the clinical diagnosis of viral encephalitis (VE), but their value in the diagnosis of VE and the detection rate of abnormal indicators need to be further supported by more clinical data. METHODS In this study, routine laboratory testing, biochemical examinations of cerebrospinal fluid (CSF) and EEG characteristics were performed in patients with VE to guide the diagnosis and treatment of VE in clinical settings. A total of 330 patients with VE were enrolled in the Department of Neurology of the Third Affiliated Hospital of Zunyi Medical University from January 1, 2015 to January 30, 2020. EEG, routine testing and assessment of biochemical indicators of CSF were performed within 10 days after admission, and the results were analyzed by paired χ 2 test to compare the diagnostic value of EEG and CSF for VE. RESULTS In 330 cases of VE, 283 cases (85.76%) had abnormal EEG, and 189 cases (57.27%) had abnormal CSF indicators. The incidence of EEG abnormalities was higher than that of CSF indicators, and the difference was statistically significant ( P <0.05). CONCLUSIONS Both the EEG and CSF analysis are valuable indicators in the diagnosis of VE patients. Compared with the CSF examination, the EEG examination had a better diagnostic efficacy for the diagnosis of VE. In addition, a normal EEG or a normal CSF level cannot exclude VE, and it is still necessary to develop new diagnostic indicators to cover all viral encephalitides.
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Affiliation(s)
| | - Jie Wu
- Scientific Research Center
| | | | | | | | - Shang-Peng Shi
- Department of Quality Management, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University)
| | | | | | - Chang-Yin Yu
- Department of Neurology, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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Aseptic Meningitis in Oral Medicine: Exploring the Key Elements for a Challenging Diagnosis: A Review of the Literature and Two Case Reports. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073919. [PMID: 35409601 PMCID: PMC8998084 DOI: 10.3390/ijerph19073919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/08/2022] [Accepted: 03/23/2022] [Indexed: 12/18/2022]
Abstract
Aseptic meningitis (AM) is a potentially severe and life-threatening disease characterized by meningeal inflammation, usually with mononuclear pleocytosis. It represents a challenging and controversial issue in medicine for multiple etiologies, classification, and difficult diagnosis in the face of nonspecific sets of signs and symptoms. In the area of interest of oral medicine, in specific clusters of patients, even if rare, the occurrence of aseptic meningitis can pose a diagnostic and management dilemma in the following potential etiologies: (i) systemic diseases with oral and meningeal involvement, which include Behçet’s disease and Sjögren syndrome; (ii) drug-induced aseptic meningitis; (iii) aseptic viral meningitis, mostly related to herpes simplex virus infection and hand, foot, and mouth disease, caused by enteroviruses. In this review, clinical manifestations, diagnostic methodologies, incidence, treatment, and prognosis for each of these clinical entities are provided. Furthermore, two illustrative case reports are described: a patient suffering from recurrent oral ulcers, in which a sudden onset of AM allows us to diagnose Neuro Behçet’s disease, and a patient affected by pemphigus vulgaris, manifesting a drug-induced AM. Exploring this complex clinical entity scenario, it is clear that an oral medicine specialist has a place on any multidisciplinary team in making such a challenging diagnosis.
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7
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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:e23836. [PMID: 34152040 PMCID: PMC8275001 DOI: 10.1002/jcla.23836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/14/2022] Open
Abstract
Background Despite medical advances, central nervous system (CNS) diseases put a pressure on the health care system. A number of risk factors, especially infectious agents can accelerate the progression of meningitis. As viruses probably account for most cases of meningitis, the diagnosis of them can reduce antibiotic prescriptions. Among various types of infectious diseases, the relationship between two important virus families, including Picornaviridae and Herpesviridae, and meningitis has attracted attraction. Methods In this study, one hundred and two samples were collected from patients who experienced symptoms, such as the loss of consciousness, seizures, muscle weakness, fever, headache, rash, and severe dementia, between November 2018 and September 2019. After RNA and DNA extraction, the prevalence of Enterovirus (EV), Cytomegalovirus (CMV), Epstein–Barr virus (EBV), Herpes simplex virus type 1 (HSV‐1), Herpes simplex virus type 2 (HSV‐2), and Varicella zoster virus (VZV) was evaluated using PCR, multiplex PCR, and nested PCR. Results Results indicated that there were two VZV DNA‐positive specimens, while six and five samples were infected with HSV‐1 and EBV, respectively. Conclusion We reported that the prevalence of EBV, HSV‐1, and VZV in patients, suffering from meningitis cannot be ignored; however, further investigation is needed.
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Affiliation(s)
- Shaian Tavakolian
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gita Eslami
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golnaz Dehghan
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ebrahim Faghihloo
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zhong P, Zang S, Yu H, Yang X. Herpes simplex virus type 1 related acute retinal necrosis following an encephalitis illness: a case report. BMC Neurol 2021; 21:49. [PMID: 33530932 PMCID: PMC7851902 DOI: 10.1186/s12883-021-02082-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 01/27/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Virus encephalitis is found to be a risk factor for acute retinal necrosis (ARN). CASE PRESENTATION We herein presented a case of a 20-year-old teenage boy who suffered from encephalitis of unknown etiology with early negative pathologic results, and was primarily treated with systemic administration of high-dose steroids without antiviral therapy. He later had sudden vision loss in his right eye. Intravitreal and intravenous antiviral treatments were immediately started due to suspected ARN. Herpes simplex virus (HSV)-1 was identified later in the vitreous humor of the patient. After the surgery of retinal detachment (RD), obvious improvements in vision were observed. However, the patient had recurrent RD and vision declination 5 weeks later. CONCLUSIONS The case with suspected viral encephalitis should be treated with antiviral therapy regardless of early virologic results in order to avoid complications of a missed viral encephalitis diagnosis, especially if systemic steroid treatment is being considered.
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Affiliation(s)
- Pingting Zhong
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
- Shantou University Medical College, Shantou, China
| | - Siwen Zang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Honghua Yu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Xiaohong Yang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
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Hensel N, Raker V, Förthmann B, Buch A, Sodeik B, Pich A, Claus P. The Proteome and Secretome of Cortical Brain Cells Infected With Herpes Simplex Virus. Front Neurol 2020; 11:844. [PMID: 32973653 PMCID: PMC7481480 DOI: 10.3389/fneur.2020.00844] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/07/2020] [Indexed: 01/22/2023] Open
Abstract
Infections of the brain with herpes simplex virus type 1 (HSV-1) cause life-threatening Herpes simplex encephalitis (HSE) characterized by viral replication in neurons and neuro-inflammation including an infiltration of peripheral immune cells. HSV-1 reprograms host cells to foster its own replication and for immune evasion, but eventually the immune responses clear the infection in most patients. However, many survivors suffer from long-term neuronal damage and cannot regenerate all brain functions. HSV-1 influences the physiology of neurons, astrocytes, oligodendrocytes and microglia, and significantly changes their protein expression and secretion pattern. To characterize temporal changes upon HSV-1 infection in detail, we inoculated mixed primary cultures of the murine brain cortex, and performed quantitative mass spectrometry analyses of the cell-associated proteome and the secretome. We identified 28 differentially regulated host proteins influencing inflammasome formation and intracellular vesicle trafficking during endocytosis and secretion. The NIMA-related kinase 7 (NEK7), a critical component of the inflammasome, and ArfGap1, a regulator of endocytosis, were significantly up-regulated upon HSV-1 infection. In the secretome, we identified 71 proteins including guidance cues regulating axonal regeneration, such as semaphorin6D, which were enriched in the conditioned media of HSV-1 infected cells. Modulation of inflammasome activity and intracellular membrane traffic are critical for HSV-1 cell entry, virus assembly, and intracellular spread. Our proteome analysis provides first clues on host factors that might dampen the inflammasome response and modulate intracellular vesicle transport to promote HSV infection of the brain. Furthermore, our secretome analysis revealed a set of proteins involved in neuroregeneration that might foster neuronal repair processes to restore brain functions after clearance of an HSV-1 infection.
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Affiliation(s)
- Niko Hensel
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hanover, Germany.,Niedersachsen-Research Network on Neuroinfectiology (N-RENNT), Hanover, Germany.,Center for Systems Neuroscience (ZSN), Hanover, Germany
| | - Verena Raker
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hanover, Germany.,Niedersachsen-Research Network on Neuroinfectiology (N-RENNT), Hanover, Germany.,Center for Systems Neuroscience (ZSN), Hanover, Germany
| | - Benjamin Förthmann
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hanover, Germany.,Niedersachsen-Research Network on Neuroinfectiology (N-RENNT), Hanover, Germany.,Center for Systems Neuroscience (ZSN), Hanover, Germany
| | - Anna Buch
- Niedersachsen-Research Network on Neuroinfectiology (N-RENNT), Hanover, Germany.,Institute of Virology, Hannover Medical School, Hanover, Germany
| | - Beate Sodeik
- Niedersachsen-Research Network on Neuroinfectiology (N-RENNT), Hanover, Germany.,Center for Systems Neuroscience (ZSN), Hanover, Germany.,Institute of Virology, Hannover Medical School, Hanover, Germany.,DZIF-German Centre for Infection Research, Partner Site Hannover-Braunschweig, Hanover, Germany
| | - Andreas Pich
- Institute for Toxicology, Hannover Medical School, Hanover, Germany.,Core Facility Proteomics, Hannover Medical School, Hanover, Germany
| | - Peter Claus
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hanover, Germany.,Niedersachsen-Research Network on Neuroinfectiology (N-RENNT), Hanover, Germany.,Center for Systems Neuroscience (ZSN), Hanover, Germany
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Hansen ABE, Vestergaard HT, Dessau RB, Bodilsen J, Andersen NS, Omland LH, Christiansen CB, Ellermann-Eriksen S, Nielsen L, Benfield T, Sørensen HT, Andersen CØ, Lebech AM, Obel N. Long-Term Survival, Morbidity, Social Functioning and Risk of Disability in Patients with a Herpes Simplex Virus Type 1 or Type 2 Central Nervous System Infection, Denmark, 2000-2016. Clin Epidemiol 2020; 12:745-755. [PMID: 32765109 PMCID: PMC7371560 DOI: 10.2147/clep.s256838] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/15/2020] [Indexed: 12/24/2022] Open
Abstract
Background The long-term prognosis following herpes simplex virus (HSV) central nervous system (CNS) infection is still debated. Patients and Methods We examined outcomes in all Danish residents who, during 2000–2016, tested PCR positive for HSV-1 (n=208) or HSV-2 (n=283) in the cerebrospinal fluid, compared to comparison cohorts from the general population (n=2080 and n=2830). Results One-year mortality was increased among HSV-1 patients (difference 19.3%; 95% CI: 13.6% to 25.0%) and HSV-2 patients (difference 5.3%; 95% CI: 2.5% to 8.1%), but thereafter mortality was not increased. After exclusion of persons diagnosed with cancer prior to study inclusion, one-year mortality difference for HSV-2 patients was 1.7% (−0.1% to 3.5%). After five years, HSV-1 patients had lower employment (difference −19.8%; 95% CI: −34.7% to −4.8%) and higher disability pension rates (difference 22.2%; 95% CI: 8.4% to 36.0%) than the comparison cohort, but similar number of inpatient days, outpatient visits, and sick leave. HSV-2 patients had employment and disability pension rates comparable to the comparison cohort, but more inpatient days (difference 1.5/year; 95% CI: −0.2 to 3.2), outpatient visits (difference 1.3/year; 95% CI: 0.3 to 3.2), and sick leave days (difference 9.1/year; 95% CI: 7.9 to 10.4). Conclusion HSV-1 and HSV-2 CNS infections differ substantially with respect to prognosis. HSV-1 CNS infection is followed by increased short-term mortality and long-term risk of disability. HSV-2 CNS infection has no substantial impact on mortality or working capability but is associated with increased morbidity.
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Affiliation(s)
- Ann-Brit E Hansen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Infectious Diseases, Amager Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hanne T Vestergaard
- Department of Virus & Microbiological Special Diagnostics, Statens Serum Institute, Copenhagen, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Jacob Bodilsen
- Departments of Infectious Diseases and Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - Nanna S Andersen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Lars H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Claus B Christiansen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Lene Nielsen
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Amager Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Ø Andersen
- Department of Clinical Microbiology, Amager Hvidovre University Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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11
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Hensel N, Raker V, Förthmann B, Detering NT, Kubinski S, Buch A, Katzilieris-Petras G, Spanier J, Gudi V, Wagenknecht S, Kopfnagel V, Werfel TA, Stangel M, Beineke A, Kalinke U, Paludan SR, Sodeik B, Claus P. HSV-1 triggers paracrine fibroblast growth factor response from cortical brain cells via immediate-early protein ICP0. J Neuroinflammation 2019; 16:248. [PMID: 31791351 PMCID: PMC6889453 DOI: 10.1186/s12974-019-1647-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Herpes simplex virus-1 (HSV-1) infections of the central nervous system (CNS) can result in HSV-1 encephalitis (HSE) which is characterized by severe brain damage and long-term disabilities. Different cell types including neurons and astrocytes become infected in the course of an HSE which leads to an activation of glial cells. Activated glial cells change their neurotrophic factor profile and modulate inflammation and repair. The superfamily of fibroblast growth factors (FGFs) is one of the largest family of neurotrophic factors comprising 22 ligands. FGFs induce pro-survival signaling in neurons and an anti-inflammatory answer in glial cells thereby providing a coordinated tissue response which favors repair over inflammation. Here, we hypothesize that FGF expression is altered in HSV-1-infected CNS cells. METHOD We employed primary murine cortical cultures comprising a mixed cell population of astrocytes, neurons, microglia, and oligodendrocytes. Astrocyte reactivity was morphometrically monitored by an automated image analysis algorithm as well as by analyses of A1/A2 marker expression. Altered FGF expression was detected by quantitative real-time PCR and its paracrine FGF activity. In addition, HSV-1 mutants were employed to characterize viral factors important for FGF responses of infected host cells. RESULTS Astrocytes in HSV-1-infected cortical cultures were transiently activated and became hypertrophic and expressed both A1- and A2-markers. Consistently, a number of FGFs were transiently upregulated inducing paracrine neurotrophic signaling in neighboring cells. Most prominently, FGF-4, FGF-8, FGF-9, and FGF-15 became upregulated in a switch-on like mechanism. This effect was specific for CNS cells and for a fully functional HSV-1. Moreover, the viral protein ICP0 critically mediated the FGF switch-on mechanism. CONCLUSIONS HSV-1 uses the viral protein ICP0 for the induction of FGF-expression in CNS cells. Thus, we propose that HSV-1 triggers FGF activity in the CNS for a modulation of tissue response upon infection.
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Affiliation(s)
- Niko Hensel
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hannover, Germany
- Niedersachsen-Research Network on Neuroinfectiology (N-RENNT), Hannover, Germany
- Center for Systems Neuroscience (ZSN), Hannover, Germany
| | - Verena Raker
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hannover, Germany
- Niedersachsen-Research Network on Neuroinfectiology (N-RENNT), Hannover, Germany
- Center for Systems Neuroscience (ZSN), Hannover, Germany
| | - Benjamin Förthmann
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hannover, Germany
- Niedersachsen-Research Network on Neuroinfectiology (N-RENNT), Hannover, Germany
| | - Nora Tula Detering
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hannover, Germany
- Niedersachsen-Research Network on Neuroinfectiology (N-RENNT), Hannover, Germany
- Center for Systems Neuroscience (ZSN), Hannover, Germany
| | - Sabrina Kubinski
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hannover, Germany
- Niedersachsen-Research Network on Neuroinfectiology (N-RENNT), Hannover, Germany
- Center for Systems Neuroscience (ZSN), Hannover, Germany
| | - Anna Buch
- Niedersachsen-Research Network on Neuroinfectiology (N-RENNT), Hannover, Germany
- Institute of Virology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), Hannover-Braunschweig, Germany
| | | | - Julia Spanier
- Niedersachsen-Research Network on Neuroinfectiology (N-RENNT), Hannover, Germany
- Institute for Experimental Infection Research, TWINCORE, Centre for Experimental and Clinical Infection Research, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany
| | - Viktoria Gudi
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Sylvia Wagenknecht
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hanover, Germany
| | - Verena Kopfnagel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hanover, Germany
| | - Thomas Andreas Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hanover, Germany
| | - Martin Stangel
- Niedersachsen-Research Network on Neuroinfectiology (N-RENNT), Hannover, Germany
- Center for Systems Neuroscience (ZSN), Hannover, Germany
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Andreas Beineke
- Center for Systems Neuroscience (ZSN), Hannover, Germany
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Ulrich Kalinke
- Niedersachsen-Research Network on Neuroinfectiology (N-RENNT), Hannover, Germany
- Center for Systems Neuroscience (ZSN), Hannover, Germany
- Institute for Experimental Infection Research, TWINCORE, Centre for Experimental and Clinical Infection Research, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany
| | - Søren Riis Paludan
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Beate Sodeik
- Niedersachsen-Research Network on Neuroinfectiology (N-RENNT), Hannover, Germany
- Center for Systems Neuroscience (ZSN), Hannover, Germany
- Institute of Virology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), Hannover-Braunschweig, Germany
| | - Peter Claus
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hannover, Germany
- Niedersachsen-Research Network on Neuroinfectiology (N-RENNT), Hannover, Germany
- Center for Systems Neuroscience (ZSN), Hannover, Germany
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12
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Ng S, Le Corre M, Aloy E, Gras-Combe G, Duffau H, Boetto J. Herpes Simplex Encephalitis Shortly After Surgery for a Secondary Glioblastoma: A Case Report and Review of the Literature. World Neurosurg 2019; 129:13-17. [DOI: 10.1016/j.wneu.2019.05.173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 05/22/2019] [Indexed: 12/01/2022]
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13
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Ptaszyńska-Sarosiek I, Dunaj J, Zajkowska A, Niemcunowicz-Janica A, Król M, Pancewicz S, Zajkowska J. Post-mortem detection of six human herpesviruses (HSV-1, HSV-2, VZV, EBV, CMV, HHV-6) in trigeminal and facial nerve ganglia by PCR. PeerJ 2019; 6:e6095. [PMID: 30643675 PMCID: PMC6330031 DOI: 10.7717/peerj.6095] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/10/2018] [Indexed: 12/14/2022] Open
Abstract
Background Among over 100 types of Herpesviridae viruses, eight can infect humans: herpes simplex viruses (HSV-1, HSV-2), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpesviruses 6, 7, and 8 (HHV-6, HHV-7, HHV-8). After initial infection, the viruses remain latent for the lifetime of the host. The aim of this study was to determine the distribution of six different herpesviruses: HSV-1, HSV-2, VZV, EBV, CMV, and HHV-6 in trigeminal and facial nerve ganglia among a random group of Polish population. Methods The studied group consisted of 47 individuals (40 male, seven female); mean age of 47.4 ± 16.5 years) who died of independent causes (suicide, traffic accident, and poisoning, among others). Bilateral trigeminal and facial nerve ganglia of each cadaver were collected during the autopsy. Herpesviruses were detected using multiplex polymerase chain reaction technique. Results Herpesviruses were found in trigeminal and/or facial ganglia in 30/47 (63.8%) of cadavers. HHV-6 was the most prevalent of the herpesviruses and was found in nearly half of cadavers (n = 22; 46.8%), followed by HSV-1 (n = 7; 14.9%), VZV (n = 4; 8.5%), EBV (n = 4; 8.5%), HSV-2 (n = 2; 4.3%), and CMV (n = 1; 2.1%). Facial nerve ganglia (n = 23; 48.9%) were more often infected than trigeminal ganglia (n = 13; 27.7%). Discussion The results of this study have revealed a common presence of the herpesviruses in trigeminal and facial nerve ganglia among a random group of Polish population. Furthermore, the data also demonstrate simultaneous infection of the ganglia with different herpesviruses. This study has contributed to the knowledge of prevalence and localization of herpesviruses in different structures of the nervous system.
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Affiliation(s)
| | - Justyna Dunaj
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Białystok, Poland
| | - Agata Zajkowska
- Department of Neurology, Medical University of Bialystok, Bialystok, Poland
| | | | - Monika Król
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Białystok, Poland
| | - Sławomir Pancewicz
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Białystok, Poland
| | - Joanna Zajkowska
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Białystok, Poland
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14
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Sasaki M, Shimizu N, Zushi Y, Saito T, Tsunemine H, Itoh K, Aoyama Y, Goto Y, Kodaka T, Tsuji G, Senda E, Fujimori T, Itoh T, Takahashi T. Analysis of gastrointestinal virus infection in immunocompromised hosts by multiplex virus PCR assay. AIMS Microbiol 2018; 4:225-239. [PMID: 31294212 PMCID: PMC6604934 DOI: 10.3934/microbiol.2018.2.225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/07/2018] [Indexed: 12/30/2022] Open
Abstract
Regarding viral infection of intestinal mucosa, there have been only a few studies on limited diseases, targeting a few herpes family viruses. In this study, we analyzed 12 kinds of DNA viruses including 8 species of herpes family viruses in the gastrointestinal mucosa of patients with hematologic malignancies, inflammatory bowel diseases, collagen diseases, or other miscellaneous forms of gastroenteritis using the multiplex virus PCR assay, which we recently developed. The virus PCR assay yielded positive results in 63 of 102 patients; Epstein-Barr virus (EBV) was the most frequently detected, followed by cytomegalovirus (CMV), human herpes virus 6 (HHV-6), HHV-7, parvovirus B19, and herpes simplex virus type 1. The frequencies of viral detection in the 4 diseases were similar involving these 6 viruses. Regarding CMV colitis, the multiplex virus PCR assay was superior to the immunohistopathologic method in detecting CMV. All viruses were more efficiently detected in the mucosa than in the blood in individual patients. These results suggest that CMV, EBV, and HHV-6 were commonly detected in the gastrointestinal mucosa of patients with these 4 diseases, and our multiplex virus PCR assay was useful for the early diagnosis of gastrointestinal virus infection, especially CMV colitis.
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Affiliation(s)
- Miho Sasaki
- Laboratory of Cell Therapy, Shinko Hospital, Kobe, Japan
| | - Norio Shimizu
- Departments of Virology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuriko Zushi
- Laboratory of Cell Therapy, Shinko Hospital, Kobe, Japan
| | | | | | - Kiminari Itoh
- Laboratory of Hematology, Shinko Hospital, Kobe, Japan
| | - Yumi Aoyama
- Laboratory of Hematology, Shinko Hospital, Kobe, Japan
| | - Yuta Goto
- Laboratory of Hematology, Shinko Hospital, Kobe, Japan
| | | | - Goh Tsuji
- Laboratory of Rheumatology, Shinko Hospital, Kobe, Japan
| | - Eri Senda
- Laboratory of Gastroenterology and Hepatology, Shinko Hospital, Kobe, Japan
| | | | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
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15
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Himeno T, Shiga Y, Takeshima S, Tachiyama K, Kamimura T, Kono R, Takemaru M, Takeshita J, Shimoe Y, Kuriyama M. [Clinical, epidemiological, and etiological studies of adult aseptic meningitis: a report of 12 cases of herpes simplex meningitis, and a comparison with cases of herpes simplex encephalitis]. Rinsho Shinkeigaku 2018; 58:1-8. [PMID: 29269697 DOI: 10.5692/clinicalneurol.cn-001098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We treated 437 cases of adult aseptic meningitis and 12 cases (including 2 recurrent patients; age, 31.8 ± 8.9 years; 7 females) of herpes simplex meningitis from 2004 to 2016. The incidence rate of adult herpes simplex meningitis in the cases with aseptic meningitis was 2.7%. One patient was admitted during treatment of genital herpes, but no association was observed between genital herpes and herpes simplex meningitis in the other cases. The diagnoses were confirmed in all cases as the cerebrospinal fluid (CSF) was positive for herpes simplex virus (HSV)-DNA. For diagnosis confirmation, the DNA test was useful after 2-7 days following initial disease onset. Among other types of aseptic meningitis, the patients with herpes simplex meningitis showed relatively high white blood cell counts and relatively high CSF protein and high CSF cell counts. CSF cells showed mononuclear cell dominance from the initial stage of the disease. During same period, we also experienced 12 cases of herpes simplex encephalitis and 21 cases of non-hepatic acute limbic encephalitis. Notably, the patients with herpes simplex meningitis were younger and their CSF protein and cells counts were higher than those of the patients with herpes simplex encephalitis.
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Affiliation(s)
- Takahiro Himeno
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Yuji Shiga
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital.,Present address: Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Shinichi Takeshima
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital.,Present address: Showa University School of Medicine
| | - Keisuke Tachiyama
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital.,Present address: Hiroshima City Hiroshima Citizens Hospital
| | - Teppei Kamimura
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital.,Present address: National Central and Cardiovascular Center
| | - Ryuhei Kono
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Makoto Takemaru
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Jun Takeshita
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Yutaka Shimoe
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Masaru Kuriyama
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
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16
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CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS OF SEROUS MENINGITIS IN ADULTS IN THE KHMELNYTSKYI REGION. WORLD OF MEDICINE AND BIOLOGY 2018. [DOI: 10.26724/2079-8334-2018-3-65-110-115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Bookstaver PB, Mohorn PL, Shah A, Tesh LD, Quidley AM, Kothari R, Bland CM, Weissman S. Management of Viral Central Nervous System Infections: A Primer for Clinicians. J Cent Nerv Syst Dis 2017; 9:1179573517703342. [PMID: 28579869 PMCID: PMC5415352 DOI: 10.1177/1179573517703342] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 01/22/2017] [Indexed: 12/11/2022] Open
Abstract
Viruses are a common cause of central nervous system (CNS) infections with many host, agent, and environmental factors influencing the expression of viral diseases. Viruses can be responsible for CNS disease through a variety of mechanisms including direct infection and replication within the CNS resulting in encephalitis, infection limited to the meninges, or immune-related processes such as acute disseminated encephalomyelitis. Common pathogens including herpes simplex virus, varicella zoster, and enterovirus are responsible for the greatest number of cases in immunocompetent hosts. Other herpes viruses (eg, cytomegalovirus, John Cunningham virus) are more common in immunocompromised hosts. Arboviruses such as Japanese encephalitis virus and Zika virus are important pathogens globally, but the prevalence varies significantly by geographic region and often season. Early diagnosis from radiographic evidence and molecular (eg, rapid) diagnostics is important for targeted therapy. Antivirals may be used effectively against some pathogens, although several viruses have no effective treatment. This article provides a review of epidemiology, diagnostics, and management of common viral pathogens in CNS disease.
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Affiliation(s)
- P Brandon Bookstaver
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Phillip L Mohorn
- Department of Pharmacy, Spartanburg Medical Center, Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| | - Ansal Shah
- Division of Infectious Diseases, School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Lauren D Tesh
- Division of Advisory Committee and Consultant Management, Office of Executive Programs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - April M Quidley
- Department of Pharmacy Services, Vidant Medical Center, Greenville, NC, USA
| | - Ravish Kothari
- Department of Neurology, University of South Carolina/Palmetto Medical Group, Columbia, SC, USA
| | - Christopher M Bland
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Savannah, GA, USA
| | - Sharon Weissman
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, USA
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18
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Lupo J, Dos Santos O, Germi R, Baccard-Longère M, Stahl JP, Epaulard O, Morand P. Herpes simplex type 2 encephalitis and methotrexate medication: a fortuitous or causative association in a patient with spondyloarthritis? Antivir Ther 2016; 22:357-359. [PMID: 27879484 DOI: 10.3851/imp3110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 10/20/2022]
Abstract
It is unclear whether immunosuppression is a risk factor for herpes encephalitis. Herein, we describe a rare case of herpes simplex virus type 2 encephalitis in a patient treated with low-dose methotrexate for HLA-B27-associated spondyloarthritis. The patient was successfully treated with acyclovir but presented sequelae of encephalitis. Here we discuss the possible role of low-dose methotrexate therapy as a risk factor of neurological herpes reactivation and severe disease. The host-related and viral risk factors are also addressed.
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Affiliation(s)
- Julien Lupo
- Laboratory of Virology, University Hospital of Grenoble, Grenoble, France.,Institut de Biologie Structurale, CEA, CNRS, University Grenoble Alpes, Grenoble, France
| | - Ophélie Dos Santos
- Infectious Diseases Department, University Hospital of Grenoble, Grenoble, France
| | - Raphaele Germi
- Laboratory of Virology, University Hospital of Grenoble, Grenoble, France.,Institut de Biologie Structurale, CEA, CNRS, University Grenoble Alpes, Grenoble, France
| | | | - Jean-Paul Stahl
- Infectious Diseases Department, University Hospital of Grenoble, Grenoble, France
| | - Olivier Epaulard
- Infectious Diseases Department, University Hospital of Grenoble, Grenoble, France
| | - Patrice Morand
- Laboratory of Virology, University Hospital of Grenoble, Grenoble, France.,Institut de Biologie Structurale, CEA, CNRS, University Grenoble Alpes, Grenoble, France
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19
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Reina J, Leyes M, Taboada C. Meningitis linfocitarias causadas por el virus herpes simple tipo 2. Rev Clin Esp 2016; 216:290-1. [DOI: 10.1016/j.rce.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/08/2016] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
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20
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Jaques DA, Bagetakou S, L'Huillier AG, Bartoli A, Vargas MI, Fluss J, Kaiser L. Herpes simplex encephalitis as a complication of neurosurgical procedures: report of 3 cases and review of the literature. Virol J 2016; 13:83. [PMID: 27216026 PMCID: PMC4877812 DOI: 10.1186/s12985-016-0540-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Herpes simplex virus (HSV) is the most common identified cause of focal encephalitis worldwide. However, postoperative HSV encephalitis (HSVE) is a rare complication of neurosurgical procedures and a significant clinical challenge METHOD We describe 3 cases of postoperative HSVE and review all published reports. A total of 23 cases were identified. DISCUSSION Clinical heterogeneity represents a diagnostic challenge in the postoperative setting. Cerebral magnetic resonance imaging showed typical findings in a minority of patients only, whereas HSV-specific polymerase chain reaction on the cerebrospinal fluid proved to be a valuable test. The postoperative viral pathophysiology remains a subject of debate. The rate of adverse outcome is high and early antiviral treatment seems to be a strong predictor of clinical outcome. CONCLUSION We recommend early empirical treatment for any patient presenting with post-neurosurgical lymphocytic meningo-encephalitis, and prophylactic antiviral treatment for patients with a history of previous HSVE who will undergo a neurosurgical procedure.
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Affiliation(s)
- David A Jaques
- Division of General Internal Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Spyridoula Bagetakou
- Division of General Pediatrics, Child and Adolescent Department, Geneva University Hospitals, Geneva, Switzerland
| | - Arnaud G L'Huillier
- Laboratory of Virology, Division of Infectious Diseases and Division of Laboratory Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Andrea Bartoli
- Neurosurgery Division, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | | | - Joel Fluss
- Pediatric Neurology Unit, Pediatric Subspecialties Service, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Kaiser
- Laboratory of Virology, Division of Infectious Diseases and Division of Laboratory Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
- University of Geneva Medical School, Geneva, Switzerland.
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21
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Saraya AW, Wacharapluesadee S, Petcharat S, Sittidetboripat N, Ghai S, Wilde H, Hemachudha T. Normocellular CSF in herpes simplex encephalitis. BMC Res Notes 2016; 9:95. [PMID: 26879928 PMCID: PMC4753680 DOI: 10.1186/s13104-016-1922-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 02/08/2016] [Indexed: 11/10/2022] Open
Abstract
Background Herpes simplex virus (HSV) is the most common cause of sporadic encephalitis worldwide. The high mortality rate (70–80 %) of herpes simplex encephalitis (HSE) can be reduced to 20–30 % by antiviral therapy. However, normocellular CSF can lure physicians to look for non-infectious causes, resulting in delayed treatment. This study aimed to investigate, characterize and differentiate HSE patients, with normocellular and pleocytosis CSF, according to neuroimaging patterns, underlying disease, CSF viral load and clinical outcome. Patients with proven (by PCR positive CSF) or presumed viral infections of the CNS admitted to King Chulalongkorn Memorial Hospital between January 2002 and 2011 were analyzed. Results HSV was detected in the CSF of 43 patients but only 23 patients had encephalitis. Among these 23 patients, 6 cases (26.1 %) had normal CSF WBC (<5 cells/mm3). One patient in this normocellular CSF group had HIV infection. Although this patient had low CD4 counts (<200 cells/mm3), the peripheral WBC counts showed only mild leukopenia. The CSF HSV viral load in the pleocytosis group was higher than the normocellular group, with an average of 12,200 vs 3027 copies/ml respectively. There was no correlation between the viral load and the clinical outcome. With respect to neuroimaging, 4 (66.7 %) patients in the normocellular group had unremarkable/non-specific results. Conclusions Normocellular CSF in HSE is not rare, and can be seen in normal as well as immunocompromised hosts. Clinicians should not exclude CNS infection, especially HSE, merely based on the absence of CSF pleocytosis and/or unremarkable neuroimaging study.
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Affiliation(s)
- Abhinbhen W Saraya
- WHO-CC for Research and Training on Viral Zoonoses, Division of Neurology, Department of Medicine, Faculty of Medicine, Neuroscience Centre for Research and Development, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
| | - Supaporn Wacharapluesadee
- WHO-CC for Research and Training on Viral Zoonoses, Division of Neurology, Department of Medicine, Faculty of Medicine, Neuroscience Centre for Research and Development, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
| | - Sininat Petcharat
- WHO-CC for Research and Training on Viral Zoonoses, Division of Neurology, Department of Medicine, Faculty of Medicine, Neuroscience Centre for Research and Development, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
| | - Nuntaporn Sittidetboripat
- WHO-CC for Research and Training on Viral Zoonoses, Division of Neurology, Department of Medicine, Faculty of Medicine, Neuroscience Centre for Research and Development, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
| | - Siriporn Ghai
- WHO-CC for Research and Training on Viral Zoonoses, Division of Neurology, Department of Medicine, Faculty of Medicine, Neuroscience Centre for Research and Development, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
| | - Henry Wilde
- WHO-CC for Research and Training on Viral Zoonoses, Division of Neurology, Department of Medicine, Faculty of Medicine, Neuroscience Centre for Research and Development, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand. .,Division of Infectious Disease, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
| | - Thiravat Hemachudha
- WHO-CC for Research and Training on Viral Zoonoses, Division of Neurology, Department of Medicine, Faculty of Medicine, Neuroscience Centre for Research and Development, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
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22
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Berger A, Shahar T, Margalit N. Herpes Simplex Type 2 Encephalitis After Craniotomy: Case Report and Literature Review. World Neurosurg 2015; 88:691.e9-691.e12. [PMID: 26724620 DOI: 10.1016/j.wneu.2015.11.101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Herpes simplex encephalitis (HSE) after neurosurgical procedures is extremely uncommon, and the few published case reports mainly described herpes simplex virus type 1 (HSV-1) as being culpable. We present a rare case of HSV-2 encephalitis after craniotomy and describe its pathophysiology and optimal management. CASE DESCRIPTION A 70-year-old woman underwent an elective resection of a recurrent left sphenoid wing meningioma and clipping of a left middle cerebral artery aneurysm, the latter having been found incidentally. She returned to our department with clinical findings suggestive of meningitis 12 days after the operation. Her lack of response to empiric antibiotic treatment, taken together with the lymphocyte-predominant initial cerebrospinal fluid obtained by lumbar puncture and the electroencephalographic indications of encephalopathy, led to the suspicion of a diagnosis of HSE, which was later confirmed by a polymerase chain reaction test positive for HSV-2. The patient was then successfully treated with intravenous acyclovir for 2 weeks followed by another week of oral acyclovir treatment before being discharged. CONCLUSIONS The present case stresses the importance of recognizing the relatively rare entity of HSE after craniotomy. Timely correct diagnosis will expedite the initiation of appropriate treatment.
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Affiliation(s)
- Assaf Berger
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Shahar
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nevo Margalit
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Kristen H, Santana S, Sastre I, Recuero M, Bullido MJ, Aldudo J. Herpes simplex virus type 2 infection induces AD-like neurodegeneration markers in human neuroblastoma cells. Neurobiol Aging 2015; 36:2737-47. [DOI: 10.1016/j.neurobiolaging.2015.06.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 06/02/2015] [Accepted: 06/10/2015] [Indexed: 12/31/2022]
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Jennische E, Eriksson CE, Lange S, Trybala E, Bergström T. The anterior commissure is a pathway for contralateral spread of herpes simplex virus type 1 after olfactory tract infection. J Neurovirol 2015; 21:129-47. [PMID: 25604497 DOI: 10.1007/s13365-014-0312-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/22/2014] [Accepted: 12/26/2014] [Indexed: 01/04/2023]
Abstract
Herpes simplex encephalitis (HSE), targeting the limbic system, is the most common cause of viral encephalitis in the Western world. Two pathways for viral entry to the central nervous system (CNS) in HSE have been suggested: either via the trigeminal nerve or via the olfactory tract. This question remains unsettled, and studies of viral spread between the two brain hemispheres are scarce. Here, we investigated the olfactory infection as a model of infection and tropism of herpes simplex virus 1 (HSV-1), the causative agent of HSE, in the CNS of rats. Rats were instilled with HSV-1 in the right nostril and sacrificed 1-6 days post-infection, and tissues were analysed for viral spread using immunohistochemistry and quantitative PCR (qPCR). After nasal instillation, HSV-1 infected mitral cells of the olfactory bulb (OB) on the right side only, followed by limbic encephalitis. As a novel finding, the anterior commissure (AC) conveyed a rapid transmission of virus between the right and the left OB, acting as a shortcut also between the olfactory cortices. The neuronal cell population that conveyed the viral infection via the AC was positive for the water channel protein aquaporin 9 (AQP9) by immunohistochemistry. Quantification of AQP9 in cerebrospinal fluid samples of HSE patients showed increment as compared to controls. We conclude that the olfactory route and the AC are important for the spread of HSV-1 within the olfactory/limbic system of rats and furthermore, we suggest that AQP9 is involved in viral tropism and pathogenesis of HSE.
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Affiliation(s)
- Eva Jennische
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
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Xue C, Chen S, Lin Q, Zhou H, Huang C, Lin J, Xie W, Chen K, Zhou D, Ma W, Ma F, Xu H. Double encephalitis with herpes simplex virus type II and cytomegalovirus in an elder Chinese: a case report. Neuropsychiatr Dis Treat 2015; 11:2833-6. [PMID: 26586947 PMCID: PMC4636174 DOI: 10.2147/ndt.s92366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Herpes simplex encephalitis is a rare disease. In adults, most of the reported cytomegalovirus (CMV) infections are seen in immunocompromised patients. We present a case of 67-year-old Chinese male with the coinfection of CMV and herpes simplex virus type II (HSV-II). He had no history of being treated with immunosuppressants, showed symptoms of psychosis and was scored 109 on the Positive and Negative Syndrome Scale. This patient presented with a rare case of coinfection of CMV and herpes simplex virus type II with psychotic symptoms.
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Affiliation(s)
- Chaobiao Xue
- Outpatient Department, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, Guangdong, People’s Republic of China
- Mental Health Center, Shantou University Medical College, Shantou, Guangdong, People’s Republic of China
| | - Shaoxian Chen
- Outpatient Department, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, Guangdong, People’s Republic of China
| | - Qi Lin
- Outpatient Department, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, Guangdong, People’s Republic of China
| | - Houshi Zhou
- Outpatient Department, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, Guangdong, People’s Republic of China
| | - Chuming Huang
- Outpatient Department, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, Guangdong, People’s Republic of China
| | - Jiyuan Lin
- Outpatient Department, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, Guangdong, People’s Republic of China
| | - Weihang Xie
- Outpatient Department, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, Guangdong, People’s Republic of China
| | - Kai Chen
- Outpatient Department, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, Guangdong, People’s Republic of China
| | - Dongming Zhou
- Outpatient Department, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, Guangdong, People’s Republic of China
| | - Wan Ma
- Outpatient Department, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, Guangdong, People’s Republic of China
| | - Feiyu Ma
- Outpatient Department, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, Guangdong, People’s Republic of China
- Correspondence: Feiyu Ma, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, 114 Waima Road, Shantou, Guangdong 515065, People’s Republic of China, Tel +86 754 8890 3165, Email
| | - Haiyun Xu
- Mental Health Center, Shantou University Medical College, Shantou, Guangdong, People’s Republic of China
- Haiyun Xu, Mental Health Center, Shantou University Medical College, North Taishan Road, Shantou, Guangdong 515065, People’s Republic of China, Tel +86 754 8890 0728, Email
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