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Suzuki F, Takahashi S, Oniki A, Ishihara S, Yamagishi H, Tomimitsu H. [Herpes simplex encephalitis complicated with cerebral salt wasting syndrome: a case study]. Rinsho Shinkeigaku 2024; 64:579-582. [PMID: 39069488 DOI: 10.5692/clinicalneurol.cn-001966] [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] [Indexed: 07/30/2024]
Abstract
A 78-year-old man was admitted to the hospital with a 4-day history of fever and confusion. Physical examination revealed oral dryness and decreased skin turgor. Blood tests showed hyponatremia (121.5 mEq/l), and cerebrospinal fluid examination revealed positivity for herpes simplex virus 1 (HSV-1) via polymerase chain reaction. He was diagnosed with herpes simplex encephalitis and initiated acyclovir treatment. The hyponatremia was diagnosed as cerebral salt wasting syndrome (CSWS) and treated with hypertonic saline infusion and fludrocortisone. The cerebrospinal fluid HSV-1 DNA became negative, and the serum sodium levels normalized. Hyponatremia complicated with encephalitis is often caused by the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), whereas CSWS is rare, mostly observed in tuberculous meningitis. Differentiating between the SIADH and CSWS is important as they require distinct therapeutic strategies.
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Affiliation(s)
| | | | - Ayako Oniki
- Department of Neurology, JA Toride Medical Center
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2
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Pham TS, Montini F, Pham HN, Nguyen Tran MT, Huy NT, Cacciaguerra L, Filippi M. Radiological Features of Herpetic Encephalitis in Children. Pediatr Neurol 2024; 156:99-105. [PMID: 38744070 DOI: 10.1016/j.pediatrneurol.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/02/2024] [Accepted: 03/31/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Nonspecific clinical manifestations and unclear radiological features may delay treatment initiation in pediatric patients with Herpes simplex encephalitis (HSE). The aim of this study is to analyze the clinical and radiological features of the disease. METHODS Clinical, laboratory, and magnetic resonance imaging (MRI) data were obtained retrospectively from a group of 37 hospitalized pediatric patients older than two months and with a polymerase chain reaction-confirmed HSE diagnosis. Clinical severity (i.e., mechanical ventilatory support) and outcome at discharge (i.e., pediatric modified Rankin Scale [ped-mRS]) were also assessed. RESULTS Median age was 14 months (interquartile range: 10-36). All patients survived, 15 (41%) had complete recovery (i.e., ped-mRS = 0), and 10 (27%) had significant residual disability at discharge (i.e., ped-mRS ≥3). Brain MRI was obtained in 31 patients. T2-hyperintense lesions were usually bilateral (28, 90%) and multifocal (30, 97%). Hemorrhage and mass effect were observed in 13 (42%) and 15 (48%) patients, respectively. Parenchymal lesions involved the temporal lobes (94%), insula (90%), parietal lobes (84%), and frontal lobes (61%). Occipital lesions were rare. In multivariable binary logistic regression models the presence of altered consciousness was associated with mechanical ventilation (odds ratio [OR] = 8.2, Nagelkerke R2 = 0.22), whereas the involvement of the occipital lobes (OR = 7.8) and the administration of vasopressors (OR = 12.1) were independent predictors of poor outcome (Nagelkerke R2 = 0.41). CONCLUSIONS Brain MRI is useful for diagnosis and outcome assessment in pediatric HSE. Radiological patterns with common frontotemporal involvement overlap adults, but multifocal and parietal lobe abnormalities are observed as well.
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Affiliation(s)
- Thai Son Pham
- Department of Covid-19, Children's Hospital 2, Ho Chi Minh, Vietnam
| | - Federico Montini
- Vita-Salute San Raffaele University, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Institute of Research and Development, Duy Tan University, Da Nang, Vietnam; School of Medicine and Pharmacy, Duy Tan University, Da Nang, Vietnam
| | - Laura Cacciaguerra
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Massimo Filippi
- Vita-Salute San Raffaele University, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Sauvage A, Laurent E, Gaborit C, Guillon A, Grammatico-Guillon L. Herpes simplex encephalitis in France: incidence, 6-month rehospitalizations and mortality. Infection 2024:10.1007/s15010-024-02272-3. [PMID: 38678152 DOI: 10.1007/s15010-024-02272-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Herpes simplex encephalitis (HSE) is a disease with unfavorable vital and functional prognoses. There are no recent epidemiological data on HSE at a national level using real-life databases, especially in France. This study aimed to report the incidence, the clinical characteristics and outcomes of the patients with HSE. METHODS We conducted a comprehensive retrospective cohort study on all patients hospitalized for HSE in France between 2015 and 2022 using national hospital discharge databases. Incidence, socio-demographic and clinical characteristics (including comorbidities, seizure, stays' features, intensive care supports) were described. The short- (first stay) and long-term (6-month) outcomes were reported, in terms of mortality and rehospitalizations. RESULTS 1425 HSE patients were included (median age 67 [54-77] years old, M/F sex ratio 1.07), giving a mean yearly hospital incidence of 2.3 [2.1-2.5] per 1,000,000 inhabitants. 51.2% of the patients were admitted in ICU (n = 730), of whom 59.0% were mechanically ventilated. The overall mortality during the first stay was 14.3% (n = 204), up to 17.9% for ICU patients. Within 6 months, among the survivors, 10.1% had at least one rehospitalization related to HSE. At 6 months, 16.5% of all patients had died (n = 235), 20.8% for ICU patients. CONCLUSION In France, the incidence of hospitalizations for HSE was 2.3 per 1,000,000 inhabitants with more than half of the patients admitted in ICU and a 6-month in-hospital mortality about 16.5%. This real-life update on the characteristics and severe outcomes of the disease raises awareness among care practitioners, of the serious nature of the disease, and thus can lead to higher vigilance.
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Affiliation(s)
- Ambre Sauvage
- Clinical Data Epidemiology Unit in Centre-Val de Loire (EpiDcliC), Tours University Hospital, Tours, France
- University of Tours, Tours, France
| | - Emeline Laurent
- Clinical Data Epidemiology Unit in Centre-Val de Loire (EpiDcliC), Tours University Hospital, Tours, France
- Research Team EA 7505 "Education, Ethics, Health", University of Tours, Tours, France
| | - Christophe Gaborit
- Clinical Data Epidemiology Unit in Centre-Val de Loire (EpiDcliC), Tours University Hospital, Tours, France
| | - Antoine Guillon
- Intensive Care Unit, Tours University Hospital, Tours, France
- Research Center for Respiratory Diseases, INSERM U1100, Tours, France
| | - Leslie Grammatico-Guillon
- Clinical Data Epidemiology Unit in Centre-Val de Loire (EpiDcliC), Tours University Hospital, Tours, France.
- University of Tours, Tours, France.
- MAVIVH, INSERM U1259, Tours, France.
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Abbuehl LS, Hofmann E, Hakim A, Dietmann A. Can we forecast poor outcome in herpes simplex and varicella zoster encephalitis? A narrative review. Front Neurol 2023; 14:1130090. [PMID: 37435162 PMCID: PMC10331601 DOI: 10.3389/fneur.2023.1130090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/31/2023] [Indexed: 07/13/2023] Open
Abstract
Herpes simplex virus (HSV) and varicella zoster virus (VZV) are among the most commonly diagnosed infectious causes of sporadic encephalitis worldwide. Despite treatment, mortality and morbidity rates remain high, especially for HSV encephalitis. This review is intended to provide an overview of the existing scientific literature on this topic from the perspective of a clinician who is confronted with serious decisions about continuation or withdrawal of therapeutic interventions. We performed a literature review searching two databases and included 55 studies in the review. These studies documented or investigated specifically outcome and predictive parameters of outcome of HSV and/or VZV encephalitis. Two reviewers independently screened and reviewed full-text articles meeting the inclusion criteria. Key data were extracted and presented as a narrative summary. Both, HSV and VZV encephalitis have mortality rates between 5 and 20% and complete recovery rates range from 14 to 43% for HSV and 33 to 49% for VZV encephalitis. Prognostic factors for both VZV and HSV encephalitis are older age and comorbidity, as well as severity of disease and extent of magnetic resonance imaging (MRI) lesions on admission, and delay in treatment initiation for HSV encephalitis. Although numerous studies are available, the main limiting factors are the inconsistent patient selection and case definitions as well as the non-standardised outcome measures, which hampers the comparability of the studies. Therefore, larger and standardised observational studies applying validated case definitions and outcome measures including quality of life assessment are required to provide solid evidence to answer the research question.
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Affiliation(s)
- Lena S. Abbuehl
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eveline Hofmann
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arsany Hakim
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anelia Dietmann
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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5
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Duarte LF, Gatica S, Castillo A, Kalergis AM, Bueno SM, Riedel CA, González PA. Is there a role for herpes simplex virus type 1 in multiple sclerosis? Microbes Infect 2022; 25:105084. [PMID: 36586461 DOI: 10.1016/j.micinf.2022.105084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/15/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
Numerous studies relate the onset and severity of multiple sclerosis (MS) with viral infections. Herpes simplex virus type 1 (HSV-1), which is neurotropic and highly prevalent in the brain of healthy individuals, has been proposed to relate to MS. Here, we review and discuss the reported connections between HSV-1 and MS.
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Affiliation(s)
- Luisa F Duarte
- Millennium Institute on Immunology and Immunotherapy, Departamento de Ciencias Biológicas, Facultad de Ciencias de La Vida, Universidad Andres Bello, Santiago, Chile
| | - Sebastian Gatica
- Millennium Institute on Immunology and Immunotherapy, Departamento de Ciencias Biológicas, Facultad de Ciencias de La Vida, Universidad Andres Bello, Santiago, Chile
| | - Almendra Castillo
- Millennium Institute on Immunology and Immunotherapy, Departamento de Ciencias Biológicas, Facultad de Ciencias de La Vida, Universidad Andres Bello, Santiago, Chile
| | - Alexis M Kalergis
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Chile; Departamento de Endocrinología, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica, Chile
| | - Susan M Bueno
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Chile
| | - Claudia A Riedel
- Millennium Institute on Immunology and Immunotherapy, Departamento de Ciencias Biológicas, Facultad de Ciencias de La Vida, Universidad Andres Bello, Santiago, Chile
| | - Pablo A González
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Chile.
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Esposito S, Autore G, Argentiero A, Ramundo G, Principi N. Autoimmune encephalitis after herpes simplex encephalitis: A still undefined condition. Clin Exp Rheumatol 2022; 21:103187. [PMID: 36087700 DOI: 10.1016/j.autrev.2022.103187] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/04/2022] [Indexed: 12/14/2022]
Abstract
Herpes simplex encephalitis (HSE) is one of the most common sporadic viral encephalitis. Generally, HSE is characterized by a monophasic short course, although in some patients neurological relapses or worsening of deficits can develop some weeks later, when viral therapy has been discontinued and signs and symptoms of the central nervous system (CNS) damage seem to have stabilized. The second HSE stage is generally identified as autoimmune encephalitis after HSE (AEaHSE). Aim of this paper is to discuss which are the present knowledge in this regard. Literature analysis showed that AEaHSE exists, it is more common in younger children and it has different clinical manifestations according to age. All the patients with AEaHSE are positive for one or more neuronal cell-surface and synaptic antibodies, mainly anti-NMDAR antibodies, and the earlier the appearance of the antibodies the greater the risk of AEaHSE development. This means that a careful monitoring of antibody production starting from anti-NMDAR antibodies in all HSE cases could lead to the early identification of AEaHSE and the prompt administration of a potentially effective therapy. Further studies are needed to clarify which are the main pathogenetic mechanisms, whether there are differences in risk of development and clinical course of AEaHSE according to the type of antibody production, why response to immunosuppressive therapy significantly varies and whether administration of steroids to patients with HSE during the first phase of disease can play a role for reducing the risk of AEaHSE development.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Giovanni Autore
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alberto Argentiero
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Greta Ramundo
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Müller-Jensen L, Zierold S, Versluis JM, Boehmerle W, Huehnchen P, Endres M, Mohr R, Compter A, Blank CU, Hagenacker T, Meier F, Reinhardt L, Gesierich A, Salzmann M, Hassel JC, Ugurel S, Zimmer L, Banks P, Spain L, Soon JA, Enokida T, Tahara M, Kähler KC, Seggewiss-Bernhardt R, Harvey C, Long GV, Schöberl F, von Baumgarten L, Hundsberger T, Schlaak M, French LE, Knauss S, Heinzerling LM. Dataset of a Retrospective Multicenter Cohort Study on Characteristics of Immune Checkpoint Inhibitor-induced Encephalitis and Comparison with HSV-1 and Anti-LGI1 Encephalitis. Data Brief 2022; 45:108649. [DOI: 10.1016/j.dib.2022.108649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
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ALKAN S, ÖNDER T, AKÇA A, ŞENER A. A case of new-onset refractory status epilepticus (NORSE) due to Herpes Simplex Virus-1 encephalitis. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2022. [DOI: 10.33706/jemcr.1087340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In the medical literature, the term of "new-onset refractory status epilepticus" (NORSE) is a novel term. Herpes Simplex Virus-1 and other viral infections can be cause to NORSE. Seizures are a rare sign of HSV encephalitis, but they can occur as the first symptom. Herein, we present a case of NORSE triggered by HSV-1 encephalitis, which had been diagnosed via cerebrospinal fluid polymerase chain reaction (PCR) method and magnetic resonance imaging findings.
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Affiliation(s)
- Sevil ALKAN
- Çanakkale On sekiz Mart Üniversitesi Tıp Fakültesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Çanakkale
| | - Taylan ÖNDER
- Canakkale Onsekiz Mart University Faculty of Medicine, Infectious Disease Department, Canakkale-Turkey
| | - Anıl AKÇA
- Canakkale Onsekiz Mart University Faculty of Medicine, Infectious Disease Department, Canakkale-Turkey
| | - Alper ŞENER
- Izmir Katip Çelebi Research Hospital, Department of Infectious Diseases and Clinical Microbiology, İzmir, Turkey
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Mulatero M, Boucekine M, Felician O, Boussen S, Kaplanski G, Rossi P, Parola P, Stein A, Brouqui P, Lagier JC, Leone M, Kaphan E. Herpetic encephalitis: which treatment for which body weight? J Neurol 2022; 269:3625-3635. [DOI: 10.1007/s00415-022-10981-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 01/01/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
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Abstract
INTRODUCTION The typical herpes simplex viral encephalitis (HSVE) course is an acute illness, less commonly it may present as a chronic course, mainly in children, and rarely may it be subacute. Subacute HSVE is rarely described in the literature being reported 4 times only. CASE REPORT We here report 2 cases of subacute HSV1 encephalitis diagnosed based on cerebrospinal fluid polymerase chain reaction and magnetic resonance imaging findings and review the literature trying to find any specific clinical, laboratory, radiologic diagnostic or prognostic criteria regarding this subacute form of HSVE. CONCLUSION There is subacute form of HSVE and should be suspected with any subacute febrile illness with nonspecific cognitive impairment even in the absence of focal neurological symptoms and in cases with rapidly progressive dementia. This form has similar radiologic finding and good response to acyclovir but carry even better prognosis than that the acute HSVE.
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11
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Yong SJ, Yong MH, Teoh SL, Soga T, Parhar I, Chew J, Lim WL. The Hippocampal Vulnerability to Herpes Simplex Virus Type I Infection: Relevance to Alzheimer's Disease and Memory Impairment. Front Cell Neurosci 2021; 15:695738. [PMID: 34483839 PMCID: PMC8414573 DOI: 10.3389/fncel.2021.695738] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/20/2021] [Indexed: 12/24/2022] Open
Abstract
Herpes simplex virus type 1 (HSV-1) as a possible infectious etiology in Alzheimer’s disease (AD) has been proposed since the 1980s. The accumulating research thus far continues to support the association and a possible causal role of HSV-1 in the development of AD. HSV-1 has been shown to induce neuropathological and behavioral changes of AD, such as amyloid-beta accumulation, tau hyperphosphorylation, as well as memory and learning impairments in experimental settings. However, a neuroanatomical standpoint of HSV-1 tropism in the brain has not been emphasized in detail. In this review, we propose that the hippocampal vulnerability to HSV-1 infection plays a part in the development of AD and amnestic mild cognitive impairment (aMCI). Henceforth, this review draws on human studies to bridge HSV-1 to hippocampal-related brain disorders, namely AD and aMCI/MCI. Next, experimental models and clinical observations supporting the neurotropism or predilection of HSV-1 to infect the hippocampus are examined. Following this, factors and mechanisms predisposing the hippocampus to HSV-1 infection are discussed. In brief, the hippocampus has high levels of viral cellular receptors, neural stem or progenitor cells (NSCs/NPCs), glucocorticoid receptors (GRs) and amyloid precursor protein (APP) that support HSV-1 infectivity, as well as inadequate antiviral immunity against HSV-1. Currently, the established diseases HSV-1 causes are mucocutaneous lesions and encephalitis; however, this review revises that HSV-1 may also induce and/or contribute to hippocampal-related brain disorders, especially AD and aMCI/MCI.
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Affiliation(s)
- Shin Jie Yong
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Petaling Jaya, Malaysia
| | - Min Hooi Yong
- Department of Psychology, School of Medical and Life Sciences, Sunway University, Petaling Jaya, Malaysia.,Aging Health and Well-being Research Centre, School of Medical and Life Sciences, Sunway University, Petaling Jaya, Malaysia
| | - Seong Lin Teoh
- Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Tomoko Soga
- Jeffrey Cheah School of Medicine and Health Sciences, Brain Research Institute Monash Sunway, Monash University Malaysia, Subang Jaya, Malaysia
| | - Ishwar Parhar
- Jeffrey Cheah School of Medicine and Health Sciences, Brain Research Institute Monash Sunway, Monash University Malaysia, Subang Jaya, Malaysia
| | - Jactty Chew
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Petaling Jaya, Malaysia
| | - Wei Ling Lim
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Petaling Jaya, Malaysia.,Aging Health and Well-being Research Centre, School of Medical and Life Sciences, Sunway University, Petaling Jaya, Malaysia
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Abstract
PURPOSE OF REVIEW This article reviews infections of the brain parenchyma and includes an overview of the epidemiology, pathogenesis, diagnostic approach, and management of infectious encephalitis and brain abscess. RECENT FINDINGS The epidemiology of infectious encephalitis and brain abscess has changed in recent years. Vaccination has reduced the incidence of certain viruses associated with encephalitis, while a decrease in fulminant otogenic infections has led to fewer brain abscesses associated with otitis media. However, changes in climate and human population density and distribution have enabled the emergence of newer pathogens and expanded the geographic range of others, and greater adoption of intensive immunosuppressive regimens for autoimmune conditions has increased the risk of opportunistic infections of the brain. The widespread use of early neuroimaging, along with improved diagnostic methodologies for pathogen detection, newer antimicrobial therapies with better brain penetration, and less invasive neurosurgical techniques, has resulted in better outcomes for patients with infectious encephalitis and brain abscess. Novel technologies including metagenomic next-generation sequencing are increasingly being applied to these conditions in an effort to improve diagnosis. Nevertheless, both infectious encephalitis and brain abscess continue to be associated with substantial mortality. SUMMARY Infectious encephalitis and brain abscess can present as neurologic emergencies and require rapid assessment, thorough and appropriate diagnostic testing, and early initiation of empiric therapies directed against infectious agents. Close clinical follow-up, proper interpretation of diagnostic results, and appropriate tailoring of therapeutic agents are essential to optimizing outcomes. Diagnosis and management of parenchymal brain infections are complex and often best achieved with a multidisciplinary care team involving neurologists, neurosurgeons, neuroradiologists, infectious disease physicians, and pathologists.
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Trang TM, Chien PC, Dung BT, Thu NTH, Truc NTT, Khang VNC. Adult-onset mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome with progressive sensorineural hearing loss: A case report. Radiol Case Rep 2021; 16:1865-1869. [PMID: 34093932 PMCID: PMC8166901 DOI: 10.1016/j.radcr.2021.04.049] [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: 01/01/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 11/30/2022] Open
Abstract
Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is one of the most common maternally inherited mitochondrial disorders, with no specific treatment available. We report a case of a 34-year-old female in whom symptoms of MELAS were initially misdiagnosed as herpes simplex encephalitis (HSE). Her clinical course was marked by an acute episode of consciousness disturbance with newly developed lesions on brain MRI five years after disease onset and followed by progressive sensorineural hearing loss. Brain imaging sequences throughout the seven years of her illness are presented. The final diagnosis of MELAS syndrome was confirmed by m.3243A>G mitochondrial mutation. In conclusion, understanding the overlapping imaging features between MELAS syndrome and other mimickers, such as HSE or ischemic stroke, is crucial to help establish early diagnosis and initiate appropriate treatment.
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Affiliation(s)
- T M Trang
- Deparment of Neurology, University Medical Centre, Ho Chi Minh City, Vietnam
| | - P C Chien
- Deparment of Radiology, University Medical Centre, Ho Chi Minh City, Vietnam
| | - B T Dung
- Deparment of Neurology, University Medical Centre, Ho Chi Minh City, Vietnam
| | - N T H Thu
- Deparment of Neurology, University Medical Centre, Ho Chi Minh City, Vietnam
| | - N T T Truc
- Deparment of Neurology, Hospital 30-4, Ho Chi Minh City, Vietnam
| | - V N C Khang
- Deparment of Neurology, University Medical Centre, Ho Chi Minh City, Vietnam
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14
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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. [PMID: 34350317 DOI: 10.1007/s13337-021-00680-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/05/2021] [Indexed: 11/29/2022] Open
Abstract
Encephalitis has infectious and noninfectious etiology. Among infectious agents, viruses are the main causes of encephalitis; Herpes simplex virus (HSV) is known as the most common causative agent of viral encephalitis. In this current cross-sectional investigation, we aimed to assess the prevalence of HSV in the cerebrospinal fluid (CSF) specimens of Herpes Simplex Encephalitis (HSE) suspected patients and also determining the clinical symptoms and laboratory findings of this viral complication. Two hundred consecutive HSE suspected patients with clinical diagnosis of encephalitis were included in the study and then the presence of HSV DNA in their CSF was applied by Polymerase Chain Reaction (PCR) assay. Molecular detection of two hundred (117 males with mean age: 43 years, 83 females with mean age: 39 years) CSF samples showed that 22 (11.11%) cases were positive for HSV infection. 15(68.18%) of the positive samples were more than 50 years old, however, there was no significant correlation between age distribution, gender and HSE clinical manifestations. Fever (91%), headache (72.7%), seizer (59%), and weakness (59%) were the most common symptoms in positive patients and also mortality rate was (18.18%). CSF laboratory abnormalities of HSE cases were as follows; lymphocytic pleocytosis 19 (86.3%), leukocytosis 19 (86.3%), elevated protein level 16 (72.7%), and hypoglycorrhachia 3(13.6%). Screening of HSE suspected patients is crucial in the treatment of patients and reduce the mobility and morbidity of patients. Qualitative PCR as an available method in most developing countries could be a reliable method to monitor consecutive HSE suspected patients.
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Affiliation(s)
- Abouzar Babaei
- Department of Bacteriology and Virology, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Virology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | | | - Neda Pirbonyeh
- Department of Bacteriology and Virology, Shiraz University of Medical Sciences, Shiraz, Iran.,Burn and Wound Healing Research Center, Microbiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afagh Moattari
- Department of Bacteriology and Virology, Shiraz University of Medical Sciences, Shiraz, Iran
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A Cross-Sectional Study of Hyponatremia Associated with Acute Central Nervous System Infections. J Clin Med 2019; 8:jcm8111801. [PMID: 31717875 PMCID: PMC6912743 DOI: 10.3390/jcm8111801] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/19/2019] [Accepted: 10/25/2019] [Indexed: 01/20/2023] Open
Abstract
Hyponatremia can occur with central nervous system (CNS) infections, but the frequency and severity may depend on the organism and nature of CNS involvement. In this cross-sectional study at a large Australian hospital network from 2015 to 2018, we aimed to determine the prevalence and severity of hyponatremia associated with CNS infection clinical syndromes, and the association with specific organisms. We examined the results of cerebrospinal fluid analysis from lumbar punctures performed in 184 adult patients with a serum sodium below 135 mmol/L who had abnormal cerebrospinal fluid analysis and a clinical syndrome consistent with an acute CNS infection (meningitis or encephalitis). Hyponatremia affected 39% of patients and was more severe and frequent in patients with encephalitis compared to meningitis (odds ratio = 3.03, 95% CI: 1.43–6.39, after adjusting for age). Hyponatremia was present on admission in 85% of cases. Herpes simplex virus infection was associated with the highest odds of hyponatremia (odds ratio = 3.25, 95% CI: 1.13–7.87) while enterovirus infection was associated with the lowest (odds ratio = 0.36, 95% CI: 0.14–0.92), compared to cases without an isolated organism. We concluded that the risk of hyponatremia may vary by the organism isolated but the clinical syndrome was a useful surrogate for predicting the probability of developing hyponatremia.
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Win T, Maham N, Kumar S. Herpes encephalitis : a stroke mimicker. J Community Hosp Intern Med Perspect 2019; 9:333-335. [PMID: 31528283 PMCID: PMC6735338 DOI: 10.1080/20009666.2019.1624137] [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: 04/03/2019] [Accepted: 05/21/2019] [Indexed: 11/21/2022] Open
Abstract
Background: HSV-1 encephalitis (HSVE) usually presents with fever, altered mental status or focal seizures. Aphasia can also be a presenting symptom of HSVE but rarely occurs as the primary symptom. We present a case where aphasia was the primary presenting symptom of HSVE. Case: A 72-year-old physician with a history of hyperlipidemia and obstructive sleep apnea presented to the emergency room with sudden onset of speech difficulty lasting an hour. He did not have a fever, photophobia, neck stiffness, weakness, or numbness. The patient was brought in by the family within an hour to the emergency department. On exam, the only neurological deficit that was found was the use of inappropriate words in sentences and inability to name certain objects. He was diagnosed with an embolic stroke and received tPA. MRI brain that was done 24-hour post tPA showed an increased FLAIR and T2 signal hyperintensity within the medial left temporal lobe with slight effacement of the cysts sulci which was concerning for encephalitis. This was later confirmed by serology. The patient was started on IV Acyclovir and recovered fully after 3 weeks of acute neuro rehabilitation. Conclusion: Aphasia primarily is an unusual presentation of HSVE. It should be considered as one of the possibilities in patients presenting with features suggestive of a stroke involving the language areas of the brain.
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Affiliation(s)
- Thein Win
- Department of Internal Medicine, Greater Baltimore Medical Center, Baltimore, MD, USA
| | - Nida Maham
- Department of Internal Medicine, Greater Baltimore Medical Center, Baltimore, MD, USA
| | - Sahayini Kumar
- Department of Internal Medicine, Greater Baltimore Medical Center, Baltimore, MD, USA
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17
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Jaquet P, de Montmollin E, Dupuis C, Sazio C, Conrad M, Susset V, Demeret S, Tadie JM, Argaud L, Barbier F, Sarton B, Chabane R, Daubin D, Brulé N, Lerolle N, Alves M, Da Silva D, Kalioubi AE, Silva S, Bailly P, Wolff M, Bouadma L, Timsit JF, Sonneville R. Functional outcomes in adult patients with herpes simplex encephalitis admitted to the ICU: a multicenter cohort study. Intensive Care Med 2019; 45:1103-1111. [PMID: 31292686 DOI: 10.1007/s00134-019-05684-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE We aimed to study the association of body temperature and other admission factors with outcomes of herpes simplex encephalitis (HSE) adult patients requiring ICU admission. METHODS We conducted a retrospective multicenter study on patients diagnosed with HSE in 47 ICUs in France, between 2007 and 2017. Fever was defined as a body temperature higher or equal to 38.3 °C. Multivariate logistic regression analysis was used to identify factors associated with poor outcome at 90 days, defined by a score of 3-6 (indicating moderate-to-severe disability or death) on the modified Rankin scale. RESULTS Overall, 259 patients with a score on the Glasgow coma scale of 9 (6-12) and a body temperature of 38.7 (38.1-39.2) °C at admission were studied. At 90 days, 185 (71%) patients had a poor outcome, including 44 (17%) deaths. After adjusting for age, fever (OR = 2.21; 95% CI 1.18-4.16), mechanical ventilation (OR = 2.21; 95% CI 1.21-4.03), and MRI brain lesions > 3 lobes (OR = 3.04; 95% CI 1.35-6.81) were independently associated with poor outcome. By contrast, a direct ICU admission, as compared to initial admission to the hospital wards (i.e., indirect ICU admission), was protective (OR = 0.52; 95% CI 0.28-0.95). Sensitivity analyses performed after adjustment for functional status before admission and reason for ICU admission yielded similar results. CONCLUSIONS In HSE adult patients requiring ICU admission, several admission factors are associated with an increased risk of poor functional outcome. The identification of potentially modifiable factors, namely, elevated admission body temperature and indirect ICU admission, provides an opportunity for testing further intervention strategies.
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Affiliation(s)
- P Jaquet
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France
| | - E de Montmollin
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France.,UMR 1137, IAME, Paris Diderot University, Paris, France
| | - C Dupuis
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France.,UMR 1137, IAME, Paris Diderot University, Paris, France
| | - C Sazio
- Medical Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France
| | - M Conrad
- Medical Intensive Care Unit, Central Hospital, Nancy University Hospitals, Nancy, France
| | - V Susset
- Polyvalent Intensive Care Unit, Chambery Hospital, Chambery, France
| | - S Demeret
- Neurologic Intensive Care Unit, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - J M Tadie
- Medical Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - L Argaud
- Medical Intensive Care Unit, Edouard Herriot University Hospital, Lyon, France
| | - F Barbier
- Medical Intensive Care Unit, La Source Hospital, Orléans, France
| | - B Sarton
- Intensive Care Unit, Purpan University Hospital, Toulouse, France
| | - R Chabane
- Department of Perioperative Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - D Daubin
- Medical Intensive Care Unit, Montpellier University Hospital, Montpellier, France
| | - N Brulé
- Medical Intensive Care Unit, Nantes University Hospital, Nantes, France
| | - N Lerolle
- Medical Intensive Care Unit, CHU Angers, Angers University Hospital, Angers, France
| | - M Alves
- Polyvalent Intensive Care Unit, Poissy-Saint-Germain-en-Laye Hospital, Poissy, France
| | - D Da Silva
- Intensive Care Unit, Delafontaine Hospital, Saint-Denis, France
| | - A El Kalioubi
- Medical Intensive Care Unit, Roger Salengro University Hospital, Lille, France
| | - S Silva
- Intensive Care Unit, Purpan University Hospital, Toulouse, France
| | - P Bailly
- Medical Intensive Care Unit, La Cavale Blanche University Hospital, Brest, France
| | - M Wolff
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France
| | - L Bouadma
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France.,UMR 1137, IAME, Paris Diderot University, Paris, France
| | - J F Timsit
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France.,UMR 1137, IAME, Paris Diderot University, Paris, France
| | - R Sonneville
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France. .,UMR1148, LVTS, Sorbonne Paris Cité, Inserm/Paris Diderot University, Paris, France.
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Basaran S, Yavuz SS, Bali EA, Cagatay A, Oncul O, Ozsut H, Eraksoy H. Hyponatremia Is Predictive of HSV-1 Encephalitis among Patients with Viral Encephalitis. TOHOKU J EXP MED 2019; 247:189-195. [PMID: 30890665 DOI: 10.1620/tjem.247.189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Encephalitis is an inflammatory process involving the brain parenchyma associated with neurologic dysfunction. The main causes of infectious encephalitis are viruses, including Herpes simplex virus type 1 (HSV-1). As the mortality rate of HSV-1 encephalitis could be reduced with early acyclovir treatment, it is imperative to distinguish HSV-1 encephalitis from other type of viral encephalitis as early as possible. However, sophisticated methods for definitive diagnosis of HSV-1 encephalitis are not readily available. We aimed to explore distinctive clinical and laboratory features of HSV-1 encephalitis. All of the adult patients with viral encephalitis hospitalized between 2011-2017 were enrolled, including 16 patients with HSV-1 encephalitis and 51 patients non-HSV-1 viral encephalitis. Determination of viruses in cerebrospinal fluid was performed by PCR tests. Female sex, hyponatremia, and abnormalities in MRI were independently associated with HSV-1 encephalitis (p < 0.05 for each). In particular, hyponatremia (< 135 mEq/L) was found in nine patients with HSV-1 encephalitis (56.3%) and 10 patients with non-HSV-1 viral encephalitis (19.6%) (p = 0.005). As serum sodium is determined easily and quickly in clinical practice, the presence of hyponatremia among patients with viral encephalitis could be helpful for the early diagnosis of HSV-1 encephalitis before cerebrospinal fluid PCR results were available. Moreover, the presence of positive finding in MRI could further support the diagnosis. This is the first study that compared the serum sodium levels among patients between HSV-1 and non-HSV-1 viral encephalitis. We thus propose the diagnostic value of hyponatremia for HSV-1 encephalitis.
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Affiliation(s)
- Seniha Basaran
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University
| | - Serap Simsek Yavuz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University
| | - Elif Aguloglu Bali
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University
| | - Atahan Cagatay
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University
| | - Oral Oncul
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University
| | - Halit Ozsut
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University
| | - Haluk Eraksoy
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University
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Duarte LF, Farías MA, Álvarez DM, Bueno SM, Riedel CA, González PA. Herpes Simplex Virus Type 1 Infection of the Central Nervous System: Insights Into Proposed Interrelationships With Neurodegenerative Disorders. Front Cell Neurosci 2019; 13:46. [PMID: 30863282 PMCID: PMC6399123 DOI: 10.3389/fncel.2019.00046] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/30/2019] [Indexed: 12/21/2022] Open
Abstract
Herpes simplex virus type 1 (HSV-1) is highly prevalent in humans and can reach the brain without evident clinical symptoms. Once in the central nervous system (CNS), the virus can either reside in a quiescent latent state in this tissue, or eventually actively lead to severe acute necrotizing encephalitis, which is characterized by exacerbated neuroinflammation and prolonged neuroimmune activation producing a life-threatening disease. Although HSV-1 encephalitis can be treated with antivirals that limit virus replication, neurological sequelae are common and the virus will nevertheless remain for life in the neural tissue. Importantly, there is accumulating evidence that suggests that HSV-1 infection of the brain both, in symptomatic and asymptomatic individuals could lead to neuronal damage and eventually, neurodegenerative disorders. Here, we review and discuss acute and chronic infection of particular brain regions by HSV-1 and how this may affect neuron and cognitive functions in the host. We review potential cellular and molecular mechanisms leading to neurodegeneration, such as protein aggregation, dysregulation of autophagy, oxidative cell damage and apoptosis, among others. Furthermore, we discuss the impact of HSV-1 infection on brain inflammation and its potential relationship with neurodegenerative diseases.
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Affiliation(s)
- Luisa F Duarte
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mónica A Farías
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Diana M Álvarez
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Susan M Bueno
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia A Riedel
- Millennium Institute on Immunology and Immunotherapy, Departamento de Biología Celular, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
| | - Pablo A González
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
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20
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Cohen J, Sotoca J, Gandhi S, Yeshokumar AK, Gordon-Lipkin E, Geocadin RG, Frick KD, Probasco JC, Venkatesan A. Autoimmune encephalitis: A costly condition. Neurology 2019; 92:e964-e972. [PMID: 30674590 DOI: 10.1212/wnl.0000000000006990] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 10/22/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To assess the inpatient hospitalization burden and costs of patients with autoimmune encephalitis (AE) at a tertiary care institution. METHODS Adult inpatients with AE were identified retrospectively from July 1, 2005, to June 30, 2015. Demographic and clinical data were collected and analyzed. Billing data were compared to those of patients with herpes simplex encephalitis (HSE). Charges were adjusted for inflation. RESULTS Of 244 admissions for encephalitis reviewed, 63 patients met criteria for probable or definite AE. Thirty-one (49%) patients were antibody positive, and 27 (43%) were admitted to the intensive care unit (ICU). Median hospital charges per patient with AE were more than $70,000; median length of stay (LOS) was 15 days; and in-hospital mortality was 6%. Patients admitted to the ICU had substantially higher median hospital charges (ICU $173,000 per admission vs non-ICU $50,000 per admission, p < 0.001). LOS was strongly associated with charges and was driven by delay in diagnosis of AE, prolonged treatment courses, and lack of response to therapy. Compared with HSE, median hospital charges per patient with AE were nearly 4 times higher, median AE LOS was 3 times higher, and total charges over the study period were nearly twice as high. CONCLUSIONS Patients with AE used more inpatient health care resources per patient during a 10-year period than patients with HSE at our institution. ICU-admitted patients with AE were responsible for a substantially higher financial burden than non-ICU-admitted patients with AE. Our data underscore the need for the development of novel diagnostic and therapeutic modalities to improve patient outcomes and to decrease hospital burden in AE.
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Affiliation(s)
- Jesse Cohen
- From the Johns Hopkins Encephalitis Center (J.C., S.G., E.G.-L., R.G.G., J.C.P., A.V.), Department of Neurology, and Departments of Neurosurgery and Anaesthesia/Critical Care (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Neurology Department (J.S.), IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology and Pediatrics (A.K.Y.), Icahn School of Medicine at Mt. Sinai, New York, NY; Department of Neurology and Developmental Medicine (E.G.-L.), Kennedy Krieger Institute; and Johns Hopkins Carey Business School (K.D.F.), Baltimore MD
| | - Javier Sotoca
- From the Johns Hopkins Encephalitis Center (J.C., S.G., E.G.-L., R.G.G., J.C.P., A.V.), Department of Neurology, and Departments of Neurosurgery and Anaesthesia/Critical Care (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Neurology Department (J.S.), IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology and Pediatrics (A.K.Y.), Icahn School of Medicine at Mt. Sinai, New York, NY; Department of Neurology and Developmental Medicine (E.G.-L.), Kennedy Krieger Institute; and Johns Hopkins Carey Business School (K.D.F.), Baltimore MD
| | - Shikha Gandhi
- From the Johns Hopkins Encephalitis Center (J.C., S.G., E.G.-L., R.G.G., J.C.P., A.V.), Department of Neurology, and Departments of Neurosurgery and Anaesthesia/Critical Care (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Neurology Department (J.S.), IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology and Pediatrics (A.K.Y.), Icahn School of Medicine at Mt. Sinai, New York, NY; Department of Neurology and Developmental Medicine (E.G.-L.), Kennedy Krieger Institute; and Johns Hopkins Carey Business School (K.D.F.), Baltimore MD
| | - Anusha K Yeshokumar
- From the Johns Hopkins Encephalitis Center (J.C., S.G., E.G.-L., R.G.G., J.C.P., A.V.), Department of Neurology, and Departments of Neurosurgery and Anaesthesia/Critical Care (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Neurology Department (J.S.), IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology and Pediatrics (A.K.Y.), Icahn School of Medicine at Mt. Sinai, New York, NY; Department of Neurology and Developmental Medicine (E.G.-L.), Kennedy Krieger Institute; and Johns Hopkins Carey Business School (K.D.F.), Baltimore MD
| | - Eliza Gordon-Lipkin
- From the Johns Hopkins Encephalitis Center (J.C., S.G., E.G.-L., R.G.G., J.C.P., A.V.), Department of Neurology, and Departments of Neurosurgery and Anaesthesia/Critical Care (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Neurology Department (J.S.), IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology and Pediatrics (A.K.Y.), Icahn School of Medicine at Mt. Sinai, New York, NY; Department of Neurology and Developmental Medicine (E.G.-L.), Kennedy Krieger Institute; and Johns Hopkins Carey Business School (K.D.F.), Baltimore MD
| | - Romergyko G Geocadin
- From the Johns Hopkins Encephalitis Center (J.C., S.G., E.G.-L., R.G.G., J.C.P., A.V.), Department of Neurology, and Departments of Neurosurgery and Anaesthesia/Critical Care (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Neurology Department (J.S.), IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology and Pediatrics (A.K.Y.), Icahn School of Medicine at Mt. Sinai, New York, NY; Department of Neurology and Developmental Medicine (E.G.-L.), Kennedy Krieger Institute; and Johns Hopkins Carey Business School (K.D.F.), Baltimore MD
| | - Kevin D Frick
- From the Johns Hopkins Encephalitis Center (J.C., S.G., E.G.-L., R.G.G., J.C.P., A.V.), Department of Neurology, and Departments of Neurosurgery and Anaesthesia/Critical Care (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Neurology Department (J.S.), IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology and Pediatrics (A.K.Y.), Icahn School of Medicine at Mt. Sinai, New York, NY; Department of Neurology and Developmental Medicine (E.G.-L.), Kennedy Krieger Institute; and Johns Hopkins Carey Business School (K.D.F.), Baltimore MD
| | - John C Probasco
- From the Johns Hopkins Encephalitis Center (J.C., S.G., E.G.-L., R.G.G., J.C.P., A.V.), Department of Neurology, and Departments of Neurosurgery and Anaesthesia/Critical Care (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Neurology Department (J.S.), IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology and Pediatrics (A.K.Y.), Icahn School of Medicine at Mt. Sinai, New York, NY; Department of Neurology and Developmental Medicine (E.G.-L.), Kennedy Krieger Institute; and Johns Hopkins Carey Business School (K.D.F.), Baltimore MD
| | - Arun Venkatesan
- From the Johns Hopkins Encephalitis Center (J.C., S.G., E.G.-L., R.G.G., J.C.P., A.V.), Department of Neurology, and Departments of Neurosurgery and Anaesthesia/Critical Care (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Neurology Department (J.S.), IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology and Pediatrics (A.K.Y.), Icahn School of Medicine at Mt. Sinai, New York, NY; Department of Neurology and Developmental Medicine (E.G.-L.), Kennedy Krieger Institute; and Johns Hopkins Carey Business School (K.D.F.), Baltimore MD.
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Kakooza-Mwesige A, Tshala-Katumbay D, Juliano SL. Viral infections of the central nervous system in Africa. Brain Res Bull 2019; 145:2-17. [PMID: 30658129 DOI: 10.1016/j.brainresbull.2018.12.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 12/26/2022]
Abstract
Viral infections are a major cause of human central nervous system infection, and may be associated with significant mortality, and long-term sequelae. In Africa, the lack of effective therapies, limited diagnostic and human resource facilities are especially in dire need. Most viruses that affect the central nervous system are opportunistic or accidental pathogens. Some of these viruses were initially considered harmless, however they have now evolved to penetrate the nervous system efficiently and exploit neuronal cell biology thus resulting in severe illness. A number of potentially lethal neurotropic viruses have been discovered in Africa and over the course of time shown their ability to spread wider afield involving other continents leaving a devastating impact in their trail. In this review we discuss key viruses involved in central nervous system disease and of major public health concern with respect to Africa. These arise from the families of Flaviviridae, Filoviridae, Retroviridae, Bunyaviridae, Rhabdoviridae and Herpesviridae. In terms of the number of cases affected by these viruses, HIV (Retroviridae) tops the list for morbidity, mortality and long term disability, while the Rift Valley Fever virus (Bunyaviridae) is at the bottom of the list. The most deadly are the Ebola and Marburg viruses (Filoviridae). This review describes their epidemiology and key neurological manifestations as regards the central nervous system such as meningoencephalitis and Guillain-Barré syndrome. The potential pathogenic mechanisms adopted by these viruses are debated and research perspectives suggested.
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Affiliation(s)
- Angelina Kakooza-Mwesige
- Department of Paediatrics & Child Health, Makerere University College of Health Sciences and Mulago Hospital, Kampala, Uganda; Astrid Lindgren Children's Hospital, Neuropediatric Research Unit, Karolinska Institutet, Sweden.
| | - Desire Tshala-Katumbay
- Department of Neurology and School of Public Health, Oregon Health & Science University, Portland, OR, USA; Department of Neurology, University of Kinshasa, and Institut National de Recherches Biomedicales, University of Kinshasa, Democratic Republic of the Congo.
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22
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Kusulja M, Santini M. Decompressive craniectomy as salvage treatment in herpes simplex encephalitis: Two case reports. Int J Infect Dis 2018; 73:49-51. [PMID: 29870796 DOI: 10.1016/j.ijid.2018.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 10/14/2022] Open
Abstract
Herpes simplex encephalitis is a rare disease with significant morbidity and mortality, although targeted therapy is widely available. This report presents two cases of herpes simplex encephalitis in previously healthy, young adults treated with acyclovir, who developed severe brain edema. Decompressive craniectomy prevented imminent brain herniation and a fatal outcome in both of these patients.
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Affiliation(s)
- Marija Kusulja
- Department of Neuroinfections and Intensive Care Medicine, University Hospital for Infectious Diseases "Dr Fran Mihaljević", Zagreb, Croatia.
| | - Marija Santini
- Department of Neuroinfections and Intensive Care Medicine, University Hospital for Infectious Diseases "Dr Fran Mihaljević", Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
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23
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Shoaib M, Kraus JJ, Khan MT. Herpes Simplex Virus Encephalitis: Atypical Presentation as a Right Middle Cerebral Artery Stroke. Cureus 2018; 10:e2067. [PMID: 29564192 PMCID: PMC5858849 DOI: 10.7759/cureus.2067] [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] [Indexed: 11/20/2022] Open
Abstract
Herpes simplex virus encephalitis (HSVE) is a medical emergency associated with high mortality and morbidity. Definitive diagnosis is established by history, clinical examination, neuroimaging studies, supportive electroencephalogram (EEG) findings, and cerebrospinal fluid (CSF) analysis. We report a case of HSVE presenting as a stroke mimic in a 76-year-old female with a history of atrial fibrillation on warfarin. She was admitted to our medical intensive care unit with intermittent fever, lethargy, and new onset left-sided hemiparesis. A computed tomography (CT) of the head showed a right middle cerebral artery (MCA) acute ischemic stroke with midline shift and a dense right MCA sign. Brain magnetic resonance imaging (MRI) showed evidence of acute stroke with consideration of herpes encephalitis. CSF analysis was positive for herpes simplex virus (HSV) type one. She recovered with high-dose intravenous acyclovir therapy. Our patient was a diagnostic dilemma, initially being diagnosed with an acute ischemic stroke and yet found to have HSVE, which mimicked an acute ischemic stroke. Delay in treatment may result in devastating clinical outcomes that may include severe cognitive, focal neurological deficits, persistent seizures, and even death. This case highlights the importance of a multidisciplinary approach and the need for increased awareness of an atypical presentation of HSVE among emergency physicians, neurologist, intensivists, and radiologists.
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Affiliation(s)
- Maria Shoaib
- Department of Medicine, Dow Medical College Pakistan
| | - Jacqueline J Kraus
- Attending Physician, Charleston Area Medical Center / West Virginia University
| | - Muhammad T Khan
- Attending Physician, Charleston Area Medical Center / West Virginia University
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Mielcarska MB, Bossowska-Nowicka M, Toka FN. Functional failure of TLR3 and its signaling components contribute to herpes simplex encephalitis. J Neuroimmunol 2017; 316:65-73. [PMID: 29305044 DOI: 10.1016/j.jneuroim.2017.12.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/17/2017] [Accepted: 12/17/2017] [Indexed: 02/06/2023]
Abstract
Herpes simplex encephalitis (HSE) is a severe neurological disease in children and adults caused by herpes simplex virus. This review discusses recent findings on the role of Toll-like receptor 3 (TLR3) deficiencies in the HSE development. Critical checkpoints in the TLR3 signaling that contribute to innate response are discussed, including the importance of TLR3 ligand recognition site and transportation in the cell. We also indicate unresolved issues in the TLR3 functioning that might lead to thorough understanding of immunity during HSE. Such a knowledge base will lead to discovery and design of a rationale therapeutic and preventive approach against HSE.
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Affiliation(s)
- Matylda Barbara Mielcarska
- Division of Immunology, Department of Preclinical Sciences, Faculty of Veterinary Medicine, Warsaw University of Life Sciences, Ciszewskiego 8 Str., 02-786 Warsaw, Poland.
| | - Magdalena Bossowska-Nowicka
- Division of Immunology, Department of Preclinical Sciences, Faculty of Veterinary Medicine, Warsaw University of Life Sciences, Ciszewskiego 8 Str., 02-786 Warsaw, Poland
| | - Felix Ngosa Toka
- Division of Immunology, Department of Preclinical Sciences, Faculty of Veterinary Medicine, Warsaw University of Life Sciences, Ciszewskiego 8 Str., 02-786 Warsaw, Poland; Center for Integrative Mammalian Research, Ross University School of Veterinary Medicine, PO Box 334, Basseterre, Saint Kitts and Nevis
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Modi S, Mahajan A, Dharaiya D, Varelas P, Mitsias P. Burden of herpes simplex virus encephalitis in the United States. J Neurol 2017; 264:1204-1208. [PMID: 28516331 DOI: 10.1007/s00415-017-8516-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 04/29/2017] [Accepted: 05/09/2017] [Indexed: 11/29/2022]
Abstract
Herpes simplex virus encephalitis (HSVE) is a disease of public health concern, but its burden on the healthcare of United States has not been adequately assessed recently. We aimed to define the incidence, complications and outcomes of HSVE in the recent decade by analyzing data from a nationally representative database. Healthcare Cost and Utilization Project databases were utilized to identify patients with primary discharge diagnosis of HSVE. Annual hospitalization rate was estimated and several preselected inpatient complications were identified. Regression analyses were used to identify mortality predictors. Key epidemiological factors were compared with those from other countries. Total 4871 patients of HSVE were included in our study. The annual hospitalization rate was 10.3 ± 2.2 cases/million in neonates, 2.4 ± 0.3 cases/million in children and 6.4 ± 0.4 cases/million in adults. Median age was 57 years and male:female incidence ratio was 1:1. Rates of some central nervous system complications were seizures (38.4%), status epilepticus (5.5%), acute respiratory failure (20.1%), ischemic stroke (5.6%) and intracranial hemorrhage (2.7%), all of which were significantly associated with mortality. In-hospital mortality in neonates, children and adults were 6.9, 1.2 and 7.7%, respectively. HSVE still remains a potentially lethal infectious disease with high morbidity and mortality. Most recent epidemiological data in this study may help understanding this public health disease, and the patient outcome data may have prognostic significance.
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Affiliation(s)
- S Modi
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - Abhimanyu Mahajan
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
| | - D Dharaiya
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - P Varelas
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - P Mitsias
- Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
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Abstract
PURPOSE OF REVIEW The goal of this review is to provide an update on current thinking regarding herpes simplex encephalitis (HSE), emphasizing new information about pathogenesis, diagnosis, and immune responses. Specific questions to be addressed are the following: (1) Is there a genetic predisposition to HSE? (2) What clinical approaches have the greatest impact on improving the long-term outcomes in patients with HSE? And (3) are there immune-mediated mechanisms that may account for relapsing HSE? RECENT FINDINGS Toll-like receptor 3 (TLR 3) plays an important role in innate immune responses, including generation of interferons. Multiple single-gene errors in TLR 3 interferon pathways have recently been described in children that result in increased susceptibility to HSE. Conversely, studies in both animal models and humans indicate that both cytolytic viral replication and immune-mediated responses (including cytotoxic T lymphocytes and immune mechanisms mediated by TLR 2) contribute to the pathology of HSV, suggesting possible new therapeutic approaches. In terms of treatment, data clearly indicate that a longer duration between onset of symptoms and initiation of effective antiviral therapy correlates directly with less favorable clinical outcome. Recurrent or relapsing HSE may occasionally occur, but recent observations indicate that many instances of "relapsing HSE", especially in children, are more often anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis triggered by the antecedent HSV infection. Innate immune responses are critical for defense against HSV; genetic defects in this system may predispose patients to HSE. During acute HSE, exuberant immune responses may contribute to the CNS pathology, suggesting that selective immunosuppressive therapy, coupled with potent antiviral drugs, may eventually play a role in the therapeutic management of HSV. While overall clinical outcomes of HSE remain suboptimal, the initiation of high-dose acyclovir therapy as early as possible in the course of the illness provides the best chance for a patient to survive with minimal neurologic damage. Distinguishing relapsing HSE from autoimmune anti-NMDAR antibody encephalitis is critically important because therapeutic approaches will be very different.
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Affiliation(s)
- John W Gnann
- Department of Medicine, Division of Infectious Diseases, Medical University of South Carolina, 135 Rutledge Avenue, MSC 752, Charleston, SC, 29425, USA.
| | - Richard J Whitley
- University of Alabama at Birmingham, 303 CHB, 1600 7th Ave. S, Birmingham, AL, 35233-1711, USA
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Defres S, Keller SS, Das K, Vidyasagar R, Parkes LM, Burnside G, Griffiths M, Kopelman M, Roberts N, Solomon T. A Feasibility Study of Quantifying Longitudinal Brain Changes in Herpes Simplex Virus (HSV) Encephalitis Using Magnetic Resonance Imaging (MRI) and Stereology. PLoS One 2017; 12:e0170215. [PMID: 28125598 PMCID: PMC5268482 DOI: 10.1371/journal.pone.0170215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 01/02/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To assess whether it is feasible to quantify acute change in temporal lobe volume and total oedema volumes in herpes simplex virus (HSV) encephalitis as a preliminary to a trial of corticosteroid therapy. METHODS The study analysed serially acquired magnetic resonance images (MRI), of patients with acute HSV encephalitis who had neuroimaging repeated within four weeks of the first scan. We performed volumetric measurements of the left and right temporal lobes and of cerebral oedema visible on T2 weighted Fluid Attenuated Inversion Recovery (FLAIR) images using stereology in conjunction with point counting. RESULTS Temporal lobe volumes increased on average by 1.6% (standard deviation (SD 11%) in five patients who had not received corticosteroid therapy and decreased in two patients who had received corticosteroids by 8.5%. FLAIR hyperintensity volumes increased by 9% in patients not receiving treatment with corticosteroids and decreased by 29% in the two patients that had received corticosteroids. CONCLUSIONS This study has shown it is feasible to quantify acute change in temporal lobe and total oedema volumes in HSV encephalitis and suggests a potential resolution of swelling in response to corticosteroid therapy. These techniques could be used as part of a randomized control trial to investigate the efficacy of corticosteroids for treating HSV encephalitis in conjunction with assessing clinical outcomes and could be of potential value in helping to predict the clinical outcomes of patients with HSV encephalitis.
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Affiliation(s)
- Sylviane Defres
- Clinical Infection, microbiology and immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Tropical and Infectious diseases Unit, Liverpool and Broadgreen University Hospital Trust, Liverpool, United Kingdom
- NIHR HPRU in Emerging and Zoonotic Infections, University of Liverpool, Institute of infection and Global Health, Waterhouse Building, Liverpool, United Kingdom
| | - Simon S. Keller
- The Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- The Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, Liverpool, United Kingdom
| | - Kumar Das
- The Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, Liverpool, United Kingdom
| | - Rishma Vidyasagar
- Florey Institute of Neuroscience and mental health, Heidelberg, Victoria, Australia
- Department of Anatomy and Neuroscience, University of Melbourne, Victoria, Australia
| | - Laura M. Parkes
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Girvan Burnside
- The department of Biostatistics, Institute of translational medicine, University of Liverpool, Liverpool, United Kingdom
| | - Michael Griffiths
- Clinical Infection, microbiology and immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Michael Kopelman
- Institute of Psychiatry, Kings College London, London, United Kingdom
| | - Neil Roberts
- Medical Physics and Imaging Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Tom Solomon
- Clinical Infection, microbiology and immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- NIHR HPRU in Emerging and Zoonotic Infections, University of Liverpool, Institute of infection and Global Health, Waterhouse Building, Liverpool, United Kingdom
- The Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, Liverpool, United Kingdom
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Menasria R, Canivet C, Piret J, Gosselin J, Boivin G. Both Cerebral and Hematopoietic Deficiencies in CCR2 Result in Uncontrolled Herpes Simplex Virus Infection of the Central Nervous System in Mice. PLoS One 2016; 11:e0168034. [PMID: 27930721 PMCID: PMC5145225 DOI: 10.1371/journal.pone.0168034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 11/23/2016] [Indexed: 12/11/2022] Open
Abstract
CCR2 is a chemokine receptor expressed on the surface of blood leukocytes, particularly «Ly6Chi» inflammatory monocytes and microglia. Signaling through this receptor is thought to influence the immune activity of microglia as well as monocytes egress from the bone marrow (BM) and their trafficking into the central nervous system (CNS) in several neurological diseases. During experimental herpes simplex virus 1 (HSV-1) encephalitis (HSE), CCR2 deficiency has been reported to exacerbate the outcome of the disease. However, the precise contribution of CCR2 expressed in cells of the CNS or peripheral monocytes in the protection against HSE remains unclear. To dissect the differential role of CCR2 during HSE, chimeric mice with receptor deficiency in the brain or blood cells were generated by transplanting wild-type (WT) C57BL/6 or CCR2-/- BM-derived cells in CCR2-/- (WT→CCR2-/-) and WT (CCR2-/-→WT) mice, respectively. Our results indicate that following intranasal infection with 1.2x106 plaque forming units of HSV-1, CCR2 deficiency in hematopoietic cells and, to a lesser extent, in CNS exacerbates the outcome of HSE. Mortality rates of CCR2-/- (71.4%) and CCR2-/-→WT (57.1%) mice were significantly higher than that of WT (15.3%; P<0.01 and P<0.05, respectively) but the difference did not reach statistical significance for WT→CCR2-/- animals (42.8%; P = 0.16). Both peripheral and CNS deficiencies in CCR2 resulted in increased infectious viral titers and wider dissemination of HSV antigens in the brain as well as an overproduction of inflammatory cytokines and chemokines including IL-1β, IL-6, CCL2, CCL3 and CCL5. Furthermore, CCR2 deficiency in the hematopoietic system altered monocytes egress from the BM and their recruitment to the CNS, which may contribute to the failure in HSV-1 containment. Collectively, these data suggest that CCR2 expressed on cells of CNS and especially on peripheral monocytes is important for the control of HSV-1 replication and inflammatory environment during experimental HSE.
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Affiliation(s)
- Rafik Menasria
- Research Center in Infectious Diseases, CHU of Quebec Research Center, Department of microbiology-immunology and infectious diseases, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Coraline Canivet
- Research Center in Infectious Diseases, CHU of Quebec Research Center, Department of microbiology-immunology and infectious diseases, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Jocelyne Piret
- Research Center in Infectious Diseases, CHU of Quebec Research Center, Department of microbiology-immunology and infectious diseases, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Jean Gosselin
- Laboratory of Innate Immunity, CHU of Quebec Research Center, Department of Molecular Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Guy Boivin
- Research Center in Infectious Diseases, CHU of Quebec Research Center, Department of microbiology-immunology and infectious diseases, Faculty of Medicine, Laval University, Quebec City, QC, Canada
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Bradshaw MJ, Venkatesan A. Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management. Neurotherapeutics 2016; 13:493-508. [PMID: 27106239 PMCID: PMC4965403 DOI: 10.1007/s13311-016-0433-7] [Citation(s) in RCA: 238] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Herpetic infections have plagued humanity for thousands of years, but only recently have advances in antiviral medications and supportive treatments equipped physicians to combat the most severe manifestations of disease. Prompt recognition and treatment can be life-saving in the care of patients with herpes simplex-1 virus encephalitis, the most commonly identified cause of sporadic encephalitis worldwide. Clinicians should be able to recognize the clinical signs and symptoms of the infection and familiarize themselves with a rational diagnostic approach and therapeutic modalities, as early recognition and treatment are key to improving outcomes. Clinicians should also be vigilant for the development of acute complications, including cerebral edema and status epilepticus, as well as chronic complications, including the development of autoimmune encephalitis associated with antibodies to the N-methyl-D-aspartate receptor and other neuronal cell surface and synaptic epitopes. Herein, we review the pathophysiology, differential diagnosis, and clinical and radiological features of herpes simplex virus-1 encephalitis in adults, including a discussion of the most common complications and their treatment. While great progress has been made in the treatment of this life-threatening infection, a majority of patients will not return to their previous neurologic baseline, indicating the need for further research efforts aimed at improving the long-term sequelae.
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Affiliation(s)
- Michael J Bradshaw
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Arun Venkatesan
- Division of Neuroimmunology & Neuroinfectious Diseases, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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30
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Jørgensen LK, Dalgaard LS, Østergaard LJ, Andersen NS, Nørgaard M, Mogensen TH. Validity of the coding for herpes simplex encephalitis in the Danish National Patient Registry. Clin Epidemiol 2016; 8:133-40. [PMID: 27330328 PMCID: PMC4896464 DOI: 10.2147/clep.s104379] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Large health care databases are a valuable source of infectious disease epidemiology if diagnoses are valid. The aim of this study was to investigate the accuracy of the recorded diagnosis coding of herpes simplex encephalitis (HSE) in the Danish National Patient Registry (DNPR). Methods The DNPR was used to identify all hospitalized patients, aged ≥15 years, with a first-time diagnosis of HSE according to the International Classification of Diseases, tenth revision (ICD-10), from 2004 to 2014. To validate the coding of HSE, we collected data from the Danish Microbiology Database, from departments of clinical microbiology, and from patient medical records. Cases were classified as confirmed, probable, or no evidence of HSE. We estimated the positive predictive value (PPV) of the HSE diagnosis coding stratified by diagnosis type, study period, and department type. Furthermore, we estimated the proportion of HSE cases coded with nonspecific ICD-10 codes of viral encephalitis and also the sensitivity of the HSE diagnosis coding. Results We were able to validate 398 (94.3%) of the 422 HSE diagnoses identified via the DNPR. Hereof, 202 (50.8%) were classified as confirmed cases and 29 (7.3%) as probable cases providing an overall PPV of 58.0% (95% confidence interval [CI]: 53.0–62.9). For “Encephalitis due to herpes simplex virus” (ICD-10 code B00.4), the PPV was 56.6% (95% CI: 51.1–62.0). Similarly, the PPV for “Meningoencephalitis due to herpes simplex virus” (ICD-10 code B00.4A) was 56.8% (95% CI: 39.5–72.9). “Herpes viral encephalitis” (ICD-10 code G05.1E) had a PPV of 75.9% (95% CI: 56.5–89.7), thereby representing the highest PPV. The estimated sensitivity was 95.5%. Conclusion The PPVs of the ICD-10 diagnosis coding for adult HSE in the DNPR were relatively low. Hence, the DNPR should be used with caution when studying patients with encephalitis caused by herpes simplex virus.
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Affiliation(s)
| | - Lars Skov Dalgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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31
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Herpes Simplex Viral Encephalitis Masquerading as a Classic Left MCA Stroke. Case Rep Neurol Med 2015; 2015:673724. [PMID: 26770849 PMCID: PMC4681801 DOI: 10.1155/2015/673724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/10/2015] [Indexed: 12/20/2022] Open
Abstract
Objective. Stroke is a clinical diagnosis, with a history and physical examination significant for acute onset focal neurological symptoms and signs, often occurring in patients with known vascular risk factors and is frequently confirmed radiographically. Case Report. A 79-year-old right-handed woman, with a past medical history of hypertension, hyperlipidemia, and prior transient ischemic attack (TIA), presented with acute onset global aphasia and right hemiparesis, in the absence of fever or prodrome. This was initially diagnosed as a proximal left middle cerebral artery (MCA) stroke. However, CT perfusion failed to show evidence of reduced blood volume, and CT angiogram did not show evidence of a proximal vessel occlusion. Furthermore, MRI brain did not demonstrate any areas of restricted diffusion. EEG demonstrated left temporal periodic lateralized epileptiform discharges (PLEDs). The patient was empirically loaded with a bolus valproic acid and started on acyclovir, both intravenously. CSF examination demonstrated a pleocytosis and PCR confirmed the diagnosis of herpes simplex viral encephalitis (HSVE). Conclusions. HSVE classically presents in a nonspecific fashion with fever, headache, and altered mental status. However, acute focal neurological signs, mimicking stroke, are possible. A high degree of suspicion is required to institute appropriate therapy and decrease morbidity and mortality associated with HSVE.
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32
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Sutter R, Kaplan PW. What to see when you are looking at confusion: a review of the neuroimaging of acute encephalopathy. J Neurol Neurosurg Psychiatry 2015; 86:446-59. [PMID: 25091365 DOI: 10.1136/jnnp-2014-308216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Acute encephalopathy is a clinical conundrum in neurocritical care facing physicians with diagnostic and therapeutic challenges. Encephalopathy arises from several concurrent causes, and delayed diagnosis adds to its grim prognosis. Diagnosis is reached by melding clinical, neurophysiological and biochemical features with various neuroimaging studies. We aimed to compile the pathophysiology of acute encephalopathies in adults, and the contribution of cerebral CT, MRI, MR spectroscopy (MRS), positron emission tomography (PET) and single-photon emission CT (SPECT) to early diagnosis, treatment and prognostication. Reports from 1990 to 2013 were identified. Therefore, reference lists were searched to identify additional publications. Encephalopathy syndromes best studied by neuroimaging emerge from hypoxic-ischaemic injury, sepsis, metabolic derangements, autoimmune diseases, infections and rapidly evolving dementias. Typical and pathognomonic neuroimaging patterns are presented. Cerebral imaging constitutes an important component of diagnosis, management and prognosis of acute encephalopathy. Its respective contribution is dominated by rapid exclusion of acute cerebral lesions and further varies greatly depending on the underlying aetiology and the range of possible differential diagnoses. CT has been well studied, but is largely insensitive, while MRI appears to be the most helpful in the evaluation of encephalopathies. MRS may provide supplementary biochemical information and determines spectral changes in the affected brain tissue. The less frequently used PET and SPECT may delineate areas of high or low metabolic activity or cerebral blood flow. However, publications of MRS, PET and SPECT are limited only providing anecdotal evidence of their usefulness and sensitivity.
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Affiliation(s)
- Raoul Sutter
- Division of Neurosciences Critical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA Clinic of Intensive Care Medicine, University Hospital Basel, Basel, Switzerland Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Peter W Kaplan
- Division of Neurosciences Critical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
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Suazo PA, Tognarelli EI, Kalergis AM, González PA. Herpes simplex virus 2 infection: molecular association with HIV and novel microbicides to prevent disease. Med Microbiol Immunol 2015; 204:161-76. [PMID: 25209142 PMCID: PMC7102243 DOI: 10.1007/s00430-014-0358-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 09/01/2014] [Indexed: 12/17/2022]
Abstract
Infection with herpes simplex viruses is one of the most ancient diseases described to affect humans. Infection with these viruses produces vexing effects to the host, which frequently recur. Infection with herpes simplex viruses is lifelong, and currently there is no vaccine or drug to prevent or cure infection. Prevalence of herpes simplex virus 2 (HSV-2) infection varies significantly depending on the geographical region and nears 20% worldwide. Importantly, HSV-2 is the first cause of genital ulcers in the planet. HSV-2 affects approximately 500 million people around the globe and significantly increases the likelihood of acquiring the human immunodeficiency virus (HIV), as well as its shedding. Thus, controlling HSV-2 infection and spread is of public health concern. Here, we review the diseases produced by herpes simplex viruses, the factors that modulate HSV-2 infection, the relationship between HSV-2 and HIV and novel therapeutic and prophylactic microbicides/antivirals under development to prevent infection and pathological outcomes produced by this virus. We also review mutations associated with HSV-2 resistance to common antivirals.
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Affiliation(s)
- Paula A. Suazo
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Avenida Portugal 49, 8331010 Santiago, Chile
| | - Eduardo I. Tognarelli
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Avenida Portugal 49, 8331010 Santiago, Chile
| | - Alexis M. Kalergis
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Avenida Portugal 49, 8331010 Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Avenida Portugal 49, 8331010 Santiago, Chile
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- INSERM U1064, Nantes, France
| | - Pablo A. González
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Avenida Portugal 49, 8331010 Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Avenida Portugal 49, 8331010 Santiago, Chile
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Abstract
ABSTRACT Enveloped viruses encode proteins that can induce cell fusion to allow spread of infection without exposure to immune surveillance. In this review, we discuss cell fusion events caused by neurotropic α-herpesviruses. Syncytia (large, multinucleated cells) are clinically indicative of α herpesvirus infections, and peripheral neuropathies are clinical hallmarks. We examine the viral and cellular factors required for cell fusion, as well as mutations which confer a more aggressive ‘hypersyncytial’ phenotype. Finally, we consider the causes of fusion events in infected neurons, and the implications for neuronal dysfunction and pathophysiology.
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Affiliation(s)
- Anthony E Ambrosini
- Department of Molecular Biology & Princeton Neuroscience Institute, Princeton University, Princeton, NJ 08544, USA
| | - Lynn W Enquist
- Department of Molecular Biology & Princeton Neuroscience Institute, Princeton University, Princeton, NJ 08544, USA
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35
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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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Krishnan V, Leung LY, Caplan LR. A neurologist's approach to delirium: diagnosis and management of toxic metabolic encephalopathies. Eur J Intern Med 2014; 25:112-6. [PMID: 24332366 DOI: 10.1016/j.ejim.2013.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 11/22/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Abstract
Toxic metabolic encephalopathies (TMEs) present as an acute derangement in consciousness, cognition and behavior, and can be brought about by various triggers, including endocrine and metabolic disturbances, exogenous toxins, pain and infection. Also referred to as "delirium" or "acute confusional states," TMEs are characterized by (1) an altered level of consciousness and activity, (2) global changes in cognition with inattention, (3) a fluctuating course with disturbances in the sleep-wake cycle, and (4) asterixis and myoclonus. The pathophysiology of this syndrome is poorly understood. Imbalanced neurotransmitter signaling and pathologically heightened brain inflammatory cytokine signaling have been proposed as candidate mechanisms. Focal brain lesions can also occasionally mimic TMEs. A neurological examination is required to identify the presence of focal findings, which when present, identify a new focal lesion or the recrudescence of prior ischemic, inflammatory or neoplastic insults. Diagnostic testing must include a search for metabolic and infectious derangements. Offending medications should be withdrawn. Magnetic resonance imaging, cerebrospinal fluid analysis and electroencephalography should be considered in select clinical situations. In addition to being an unpleasant experience for the patient and family, this condition is associated with extended hospital stays, increased mortality and high costs. In individuals with diminished cognitive reserve, episodes of TME lead to an accelerated decline in cognitive functioning. Starting with an illustrative case, this paper provides a neurologist's approach to the diagnosis, differential diagnosis and management of toxic metabolic encephalopathies.
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Affiliation(s)
- Vaishnav Krishnan
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States.
| | - Lester Y Leung
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Louis R Caplan
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States
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