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Poussier L, Mailles A, Tattevin P, Stahl JP, Fillâtre P. Characteristics, management and outcome of Herpes Simplex and Varicella-Zoster virus encephalitis: a multicentre prospective cohort study. Clin Microbiol Infect 2024; 30:917-923. [PMID: 38527616 DOI: 10.1016/j.cmi.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/03/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE To characterize differences between Herpes Simplex virus encephalitis and Varicella-Zoster virus encephalitis (HSVE and VZVE) and other aetiologies of infectious encephalitis (IE), and to investigate the impact of time-to-aciclovir (ACV) start, ACV dose and duration on outcome. METHODS We compared 132 HSVE, 65 VZVE and 297 other IE enrolled in a prospective cohort (ENCEIF). We estimated associations between time-to-ACV start, dose or duration and outcome through adjusted odds ratio (aOR) using logistic regression analysis. RESULTS Prevalence of immunodepression differed among aetiologies: 15/65 (23%) for VZVE, 13/132 (10%) for HSVE and 30/297 (10%) for other IE (p <0.05), as was presence of seizure at admission: 27/132 (20%) for HSVE, 4/65 (6%) for VZVE and 43/297 (14%) for other IE (p <0.05). Poor outcome at hospital discharge (Glasgow outcome scale ≤3) differed among the three groups: 40/127 (31%) for HSVE, 12/65 (18%) for VZVE and 38/290 (13%) for other IE (p <0.05). Time-to-ACV start was associated with outcome in HSVE (aOR 3.61 [1.25-10.40]), but not in VZVE (aOR 0.84 [0.18-3.85]). Increased ACV dose was not associated with outcome among HSVE (aOR 1.25 [0.44-3.64]) nor VZVE (aOR 1.16 [0.24-5.73]). DISCUSSION HSVE and VZVE are distinct in clinical presentation, outcome and prognostic factors. The impact of early ACV initiation was more apparent for HSVE than for VZVE; however, this could be because of VZVE's smaller sample size and lower outcome rate leading to low statistical power or because of potential distinct IE pathophysiology.
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Affiliation(s)
- Léa Poussier
- Infectious Diseases and Intensive Care Unit, CHU Pontchaillou, Rennes, France; INSERM, CIC 1414, Rennes, France
| | | | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, CHU Pontchaillou, Rennes, France; INSERM, CIC 1414, Rennes, France
| | - Jean-Paul Stahl
- Infectious Diseases Department, University Grenoble Alpes, Grenoble, France
| | - Pierre Fillâtre
- INSERM, CIC 1414, Rennes, France; Intensive Care Unit, Yves Le Foll Hospital, Saint Brieuc, France.
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Ngan TTD, Tuyet NT, Hung DT, Cap NT, Nguyen DM, Dat VQ. Clinical characteristics and outcomes of patients with Herpes Simplex Encephalitis in Vietnam: a retrospective study. BMC Infect Dis 2024; 24:556. [PMID: 38831304 PMCID: PMC11149218 DOI: 10.1186/s12879-024-09453-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 05/30/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Herpes simplex encephalitis (HSE) is an important central nervous infection with severe neurological sequelae. The aim of this study was to describe clinical characteristic and outcomes of patients with HSE in Vietnam. METHODS This was a retrospective study of 66 patients with herpes simplex encephalitis who admitted to the National Hospital for Tropical Diseases, Hanoi, Vietnam from 2018 to 2021. The detection of herpes simplex virus (HSV) in cerebrospinal fluid was made by the real-time PCR assay. We reported the clinical manifestation on admission and evaluated clinical outcomes at the hospital discharge by modified Rankin Scale (mRS). Multivariate logistic regression analysis was used to analyze the independent risk factors of severe outcomes. RESULTS Of the 66 patients with laboratory confirmed HSE, the median age was 53 years (IQR 38-60) and 44 patients (69.7%) were male. The most common manifestations included fever (100%), followed by the consciousness disorder (95.5%). Other neurological manifestation were seizures (36.4%), memory disorders (31.8%), language disorders (19.7%) and behavioral disorders (13.6%). Conventional magnetic resonance imaging (MRI) showed 93.8% patients with temporal lobe lesions, followed by abnormalities in insula (50%), frontal lobe (34.4%) and 48.4% of patients had bilateral lesions. At discharge, 19 patients (28.8%) completely recovered, 15 patients (22.7%) had mild sequelae, 28 patients (42.4%) had moderate to severe sequelae. Severe neurological sequelae were memory disorders (55.8%), movement disorders (53.5%), language disorders (30.2%). Multivariate logistic regression analysis showed that Glasgow score decrement at admission, seizures, and time duration from onset of symptoms to the start of Acyclovir treatment > 4 days were independent factors associated with severe outcomes in HSE patients. CONCLUSION Glasgow score decrement, seizures and delay treatment with Acyclovir were associated with the poor outcome of patients with HSE.
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Affiliation(s)
- Ta Thi Dieu Ngan
- Department of Infectious Diseases, Hanoi Medical University, 1 Ton That Tung Street, Dong Da district, Hanoi, Vietnam.
- National Hospital for Tropical Diseases, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam.
- Hanoi Medical University Hospital, 1 Ton That Tung Street, Dong Da District, Hanoi, Vietnam.
| | - Nguyen Thi Tuyet
- Thai Nguyen University of Medicine and Pharmacy, 284 Luong Ngoc Quyen Street, Thai Nguyen City, Thai Nguyen Province, Vietnam
| | - Dinh Trong Hung
- Department of Infectious Diseases, Hanoi Medical University, 1 Ton That Tung Street, Dong Da district, Hanoi, Vietnam
| | - Nguyen Trung Cap
- National Hospital for Tropical Diseases, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam
| | | | - Vu Quoc Dat
- Department of Infectious Diseases, Hanoi Medical University, 1 Ton That Tung Street, Dong Da district, Hanoi, Vietnam
- Hanoi Medical University Hospital, 1 Ton That Tung Street, Dong Da District, Hanoi, Vietnam
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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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Roçi E, Dodaj S, Vyshka G. Herpes simplex virus encephalitis mimicking acute ischemic stroke. Surg Neurol Int 2023; 14:60. [PMID: 36895212 PMCID: PMC9990771 DOI: 10.25259/sni_1123_2022] [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: 12/13/2022] [Accepted: 02/07/2023] [Indexed: 02/19/2023] Open
Abstract
Background Infections of the central nervous system might present in an acute form such as to be similar with the clinical characteristics of a stroke. This situation will hamper a correct diagnosis and a prompt treatment that can otherwise be successful. Case Description We present the case of a herpes virus encephalitis that came up in the emergency department with an admission diagnosis of ischemic cerebral accident. Being the symptomatology unclear, the findings of magnetic resonance of the brain oriented versus an infectious disorder. The lumbar tap confirmed the presence of herpes simplex virus (HSV) 1 virus and an antiviral therapy was administered, leading to resolution of the condition within the 3 weeks of hospitalization. Conclusion HSV infections may mimic stroke and therefore should be included in the differential diagnosis of atypical acute nervous conditions. In neurological events of acute nature, especially in febrile patients whose brain imaging is suspicious or inconclusive, the eventuality of a herpetic encephalitis should be kept in mind. This will lead to a prompt antiviral therapy and to a favorable outcome.
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Affiliation(s)
- Ermir Roçi
- Department of Neurovascular Service, "Mother Teresa" University Medical Center, Tirana, Albania
| | - Stela Dodaj
- Department of Neurovascular Service, "Mother Teresa" University Medical Center, Tirana, Albania
| | - Gentian Vyshka
- Department of Biomedical and Experimental, Faculty of Medicine, University of Medicine, Tirana, Albania
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6
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Acyclovir resistance in herpes simplex viruses: Prevalence and therapeutic alternatives. Biochem Pharmacol 2022; 206:115322. [DOI: 10.1016/j.bcp.2022.115322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/20/2022] [Accepted: 10/20/2022] [Indexed: 11/19/2022]
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7
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Hu Z, Zhou J, Han L, Li X, Li C, Wu T, Liu J, Zhao W, Kang J, Chen X. Acyclovir alleviates insulin resistance via activating PKM1 in diabetic mice. Life Sci 2022; 304:120725. [PMID: 35751919 DOI: 10.1016/j.lfs.2022.120725] [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: 05/08/2022] [Revised: 06/09/2022] [Accepted: 06/15/2022] [Indexed: 11/26/2022]
Abstract
AIMS Diabetes mellitus (DM) is a major global health threat characterized by insulin resistance. A new tactic to ameliorate insulin resistance, thereby reversing the exacerbation of DM, is urgently needed. The work is aiming to provide a new strategy for DM treatment as well as to identify new targets. MAIN METHODS C57BL/6 N mice were raised with high-fat diet (HFD) and infused with streptozotocin (STZ) to induce diabetes. The blood glucose, serum insulin, blood lipid and oxidative stress were detected. In vitro insulin resistance model experiment has been made to examine the molecular mechanisms underlying anti-diabetic effect of potential active chemicals in human hepatocellular carcinoma cells (HepG2). KEY FINDINGS Acyclovir, an antiviral nucleotide analog, alleviates insulin resistance by reducing blood lipids as well as oxidative stress and elevating insulin sensitivity on diabetic mice, which is in accord with results in the insulin resistance model of HepG2 cells. Mechanically, acyclovir stimulates pyruvate kinase M1 (PKM1) directly to activate adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK)/Sirtuin1 (SIRT1) signaling pathway, thus improving insulin resistance. SIGNIFICANCE The present study supports that acyclovir should be translated to remedy DM, and PKM1 might be a valuable target to develop new medicines.
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Affiliation(s)
- Zhuozhou Hu
- Department of Pharmacy, Lanzhou University, Lanzhou 730000, PR China
| | - Jing Zhou
- Department of Pharmacy, Lanzhou University, Lanzhou 730000, PR China
| | - Liang Han
- Department of Pharmacy, Lanzhou University, Lanzhou 730000, PR China
| | - Xiangxiang Li
- Department of Pharmacy, Lanzhou University, Lanzhou 730000, PR China
| | - Chun Li
- Department of Pharmacy, Lanzhou University, Lanzhou 730000, PR China
| | - Tongyu Wu
- Department of Pharmacy, Lanzhou University, Lanzhou 730000, PR China
| | - Jingjing Liu
- Department of Pharmacy, Lanzhou University, Lanzhou 730000, PR China
| | - Wenyang Zhao
- Department of Pharmacy, Lanzhou University, Lanzhou 730000, PR China
| | - Jia Kang
- Department of Pharmacy, Lanzhou University, Lanzhou 730000, PR China
| | - Xinping Chen
- Department of Pharmacy, Lanzhou University, Lanzhou 730000, PR China; State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou 730000, PR China.
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8
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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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9
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Song X, Wang Y, Li F, Cao W, Zeng Q, Qin S, Wang Z, Jia J, Xiao J, Hu X, Liu K, Wang Y, Ren Z. Hsp90 Inhibitors Inhibit the Entry of Herpes Simplex Virus 1 Into Neuron Cells by Regulating Cofilin-Mediated F-Actin Reorganization. Front Microbiol 2022; 12:799890. [PMID: 35082770 PMCID: PMC8785254 DOI: 10.3389/fmicb.2021.799890] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/10/2021] [Indexed: 11/15/2022] Open
Abstract
Herpes simplex virus 1 (HSV-1) is a common neurotropic virus, the herpes simplex encephalitis (HSE) caused by which is considered to be the most common sporadic but fatal encephalitis. Traditional antiviral drugs against HSV-1 are limited to nucleoside analogs targeting viral factors. Inhibition of heat shock protein 90 (Hsp90) has potent anti-HSV-1 activities via numerous mechanisms, but the effects of Hsp90 inhibitors on HSV-1 infection in neuronal cells, especially in the phase of virus entry, are still unknown. In this study, we aimed to investigate the effects of the Hsp90 inhibitors on HSV-1 infection of neuronal cells. Interestingly, we found that Hsp90 inhibitors promoted viral adsorption but inhibited subsequent penetration in neuronal cell lines and primary neurons, which jointly confers the antiviral activity of the Hsp90 inhibitors. Mechanically, Hsp90 inhibitors mainly impaired the interaction between Hsp90 and cofilin, resulting in reduced cofilin membrane distribution, which led to F-actin polymerization to promote viral attachment. However, excessive polymerization of F-actin inhibited subsequent viral penetration. Consequently, unidirectional F-actin polymerization limits the entry of HSV-1 virions into neuron cells. Our research extended the molecular mechanism of Hsp90 in HSV-1 infection in neuron cells and provided a theoretical basis for developing antiviral drugs targeting Hsp90.
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Affiliation(s)
- Xiaowei Song
- Guangzhou Jinan Biomedicine Research and Development Center, Institute of Biomedicine, College of Life Science and Technology, Jinan University, Guangzhou, China
| | - Yiliang Wang
- Guangzhou Jinan Biomedicine Research and Development Center, Institute of Biomedicine, College of Life Science and Technology, Jinan University, Guangzhou, China.,Key Laboratory of Virology of Guangzhou, Jinan University, Guangzhou, China.,Key Laboratory of Bioengineering Medicine of Guangdong Province, Jinan University, Guangzhou, China
| | - Feng Li
- Guangzhou Jinan Biomedicine Research and Development Center, Institute of Biomedicine, College of Life Science and Technology, Jinan University, Guangzhou, China.,Key Laboratory of Virology of Guangzhou, Jinan University, Guangzhou, China
| | - Wenyan Cao
- Guangzhou Jinan Biomedicine Research and Development Center, Institute of Biomedicine, College of Life Science and Technology, Jinan University, Guangzhou, China.,Key Laboratory of Virology of Guangzhou, Jinan University, Guangzhou, China.,Key Laboratory of Bioengineering Medicine of Guangdong Province, Jinan University, Guangzhou, China
| | - Qiongzhen Zeng
- Guangzhou Jinan Biomedicine Research and Development Center, Institute of Biomedicine, College of Life Science and Technology, Jinan University, Guangzhou, China.,Key Laboratory of Virology of Guangzhou, Jinan University, Guangzhou, China.,Key Laboratory of Bioengineering Medicine of Guangdong Province, Jinan University, Guangzhou, China
| | - Shurong Qin
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Zhaoyang Wang
- Guangzhou Jinan Biomedicine Research and Development Center, Institute of Biomedicine, College of Life Science and Technology, Jinan University, Guangzhou, China.,Key Laboratory of Virology of Guangzhou, Jinan University, Guangzhou, China
| | - Jiaoyan Jia
- Guangzhou Jinan Biomedicine Research and Development Center, Institute of Biomedicine, College of Life Science and Technology, Jinan University, Guangzhou, China.,Key Laboratory of Virology of Guangzhou, Jinan University, Guangzhou, China
| | - Ji Xiao
- Guangzhou Jinan Biomedicine Research and Development Center, Institute of Biomedicine, College of Life Science and Technology, Jinan University, Guangzhou, China
| | - Xiao Hu
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Kaisheng Liu
- The Second Clinical Medical College, Shenzhen People's Hospital, Jinan University, Guangzhou, China
| | - Yifei Wang
- Guangzhou Jinan Biomedicine Research and Development Center, Institute of Biomedicine, College of Life Science and Technology, Jinan University, Guangzhou, China
| | - Zhe Ren
- Guangzhou Jinan Biomedicine Research and Development Center, Institute of Biomedicine, College of Life Science and Technology, Jinan University, Guangzhou, China
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Kirichenko T, Turkot N, Dodina M, Volok V, Belyaletdinova I. Viral meningoencephalitis with damage to the right temporal lobe with a favorable outcome. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:112-116. [DOI: 10.17116/jnevro2022122031112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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11
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Feige L, Zaeck LM, Sehl-Ewert J, Finke S, Bourhy H. Innate Immune Signaling and Role of Glial Cells in Herpes Simplex Virus- and Rabies Virus-Induced Encephalitis. Viruses 2021; 13:2364. [PMID: 34960633 PMCID: PMC8708193 DOI: 10.3390/v13122364] [Citation(s) in RCA: 11] [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: 10/24/2021] [Revised: 11/12/2021] [Accepted: 11/18/2021] [Indexed: 12/19/2022] Open
Abstract
The environment of the central nervous system (CNS) represents a double-edged sword in the context of viral infections. On the one hand, the infectious route for viral pathogens is restricted via neuroprotective barriers; on the other hand, viruses benefit from the immunologically quiescent neural environment after CNS entry. Both the herpes simplex virus (HSV) and the rabies virus (RABV) bypass the neuroprotective blood-brain barrier (BBB) and successfully enter the CNS parenchyma via nerve endings. Despite the differences in the molecular nature of both viruses, each virus uses retrograde transport along peripheral nerves to reach the human CNS. Once inside the CNS parenchyma, HSV infection results in severe acute inflammation, necrosis, and hemorrhaging, while RABV preserves the intact neuronal network by inhibiting apoptosis and limiting inflammation. During RABV neuroinvasion, surveilling glial cells fail to generate a sufficient type I interferon (IFN) response, enabling RABV to replicate undetected, ultimately leading to its fatal outcome. To date, we do not fully understand the molecular mechanisms underlying the activation or suppression of the host inflammatory responses of surveilling glial cells, which present important pathways shaping viral pathogenesis and clinical outcome in viral encephalitis. Here, we compare the innate immune responses of glial cells in RABV- and HSV-infected CNS, highlighting different viral strategies of neuroprotection or Neuroinflamm. in the context of viral encephalitis.
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Affiliation(s)
- Lena Feige
- Institut Pasteur, Université de Paris, Lyssavirus Epidemiology and Neuropathology, 28 Rue Du Docteur Roux, 75015 Paris, France;
| | - Luca M. Zaeck
- Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institut (FLI), Federal Institute of Animal Health, Südufer 10, 17493 Greifswald-Insel Riems, Germany; (L.M.Z.); (S.F.)
| | - Julia Sehl-Ewert
- Department of Experimental Animal Facilities and Biorisk Management, Friedrich-Loeffler-Institut (FLI), Federal Institute of Animal Health, Südufer 10, 17493 Greifswald-Insel Riems, Germany;
| | - Stefan Finke
- Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institut (FLI), Federal Institute of Animal Health, Südufer 10, 17493 Greifswald-Insel Riems, Germany; (L.M.Z.); (S.F.)
| | - Hervé Bourhy
- Institut Pasteur, Université de Paris, Lyssavirus Epidemiology and Neuropathology, 28 Rue Du Docteur Roux, 75015 Paris, France;
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12
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Abbott A, Lusby H, Islam SP. A Protracted Course of Herpes Simplex Virus Type 1 Encephalitis With Persistent Cerebrospinal Fluid Polymerase Chain Reaction Positivity Post Treatment. Cureus 2021; 13:e18107. [PMID: 34692318 PMCID: PMC8525692 DOI: 10.7759/cureus.18107] [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] [Accepted: 09/19/2021] [Indexed: 11/11/2022] Open
Abstract
Herpes simplex virus type 1 encephalitis presenting as an undulating course for more than two weeks prior to treatment. Despite 21 days of intravenous acyclovir, the virus remained detectable in the cerebrospinal fluid. The patient was treated with an additional 21 days of acyclovir with further improvement in mental status.
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Affiliation(s)
- Andrew Abbott
- Department of Infectious Diseases and Global Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Heather Lusby
- Department of Infectious Diseases and Global Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Shehla P Islam
- Department of Infectious Diseases and Global Medicine, University of Florida College of Medicine, Gainesville, USA
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Bumburidi Y, Utepbergenova G, Yerezhepov B, Berdiyarova N, Kulzhanova K, Head J, Moffett D, Singer D, Angra P, Whistler T, Sejvar J. Etiology of acute meningitis and encephalitis from hospital-based surveillance in South Kazakhstan oblast, February 2017-January 2018. PLoS One 2021; 16:e0251494. [PMID: 33989305 PMCID: PMC8121361 DOI: 10.1371/journal.pone.0251494] [Citation(s) in RCA: 3] [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: 02/08/2021] [Accepted: 04/28/2021] [Indexed: 11/19/2022] Open
Abstract
Encephalitis and meningitis (EM) are severe infections of the central nervous system associated with high morbidity and mortality. The etiology of EM in Kazakhstan is not clearly defined, so from February 1, 2017 to January 31, 2018 we conducted hospital-based syndromic surveillance for EM at the Shymkent City Hospital, in the South Kazakhstan region. All consenting inpatients meeting a standard case definition were enrolled. Blood and cerebrospinal fluid (CSF) samples were collected for bacterial culture, and CSF samples were additionally tested by PCR for four bacterial species and three viruses using a cascading algorithm. We enrolled 556 patients. Of these, 494 were of viral etiology (including 4 probable rabies cases), 37 were of bacterial etiology, 19 were of unknown etiology and 6 were not tested. The most commonly identified pathogens included enterovirus (73%, n = 406 cases), herpes simplex virus (12.8%, n = 71), and Neisseria meningitidis (3.8%, n = 21). The incidence rates (IRs) for enteroviral and meningococcal EM were found to be 14.5 and 0.7 per 100,000 persons, respectively. The IR for bacterial EM using both PCR and culture results was 3–5 times higher compared to culture-only results. Antibacterial medicines were used to treat 97.2% (480/494) of virus-associated EM. Incorporation of PCR into routine laboratory diagnostics of EM improves diagnosis, pathogen identification, ensures IRs are not underestimated, and can help avoid unnecessary antibacterial treatment.
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Affiliation(s)
- Yekaterina Bumburidi
- Central Asian Regional Office, Centers for Disease Control and Prevention, Almaty, Kazakhstan
- * E-mail:
| | - Gulmira Utepbergenova
- Shymkent City Infectious Disease Hospital–Regional Department of Health Care, Southern Kazakhstan Region, Kazakhstan, Shymkent
- Department of Infectious Diseases and Phthisiatry, Khoja Akhmet Yassawi International Kazakh-Turkish University, Kazakhstan, Turkestan
| | - Bakhtygali Yerezhepov
- Shymkent City Infectious Disease Hospital–Regional Department of Health Care, Southern Kazakhstan Region, Kazakhstan, Shymkent
| | - Nursulu Berdiyarova
- Shymkent City Infectious Disease Hospital–Regional Department of Health Care, Southern Kazakhstan Region, Kazakhstan, Shymkent
| | - Kaldikul Kulzhanova
- Shymkent City Infectious Disease Hospital–Regional Department of Health Care, Southern Kazakhstan Region, Kazakhstan, Shymkent
| | - Jennifer Head
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- Public Health Institute, Oakland, CA, United States of America
- Association of Schools and Programs of Public Health, Washington DC, United States of America
| | - Daphne Moffett
- Central Asian Regional Office, Centers for Disease Control and Prevention, Almaty, Kazakhstan
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Daniel Singer
- Central Asian Regional Office, Centers for Disease Control and Prevention, Almaty, Kazakhstan
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Pawan Angra
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Toni Whistler
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - James Sejvar
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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14
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Untreated herpes simplex virus encephalitis without a fatal outcome. J Neurovirol 2021; 27:493-497. [PMID: 33788139 DOI: 10.1007/s13365-021-00968-y] [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: 06/16/2020] [Revised: 02/23/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
Herpes simplex virus encephalitis (HSE) is the most common sporadic fatal encephalitis. Although timely administered acyclovir treatment decreases mortality, neuropsychiatric sequelae is still common among survivors. Magnetic resonance imaging is frequently utilized for the diagnosis of HSE, which typically involves temporal lobe(s) and can be mixed with brain tumors involving the same area. Here, we report a case of HSE, who received acyclovir with a delay of 90 days because of presumptive tumor diagnosis and survived with minimal sequelae.
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15
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von Hofsten J, Studahl M. Comment on "Acute Retinal Necrosis: Is the Current Valacyclovir Regimen Adequate?". Ocul Immunol Inflamm 2021; 30:1289. [PMID: 33512259 DOI: 10.1080/09273948.2020.1860234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Joanna von Hofsten
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Ophthalmology, Halland Hospital Halmstad, Halmstad, Sweden
| | - Marie Studahl
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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16
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Allana A, Samannodi M, Hansen MA, DeSantis S, Ho LT, Hasbun R. Adjunctive steroids in adults with encephalitis: a propensity score analysis. J Neurol 2021; 268:2151-2160. [PMID: 33475823 DOI: 10.1007/s00415-021-10398-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Adjuvant steroids have been used for the treatment of encephalitis, although there is limited data regarding its benefit. We described the use and impact of adjunctive steroids on adverse clinical outcomes (ACO) in adults with encephalitis. METHODS Retrospective observational study of 230 adults with encephalitis at two tertiary care hospital systems in Houston, Texas, between August 2008 and September 2017. An ACO was assessed at the time of death or discharge and defined as a Glasgow Outcome Scale 1-4. A propensity score analysis was performed. RESULTS Out of 230 adult encephalitis patients enrolled, 121 (52.6%) received steroids. Adjunctive steroids were given more frequently to those who had focal neurological deficits (P = 0.01), required mechanical ventilation (MV) (P = 0.01), had intensive care unit admission (P < 0.001), had white matter abnormalities (P = 0.01) or cerebral edema on magnetic resonance imaging of the brain (P = 0.003). An ACO was seen in 135 (58.7%) of patients. The use of adjunctive steroids did not impact ACOs (P = 0.52) on univariate analyses or after propensity score matching. Predictors for an ACO in logistic regression analyses included a Glasgow Coma Score (GCS) < 8, fever, MV, and cerebral edema. INTERPRETATION Adjunctive steroids are used more frequently in sicker patients and are not associated with improved clinical outcomes.
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Affiliation(s)
- Ambreen Allana
- Division of Infectious Diseases, UT Health Science Center At Houston, McGovern Medical School, 6431 Fannin St. MSB 2.112, Houston, TX, 77030, USA
| | - Mohammed Samannodi
- Division of Infectious Diseases, UT Health Science Center At Houston, McGovern Medical School, 6431 Fannin St. MSB 2.112, Houston, TX, 77030, USA.,Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Michael A Hansen
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Stacia DeSantis
- Department of Biostatistics, UT School of Public Health, Dallas, TX, 75235, USA
| | | | - Rodrigo Hasbun
- Division of Infectious Diseases, UT Health Science Center At Houston, McGovern Medical School, 6431 Fannin St. MSB 2.112, Houston, TX, 77030, USA.
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17
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Management and results of epilepsy surgery associated with acyclovir prophylaxis in four pediatric patients with drug-resistant epilepsy due to herpetic encephalitis and review of the literature. Eur J Paediatr Neurol 2020; 29:128-136. [PMID: 32868196 DOI: 10.1016/j.ejpn.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/30/2020] [Accepted: 08/09/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE Herpes simplex virus encephalitis (HSE) is the most common cause of sporadic viral encephalitis in children and is responsible for epilepsy in approximately half of patients. In addition to medical treatment, epilepsy surgery may be offered to drug-resistant patients but carries a high risk of relapse of herpetic encephalitis. We are reporting our series of patients operated on between 2000 and 2019 with the systematic administration of acyclovir (ACV). RESULTS Four pediatric patients aged 4.5-12.8 years with drug-resistant epilepsy post-HSE underwent a tailored focal resection following invasive recordings (three patients) and a complete callosotomy (one patient). The total number of the surgical procedures for the four patients was eight, and a systematic administration of ACV as a prophylactic treatment of herpetic encephalitis relapse was done at each step. No patients had a relapse and the ACV was well-tolerated in all the cases. Following surgery two patients are seizure free, the patient who underwent callosotomy is Engel 3 and the fourth patient, in whom a large epileptic zone has contraindicated a second surgery, is Engel 4. CONCLUSIONS Our series demonstrated the dramatic efficacy of systematic ACV prophylaxis during all cranial surgeries. Moreover, our results on epilepsy, together with those of the literature, encourage more consideration regarding epilepsy surgery in this specific etiology. All types of surgical procedures (curative or palliative) can be offered to the patients, but in the case of focal surgery, due to the poor anatomical limits, invasive recordings are highly recommended.
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18
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Byun JE, Lee KY. Effectiveness of Intravenous Immunoglobulin Therapy for Pediatric Viral Encephalitis. ANNALS OF CHILD NEUROLOGY 2020. [DOI: 10.26815/acn.2020.00164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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19
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Lindström J, Helldén A, Lycke J, Grahn A, Studahl M. An unexpectedly high occurrence of aciclovir-induced neuropsychiatric symptoms in patients treated for herpesvirus CNS infection: a prospective observational study. J Antimicrob Chemother 2020; 74:3565-3572. [PMID: 31504577 PMCID: PMC6857197 DOI: 10.1093/jac/dkz357] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/13/2019] [Accepted: 07/16/2019] [Indexed: 01/28/2023] Open
Abstract
Background Aciclovir is effective in herpesvirus infections of the CNS. Aciclovir-induced neuropsychiatric symptoms (AINS) have been reported and are associated with high CSF concentrations of aciclovir metabolite 9-carboxymethoxymethylguanine (CMMG). Risk factors except for renal failure have not been explored, and disruption of the blood–brain barrier (BBB) in acute CNS infection may be of interest. Objectives To investigate the impact of risk factors on aciclovir and CMMG concentrations, and to relate the results to AINS. Methods We investigated 21 consecutively included, consenting patients treated with aciclovir or valaciclovir for herpesvirus CNS infection. Regression models were constructed to study the impact of risk factors including BBB disruption, as measured with CSF:serum albumin ratio, on CSF aciclovir and CMMG concentrations. Medical records were assessed retrospectively to identify patients with AINS. Results Increased CSF:serum albumin ratio, as well as decreased renal function and high aciclovir doses, was associated with increased aciclovir and CMMG concentrations in the CSF. We identified five patients with new neuropsychiatric symptoms; four of those were considered to have AINS and had increased CSF CMMG concentrations. Only one patient without suspicion of AINS had an increased CSF CMMG concentration. Conclusions In patients with herpesvirus CNS infections, BBB disruption is associated with increasing aciclovir and CMMG CSF concentrations. We also found an unexpectedly high number of patients with AINS. Evaluation of CSF:serum albumin ratios, renal function and CSF concentrations of aciclovir and CMMG may all contribute to the optimization of aciclovir dosing and avoidance of AINS.
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Affiliation(s)
- Johan Lindström
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Anders Helldén
- Department of Medical and Health Sciences, Division of Drug Research/Pharmacology, Linköping University Hospital, Linköping, Sweden
| | - Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Grahn
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Marie Studahl
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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20
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Abstract
Herpes simplex virus 1 (HSV-1) can be responsible for life-threatening HSV encephalitis (HSE). The mortality rate of patients with HSE who do not receive antiviral treatment is 70%, with most survivors suffering from permanent neurological sequelae. The use of intravenous acyclovir together with improved diagnostic technologies such as PCR and magnetic resonance imaging has resulted in a reduction in the mortality rate to close to 20%. However, 70% of surviving patients still do not recover complete neurological functions. Thus, there is an urgent need to develop more effective treatments for a better clinical outcome. It is well recognized that cerebral damage resulting from HSE is caused by viral replication together with an overzealous inflammatory response. Both of these processes constitute potential targets for the development of innovative therapies against HSE. In this review, we discuss recent progress in therapy that may be used to ameliorate the outcome of patients with HSE, with a particular emphasis on immunomodulatory agents. Ideally, the administration of adjunctive immunomodulatory drugs should be initiated during the rise of the inflammatory response, and its duration should be limited in time to reduce undesired effects. This critical time frame should be optimized by the identification of reliable biomarkers of inflammation.
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21
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Le Guennec L. Manifestazioni neurologiche delle infezioni. Neurologia 2020. [DOI: 10.1016/s1634-7072(20)43298-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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22
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Herpes Simplex Virus 1 Induces Brain Inflammation and Multifocal Demyelination in the Cotton Rat Sigmodon hispidus. J Virol 2019; 94:JVI.01161-19. [PMID: 31597775 PMCID: PMC6912097 DOI: 10.1128/jvi.01161-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/30/2019] [Indexed: 02/08/2023] Open
Abstract
Our work demonstrates for the first time a direct association between infection with herpes simplex virus 1, a ubiquitous human pathogen generally associated with facial cold sores, and multifocal brain demyelination in an otherwise normal host, the cotton rat Sigmodon hispidus. For a long time, demyelinating diseases were considered to be autoimmune in nature and were studied by indirect methods, such as immunizing animals with myelin components or feeding them toxic substances that induce demyelination. Treatment against demyelinating diseases has been elusive, partially because of their unknown etiology. This work provides the first experimental evidence for the role of HSV-1 as the etiologic agent of multifocal brain demyelination in a normal host and suggests that vaccination against HSV-1 can help to combat demyelinating disorders. Demyelinating central nervous system (CNS) disorders like multiple sclerosis (MS) and acute disseminated encephalomyelitis (ADEM) have been difficult to study and treat due to the lack of understanding of their etiology. Numerous cases point to the link between herpes simplex virus (HSV) infection and multifocal CNS demyelination in humans; however, convincing evidence from animal models has been missing. In this work, we found that HSV-1 infection of the cotton rat Sigmodon hispidus via a common route (lip abrasion) can cause multifocal CNS demyelination and inflammation. Remyelination occurred shortly after demyelination in HSV-1-infected cotton rats but could be incomplete, resulting in “scars,” further supporting an association between HSV-1 infection and multifocal demyelinating disorders. Virus was detected sequentially in the lip, trigeminal ganglia, and brain of infected animals. Brain pathology developed primarily on the ipsilateral side of the brain stem, in the cerebellum, and contralateral side of the forebrain/midbrain, suggesting that the changes may ascend along the trigeminal lemniscus pathway. Neurologic defects occasionally detected in infected animals (e.g., defective whisker touch and blink responses and compromised balance) could be representative of the brain stem/cerebellum dysfunction. Immunization of cotton rats with a split HSV-1 vaccine protected animals against viral replication and brain pathology, suggesting that vaccination against HSV-1 may protect against demyelinating disorders. IMPORTANCE Our work demonstrates for the first time a direct association between infection with herpes simplex virus 1, a ubiquitous human pathogen generally associated with facial cold sores, and multifocal brain demyelination in an otherwise normal host, the cotton rat Sigmodon hispidus. For a long time, demyelinating diseases were considered to be autoimmune in nature and were studied by indirect methods, such as immunizing animals with myelin components or feeding them toxic substances that induce demyelination. Treatment against demyelinating diseases has been elusive, partially because of their unknown etiology. This work provides the first experimental evidence for the role of HSV-1 as the etiologic agent of multifocal brain demyelination in a normal host and suggests that vaccination against HSV-1 can help to combat demyelinating disorders.
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23
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Reizine F, Pronier C, Lepart C, Grolhier C, Revest M, Thibault V, Tattevin P. Biphasic evolution of varicella-zoster virus meningoencephalitis : Diagnostic challenges. Med Mal Infect 2019; 50:87-89. [PMID: 31767157 DOI: 10.1016/j.medmal.2019.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/10/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
Affiliation(s)
- F Reizine
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, rue Le Guilloux, 35033 Rennes cedex, France
| | - C Pronier
- Virology, Pontchaillou University Hospital, rue Le Guilloux, 35033 Rennes cedex, France
| | - C Lepart
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, rue Le Guilloux, 35033 Rennes cedex, France
| | - C Grolhier
- Virology, Pontchaillou University Hospital, rue Le Guilloux, 35033 Rennes cedex, France
| | - M Revest
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, rue Le Guilloux, 35033 Rennes cedex, France
| | - V Thibault
- Virology, Pontchaillou University Hospital, rue Le Guilloux, 35033 Rennes cedex, France
| | - P Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, rue Le Guilloux, 35033 Rennes cedex, France.
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24
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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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25
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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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26
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Wang W, Ji M. Efficacy of acyclovir for herpes simplex encephalitis: A protocol for a systematic review of randomized controlled trial. Medicine (Baltimore) 2019; 98:e15254. [PMID: 30985731 PMCID: PMC6485799 DOI: 10.1097/md.0000000000015254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Clinical researches indicate that acyclovir can be used to herpes simplex encephalitis (HSE). However, no systematic review has explored its efficacy for the treatment of HSE. Therefore, this study systematically will investigate the efficacy and safety of acyclovir for patients with HSE. METHODS We will search the following databases from inceptions to March 1, 2019 without any language restrictions: Cochrane Library, Embase, MEDICINE, PsycINFO, Web of Science, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. This study will include randomized controlled trials that assess the efficacy and safety of acyclovir for patients with HSE. Two authors will independently carry out the study selection, data extraction, and risk of bias assessment. Cochrane risk of bias tool will be used to assess the risk of bias assessment. RESULTS This study will systematically assess the efficacy and safety of acyclovir for HSE. The primary outcome is mortality rate, which is measured by Glasgow coma score, or other instruments. The secondary outcomes include quality of life, as assessed by 36-Item Short Form Health Survey or relevant scales; overall survival, the number of patient who died; the number of patient who had severe sequelae, and adverse events. CONCLUSIONS The findings of this study may provide the existing evidence on the efficacy and safety of acyclovir for HSE. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019125999.
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27
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Affiliation(s)
- Kenneth L Tyler
- From the Departments of Neurology, Medicine, and Immunology-Microbiology and the Section on Neuroinfectious Disease, University of Colorado School of Medicine, Aurora
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28
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Mangelsdorf S, Kelso W, Velakoulis D, Walterfang M. Semantic language deficit developing following herpes simplex encephalitis: reorganization "cannibalising" language centers? Neurocase 2018; 24:72-75. [PMID: 29350572 DOI: 10.1080/13554794.2018.1428351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Herpes simplex virus encephalitis (HSVE) commonly presents with severe amnesia due to virus-mediated destruction of key regions in the temporal lobes, although language and executive impairment has been described. Little is known however of the long-term cognitive changes in these patients, including changes that may happen with cortical reorganization. We describe a patient with HSVE who presented with a highly unusual late-onset language syndrome, which may reflect distal cortical changes after her original injury.
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Affiliation(s)
- Simone Mangelsdorf
- a Neuropsychiatry Unit , Royal Melbourne Hospital , Melbourne , Australia.,b Movement Disorders Unit , Monash Health , Melbourne , Australia
| | - Wendy Kelso
- a Neuropsychiatry Unit , Royal Melbourne Hospital , Melbourne , Australia
| | - Dennis Velakoulis
- a Neuropsychiatry Unit , Royal Melbourne Hospital , Melbourne , Australia.,c Melbourne Neuropsychiatry Centre , University of Melbourne & North-Western Mental Health , Melbourne , Australia
| | - Mark Walterfang
- a Neuropsychiatry Unit , Royal Melbourne Hospital , Melbourne , Australia.,c Melbourne Neuropsychiatry Centre , University of Melbourne & North-Western Mental Health , Melbourne , Australia.,d Florey Institute of Neuroscience and Mental Health , University of Melbourne , Melbourne , Australia
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Abstract
Among the critically ill, infectious diseases can play a significant role in the etiology of neuropsychiatric disturbances. All critical care physicians are familiar with delirium as a secondary complication of systemic infection. This article focuses on key infectious diseases that commonly and directly produce neuropsychiatric symptoms, including direct infection of the central nervous system, human immunodeficiency virus infection, and AIDS.
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Affiliation(s)
- Sahil Munjal
- Department of Psychiatry, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA
| | - Stephen J Ferrando
- Department of Psychiatry, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA.
| | - Zachary Freyberg
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA; Department of Cell Biology, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
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30
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Management of adult infectious encephalitis in metropolitan France. Med Mal Infect 2017; 47:206-220. [PMID: 28336304 DOI: 10.1016/j.medmal.2017.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 02/06/2023]
Abstract
Infectious encephalitis is a severe disease leading to a high mortality and morbidity. The most frequent causes include Herpes simplex virus, Varicella Zoster virus, Listeria monocytogenes, and Mycobacterium tuberculosis. Urgent treatment is required (anti-infective therapy and nonspecific supportive care). The aim of this study was to define treatment strategy, empirical and after microbiological documentation at 48hours, through a systematic literature review.
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31
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Sili U, Tavsanli ME, Tufan A. Herpes Simplex Virus Encephalitis in Geriatric Patients. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0198-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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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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33
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Klein RS, Garber C, Howard N. Infectious immunity in the central nervous system and brain function. Nat Immunol 2017; 18:132-141. [PMID: 28092376 DOI: 10.1038/ni.3656] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 12/02/2016] [Indexed: 11/09/2022]
Abstract
Inflammation is emerging as a critical mechanism underlying neurological disorders of various etiologies, yet its role in altering brain function as a consequence of neuroinfectious disease remains unclear. Although acute alterations in mental status due to inflammation are a hallmark of central nervous system (CNS) infections with neurotropic pathogens, post-infectious neurologic dysfunction has traditionally been attributed to irreversible damage caused by the pathogens themselves. More recently, studies indicate that pathogen eradication within the CNS may require immune responses that interfere with neural cell function and communication without affecting their survival. In this Review we explore inflammatory processes underlying neurological impairments caused by CNS infection and discuss their potential links to established mechanisms of psychiatric and neurodegenerative diseases.
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Affiliation(s)
- Robyn S Klein
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Charise Garber
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nicole Howard
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
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34
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Kim KJ, Cho JH, Moon JB, Shin MC, Ohk TG, Lee HY, Park CW. What factors determine the need for lumbar puncture in patients with fever and headache? Singapore Med J 2016; 58:618-622. [PMID: 27917434 DOI: 10.11622/smedj.2016184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We performed this study to find clinical features and laboratory parameters that could facilitate the process of selecting patients who should receive lumbar punctures from among those who present with headache and fever. METHODS We selected patients aged ≥ 16 years who presented to and received lumbar puncture in the emergency department of Kangwon National University Hospital, South Korea, between 2011 and 2013. Patients who received lumbar punctures were divided into two groups - those who were diagnosed with viral meningitis and those who were not. We compared the clinical features and laboratory data between the two groups. Key indices were then used to develop a scoring system to diagnose viral meningitis in patients and identify those who should receive lumbar punctures. RESULTS Among the patients who were included in the study, 42 had viral meningitis and 96 did not. The variables of C-reactive protein level ≤ 1.291 mg/dL, neck stiffness and vomiting were assigned 3 points, 2 points and 1 point, respectively, in the scoring system. Overall scores ≥ 4 yielded a positive likelihood ratio of 7.79 (sensitivity 0.600, specificity 0.923), while negative likelihood ratio decreased to less than 0.1 (0.072) for overall scores < 3. CONCLUSION Using the proposed scoring system, we were able to determine the likelihood of viral meningitis in patients presenting with fever and headache, and to successfully identify those who should receive lumbar punctures.
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Affiliation(s)
- Ki Joong Kim
- Department of Emergency Medicine, Kangwon National University Hospital, Kangwon National University, Chuncheon, South Korea
| | - Jun Hwi Cho
- Department of Emergency Medicine, Kangwon National University Hospital, Kangwon National University, Chuncheon, South Korea
| | - Joong Bum Moon
- Department of Emergency Medicine, Kangwon National University Hospital, Kangwon National University, Chuncheon, South Korea
| | - Myoung Cheol Shin
- Department of Emergency Medicine, Kangwon National University Hospital, Kangwon National University, Chuncheon, South Korea
| | - Taek Geun Ohk
- Department of Emergency Medicine, Kangwon National University Hospital, Kangwon National University, Chuncheon, South Korea
| | - Hui Young Lee
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University, Chuncheon, South Korea
| | - Chan Woo Park
- Department of Emergency Medicine, Kangwon National University Hospital, Kangwon National University, Chuncheon, South Korea
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35
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Croll BJ, Dillon ZM, Weaver KR, Greenberg MR. Subtle presentation of herpes simplex encephalitis. Am J Emerg Med 2016; 35:200.e1-200.e2. [PMID: 27510472 DOI: 10.1016/j.ajem.2016.07.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 07/23/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Benjamin J Croll
- Department of Emergency Medicine, Lehigh Valley Hospital/USF Morsani College of Medicine, CC & I-78, Allentown, PA 18103.
| | - Zachary M Dillon
- Department of Emergency Medicine, Lehigh Valley Hospital/USF Morsani College of Medicine, CC & I-78, Allentown, PA 18103
| | - Kevin R Weaver
- Department of Emergency Medicine, Lehigh Valley Hospital/USF Morsani College of Medicine, CC & I-78, Allentown, PA 18103
| | - Marna Rayl Greenberg
- Department of Emergency Medicine, Lehigh Valley Hospital/USF Morsani College of Medicine, CC & I-78, Allentown, PA 18103
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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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37
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Köller T, Kurze D, Lange M, Scherdin M, Podbielski A, Warnke P. Implementation and Evaluation of a Fully Automated Multiplex Real-Time PCR Assay on the BD Max Platform to Detect and Differentiate Herpesviridae from Cerebrospinal Fluids. PLoS One 2016; 11:e0153991. [PMID: 27092772 PMCID: PMC4836685 DOI: 10.1371/journal.pone.0153991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/06/2016] [Indexed: 02/04/2023] Open
Abstract
A fully automated multiplex real-time PCR assay--including a sample process control and a plasmid based positive control--for the detection and differentiation of herpes simplex virus 1 (HSV1), herpes simplex virus 2 (HSV2) and varicella-zoster virus (VZV) from cerebrospinal fluids (CSF) was developed on the BD Max platform. Performance was compared to an established accredited multiplex real time PCR protocol utilizing the easyMAG and the LightCycler 480/II, both very common devices in viral molecular diagnostics. For clinical validation, 123 CSF specimens and 40 reference samples from national interlaboratory comparisons were examined with both methods, resulting in 97.6% and 100% concordance for CSF and reference samples, respectively. Utilizing the BD Max platform revealed sensitivities of 173 (CI 95%, 88-258) copies/ml for HSV1, 171 (CI 95%, 148-194) copies/ml for HSV2 and 84 (CI 95%, 5-163) copies/ml for VZV. Cross reactivity could be excluded by checking 25 common viral, bacterial and fungal human pathogens. Workflow analyses displayed shorter test duration as well as remarkable fewer and easier preparation steps with the potential to reduce error rates occurring when manually assessing patient samples. This protocol allows for a fully automated PCR assay on the BD Max platform for the simultaneously detection of herpesviridae from CSF specimens. Singular or multiple infections due to HSV1, HSV2 and VZV can reliably be differentiated with good sensitivities. Control parameters are included within the assay, thereby rendering its suitability for current quality management requirements.
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Affiliation(s)
- Thomas Köller
- Institute of Medical Microbiology, Virology, and Hygiene, Rostock University Hospital, Rostock, Germany
| | - Daniel Kurze
- Institute of Medical Microbiology, Virology, and Hygiene, Rostock University Hospital, Rostock, Germany
| | - Mirjam Lange
- Institute of Medical Microbiology, Virology, and Hygiene, Rostock University Hospital, Rostock, Germany
| | - Martin Scherdin
- Institute of Medical Microbiology, Virology, and Hygiene, Rostock University Hospital, Rostock, Germany
| | - Andreas Podbielski
- Institute of Medical Microbiology, Virology, and Hygiene, Rostock University Hospital, Rostock, Germany
| | - Philipp Warnke
- Institute of Medical Microbiology, Virology, and Hygiene, Rostock University Hospital, Rostock, Germany
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Cag Y, Erdem H, Leib S, Defres S, Kaya S, Larsen L, Poljak M, Ozturk-Engin D, Barsic B, Argemi X, Sørensen SM, Bohr AL, Tattevin P, Gunst JD, Baštáková L, Jereb M, Johansen IS, Karabay O, Pekok AU, Sipahi OR, Chehri M, Beraud G, Shehata G, Fontana R, Maresca M, Karsen H, Sengoz G, Sunbul M, Yilmaz G, Yilmaz H, Sharif-Yakan A, Kanj S, Parlak E, Pehlivanoglu F, Korkmaz F, Komur S, Kose S, Ulug M, Bolukcu S, Coskuner SA, Stahl JP, Ince N, Akkoyunlu Y, Halac G, Sahin-Horasan E, Tireli H, Kilicoglu G, Al-Mahdawi A, Nemli SA, Inan A, Senbayrak S, Vahaboglu H, Elaldi N. Managing atypical and typical herpetic central nervous system infections: results of a multinational study. Clin Microbiol Infect 2016; 22:568.e9-568.e17. [PMID: 27085724 DOI: 10.1016/j.cmi.2016.03.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 03/20/2016] [Accepted: 03/26/2016] [Indexed: 11/19/2022]
Abstract
There have been many studies pertaining to the management of herpetic meningoencephalitis (HME), but the majority of them have focussed on virologically unconfirmed cases or included only small sample sizes. We have conducted a multicentre study aimed at providing management strategies for HME. Overall, 501 adult patients with PCR-proven HME were included retrospectively from 35 referral centres in 10 countries; 496 patients were found to be eligible for the analysis. Cerebrospinal fluid (CSF) analysis using a PCR assay yielded herpes simplex virus (HSV)-1 DNA in 351 patients (70.8%), HSV-2 DNA in 83 patients (16.7%) and undefined HSV DNA type in 62 patients (12.5%). A total of 379 patients (76.4%) had at least one of the specified characteristics of encephalitis, and we placed these patients into the encephalitis presentation group. The remaining 117 patients (23.6%) had none of these findings, and these patients were placed in the nonencephalitis presentation group. Abnormalities suggestive of encephalitis were detected in magnetic resonance imaging (MRI) in 83.9% of the patients and in electroencephalography (EEG) in 91.0% of patients in the encephalitis presentation group. In the nonencephalitis presentation group, MRI and EEG data were suggestive of encephalitis in 33.3 and 61.9% of patients, respectively. However, the concomitant use of MRI and EEG indicated encephalitis in 96.3 and 87.5% of the cases with and without encephalitic clinical presentation, respectively. Considering the subtle nature of HME, CSF HSV PCR, EEG and MRI data should be collected for all patients with a central nervous system infection.
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Affiliation(s)
- Y Cag
- Dr Lütfi Kirdar Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Erdem
- Gulhane Medical Academy, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
| | - S Leib
- Institute for Infectious Diseases, University of Bern, Switzerland
| | - S Defres
- Institute of Infection and Global Health, University of Liverpool, United Kingdom; Tropical Infections Diseases Unit In Royal Liverpool and Broadgreen University Hospitals NHS Trust, United Kingdom
| | - S Kaya
- Karadeniz Technical University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey
| | - L Larsen
- Odense University Hospital, Department of Infectious Diseases Q, Odense, Denmark
| | - M Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - D Ozturk-Engin
- Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - B Barsic
- Dr. Fran Mihaljevic University Hospital for Infectious Diseases, Department of Infectious Diseases, University of Zagreb School of Medicine, Zagreb, Croatia
| | - X Argemi
- Nouvel Hôpital Civil, Department of Infectious Diseases, Strasbourg, France
| | - S M Sørensen
- Aalborg University Hospital, Department of Infectious Diseases, Denmark
| | - A L Bohr
- Copenhagen University Hospital, Institute of Inflammation Research, Department of Infectious Diseases and Rheumatology, Rigshospitalet, Denmark
| | - P Tattevin
- University Hospital of Pontchaillou, Department of Infectious and Tropical Diseases, Rennes, France
| | - J D Gunst
- Aarhus University Hospital, Department of Infectious Diseases, Aarhus, Denmark
| | - L Baštáková
- Faculty Hospital Brno, Department of Infectious Diseases, Masaryk University, Faculty of Medicine, Brno, Czech Republic
| | - M Jereb
- University Medical Centre, Department of Infectious Diseases, Ljubljana, Slovenia
| | - I S Johansen
- Odense University Hospital, Department of Infectious Diseases Q, Odense, Denmark
| | - O Karabay
- Sakarya University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sakarya, Turkey
| | - A U Pekok
- Private Erzurum Sifa Hospital, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey
| | - O R Sipahi
- Ege University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - M Chehri
- Hvidovre Hospital, Department of Infectious Diseases, Copenhagen, Denmark
| | - G Beraud
- Poitiers University Hospital, Department of Infectious Diseases, France
| | - G Shehata
- Assiut University Hospital, Department of Neurology and Psychiatry, Assiut, Egypt
| | - R Fontana
- University of Catania, Section of Infectious Diseases, Department of Clinical and Molecular Biomedicine, Catania, Italy
| | - M Maresca
- University of Catania, Section of Infectious Diseases, Department of Clinical and Molecular Biomedicine, Catania, Italy
| | - H Karsen
- Harran University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sanliurfa, Turkey
| | - G Sengoz
- Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - M Sunbul
- Ondokuz Mayis University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey
| | - G Yilmaz
- Ankara University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - H Yilmaz
- Ondokuz Mayis University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey
| | - A Sharif-Yakan
- American University of Beirut Medical Center, Beirut, Lebanon
| | - S Kanj
- American University of Beirut Medical Center, Beirut, Lebanon
| | - E Parlak
- Ataturk University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey
| | - F Pehlivanoglu
- Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - F Korkmaz
- Konya Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Konya, Turkey
| | - S Komur
- Cukurova University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkey
| | - S Kose
- Tepecik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - M Ulug
- Private Umit Hospital, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey
| | - S Bolukcu
- Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - S A Coskuner
- Izmir Bozyaka Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - J P Stahl
- Joseph Fourier University and University Hospital of Grenoble, Department of Infectious Diseases, Grenoble, France
| | - N Ince
- Duzce University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Konuralp, Duzce, Turkey
| | - Y Akkoyunlu
- Bezmi Alem Vakif University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - G Halac
- Bezmi Alem Vakif University, School of Medicine, Department of Neurology, Istanbul, Turkey
| | - E Sahin-Horasan
- Mersin University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mersin, Turkey
| | - H Tireli
- Haydarpasa Numune Training and Research Hospital, Department of Neurology, Turkey
| | - G Kilicoglu
- Haydarpasa Numune Training and Research Hospital, Department of Radiology, Turkey
| | - A Al-Mahdawi
- Department of Neurology, Baghdad Teaching Hospital, Iraq
| | - S A Nemli
- Katip Celebi University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - A Inan
- Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - S Senbayrak
- Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Vahaboglu
- Medeniyet University, Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - N Elaldi
- Cumhuriyet University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sivas, Turkey
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Sutcu M, Akturk H, Somer A, Tatli B, Torun SH, Yıldız EP, Şık G, Citak A, Agacfidan A, Salman N. Role of Autoantibodies to N-Methyl-d-Aspartate (NMDA) Receptor in Relapsing Herpes Simplex Encephalitis: A Retrospective, One-Center Experience. J Child Neurol 2016; 31:345-50. [PMID: 26184485 DOI: 10.1177/0883073815595079] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/10/2015] [Indexed: 11/16/2022]
Abstract
Post-herpes simplex virus encephalitis relapses have been recently associated with autoimmunity driven by autoantibodies against N-methyl-d-aspartate (NMDA) receptors. Because it offers different treatment options, determination of this condition is important. Between 2011 and 2014, 7 children with proven diagnosis of herpes simplex virus encephalitis were identified in a university hospital of Istanbul. Two patients had neurologic relapse characterized mainly by movement disorders 2 to 3 weeks after initial encephalitis. The first patient received a second 14 days of acyclovir treatment together with antiepileptic drugs and left with severe neurologic sequelae. The second patient was found to be NMDA receptors antibody positive in the cerebrospinal fluid. She was treated with intravenous immunoglobulin and prednisolone. She showed substantial improvement, gradually regaining lost neurologic abilities. Post-herpes simplex virus encephalitis relapses may frequently be immune-mediated rather than a viral reactivation, particularly in children displaying movement disorders like choreoathetosis. Immunotherapy may provide benefit for this potentially devastating condition, like the case described in this report.
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Affiliation(s)
- Murat Sutcu
- Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Hacer Akturk
- Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ayper Somer
- Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Burak Tatli
- Department of Pediatric Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Selda Hancerli Torun
- Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Edibe Pembegul Yıldız
- Department of Pediatric Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Guntulu Şık
- Department of Pediatric Intensive Care, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Agop Citak
- Department of Pediatric Intensive Care, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ali Agacfidan
- Department of Microbiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nuran Salman
- Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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40
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Singh TD, Fugate JE, Hocker S, Wijdicks EFM, Aksamit AJ, Rabinstein AA. Predictors of outcome in HSV encephalitis. J Neurol 2015; 263:277-289. [DOI: 10.1007/s00415-015-7960-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 10/25/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
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41
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Gnann JW, Sköldenberg B, Hart J, Aurelius E, Schliamser S, Studahl M, Eriksson BM, Hanley D, Aoki F, Jackson AC, Griffiths P, Miedzinski L, Hanfelt-Goade D, Hinthorn D, Ahlm C, Aksamit A, Cruz-Flores S, Dale I, Cloud G, Jester P, Whitley RJ. Herpes Simplex Encephalitis: Lack of Clinical Benefit of Long-term Valacyclovir Therapy. Clin Infect Dis 2015; 61:683-91. [PMID: 25956891 DOI: 10.1093/cid/civ369] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/12/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite the proven efficacy of acyclovir (ACV) therapy, herpes simplex encephalitis (HSE) continues to cause substantial morbidity and mortality. Among patients with HSE treated with ACV, the mortality rate is approximately 14%-19%. Among survivors, 45%-60% have neuropsychological sequelae at 1 year. Thus, improving therapeutic approaches to HSE remains a high priority. METHODS Following completion of a standard course of intravenous ACV, 87 adult patients with HSE (confirmed by positive polymerase chain reaction [PCR] for herpes simplex virus DNA in cerebrospinal fluid) were randomized to receive either valacyclovir (VACV) 2 g thrice daily (n = 40) or placebo tablets (n = 47) for 90 days (12 tablets of study medication daily). The primary endpoint was survival with no or mild neuropsychological impairment at 12 months, as measured by the Mattis Dementia Rating Scale (MDRS). Logistic regression was utilized to assess factors related to the primary endpoint. RESULTS The demographic characteristics of the 2 randomization groups were statistically similar with no significant differences in age, sex, or race. At 12 months, there was no significant difference in the MDRS scoring for VACV-treated vs placebo recipients, with 85.7% and 90.2%, respectively, of patients demonstrating no or mild neuropsychological impairment (P = .72). No significant study-related adverse events were encountered in either treatment group. CONCLUSIONS Following standard treatment with intravenous ACV for PCR-confirmed HSE, an additional 3-month course of oral VACV therapy did not provide added benefit as measured by neuropsychological testing 12 months later in a population of relatively high-functioning survivors. CLINICAL TRIALS REGISTRATION NCT00031486.
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Development and Validation of a Laboratory-Developed Multiplex Real-Time PCR Assay on the BD Max System for Detection of Herpes Simplex Virus and Varicella-Zoster Virus DNA in Various Clinical Specimens. J Clin Microbiol 2015; 53:1921-6. [PMID: 25878344 DOI: 10.1128/jcm.03692-14] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/07/2015] [Indexed: 01/06/2023] Open
Abstract
A multiplex real-time PCR (quantitative PCR [qPCR]) assay detecting herpes simplex virus (HSV) and varicella-zoster virus (VZV) DNA together with an internal control was developed on the BD Max platform combining automated DNA extraction and an open amplification procedure. Its performance was compared to those of PCR assays routinely used in the laboratory, namely, a laboratory-developed test for HSV DNA on the LightCycler instrument and a test using a commercial master mix for VZV DNA on the ABI7500fast system. Using a pool of negative cerebrospinal fluid (CSF) samples spiked with either calibrated controls for HSV-1 and VZV or dilutions of a clinical strain that was previously quantified for HSV-2, the empirical limit of detection of the BD Max assay was 195.65, 91.80, and 414.07 copies/ml for HSV-1, HSV-2, and VZV, respectively. All the samples from HSV and VZV DNA quality control panels (Quality Control for Molecular Diagnostics [QCMD], 2013, Glasgow, United Kingdom) were correctly identified by the BD Max assay. From 180 clinical specimens of various origins, 2 CSF samples were found invalid by the BD Max assay due to the absence of detection of the internal control; a concordance of 100% was observed between the BD Max assay and the corresponding routine tests. The BD Max assay detected the PCR signal 3 to 4 cycles earlier than did the routine methods. With results available within 2 h on a wide range of specimens, this sensitive and fully automated PCR assay exhibited the qualities required for detecting simultaneously HSV and VZV DNA on a routine basis.
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Results of a multinational study suggest the need for rapid diagnosis and early antiviral treatment at the onset of herpetic meningoencephalitis. Antimicrob Agents Chemother 2015; 59:3084-9. [PMID: 25779579 DOI: 10.1128/aac.05016-14] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/19/2015] [Indexed: 11/20/2022] Open
Abstract
Data in the literature regarding the factors that predict unfavorable outcomes in adult herpetic meningoencephalitis (HME) cases are scarce. We conducted a multicenter study in order to provide insights into the predictors of HME outcomes, with special emphasis on the use and timing of antiviral treatment. Samples from 501 patients with molecular confirmation from cerebrospinal fluid were included from 35 referral centers in 10 countries. Four hundred thirty-eight patients were found to be eligible for the analysis. Overall, 232 (52.9%) patients experienced unfavorable outcomes, 44 died, and 188 survived, with sequelae. Age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02 to 1.05), Glasgow Coma Scale score (OR, 0.84; 95% CI, 0.77 to 0.93), and symptomatic periods of 2 to 7 days (OR, 1.80; 95% CI, 1.16 to 2.79) and >7 days (OR, 3.75; 95% CI, 1.72 to 8.15) until the commencement of treatment predicted unfavorable outcomes. The outcome in HME patients is related to a combination of therapeutic and host factors. This study suggests that rapid diagnosis and early administration of antiviral treatment in HME patients are keys to a favorable outcome.
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Yang Y, Xiao J, Song H, Wang R, Hussain M, Song W. Relationship of herpes simplex encephalitis and transcranial direct current stimulation--a case report. J Clin Virol 2015; 65:46-9. [PMID: 25766987 DOI: 10.1016/j.jcv.2015.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 01/14/2015] [Accepted: 01/16/2015] [Indexed: 11/27/2022]
Abstract
We report a rare case of relapsing herpes simplex encephalitis in a-37-year-old patient which was previously confirmed by positive polymerase chain reaction, herpes simplex virus (HSV) type1 IgG antibodies in cerebrospinal fluid and characterized on MRI. During the first admission, he was treated with continuous acyclovir treatment for one month with clinical improvement except for residual aphasia, for which he received a course of outpatient transcranial direct current stimulation (tDCS). A constant current of 1.2 mA was applied for 20 min twice daily. After the 4th day the patient was found to be irritable and uncooperative by staff and family members. A subsequent MRI showed significant deterioration of the lesion on comparison to the first MRI which led to discontinuation of tDCS.The relatively rapid exacerbation of HSV in only a few days is unusual. Our aim is to discuss if tDCS is related to HSV relapse and in doing so highlight possible mechanisms.
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Affiliation(s)
- Yuanbin Yang
- Department of Rehabilitation, Xuanwu Hospital of Capital Medical University, NO. 45, Changchun Street, Xicheng District, Beijing, China.
| | - Juan Xiao
- Department of Rehabilitation, Xuanwu Hospital of Capital Medical University, NO. 45, Changchun Street, Xicheng District, Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital of Capital Medical University, NO.45, Changchun Street, Xichen District, Beijing, China
| | - Ralph Wang
- Wynscape Health and Rehabilitation and US Physiatry, 2180 Manchester Road, Wheaton, IL 60187, United States
| | - Mohammed Hussain
- Department of Neurosurgery, Wayne State University- 4160 John R St, Ste+925, Detroit, MI 48201, USA
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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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Dagsdóttir HM, Sigurðardóttir B, Gottfreðsson M, Kristjánsson M, Löve A, Baldvinsdóttir GE, Guðmundsson S. Herpes simplex encephalitis in Iceland 1987-2011. SPRINGERPLUS 2014; 3:524. [PMID: 25279315 PMCID: PMC4174550 DOI: 10.1186/2193-1801-3-524] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 09/05/2014] [Indexed: 11/18/2022]
Abstract
Herpes simplex encephalitis (HSE) is a serious disease with 10-20% mortality and high rate of neuropsychiatric sequelae. This study is a long-term, nationwide study in a single country, Iceland. Clinical data were obtained from patient records and from DNA PCR and antibody assays of CSF. Diagnosis of HSE was classified as definite, possible or rejected based on symptoms, as well as virological, laboratory and brain imaging criteria. A total of 30 definite cases of HSE were identified during the 25 year period 1987-2011 corresponding to incidence of 4.3 cases/106 inhabitants/year. Males were 57% of all patients, median age 50 years (range, 0-85). Fever (97%), cognitive deficits (79%), impaired consciousness (79% with GCS < 13), headache (55%) and seizures (55%) were the most common symptoms. Brain lesions were found in 24 patients (80%) by MRI or CT. All patients received intravenous acyclovir for a mean duration of 20 days. Three patients (10%) died within one year and 21/28 pts (75%) had a Karnofsky performance score of <70% with memory loss (59%), dysphasia (44%), frontal symptoms (44%) and seizures (30%) as the most frequent sequelae. Mean delay from onset of symptoms to treatment was 6 days; this was associated with adverse outcome. In conclusion, the incidence of `HSE is higher than recently reported in a national registry study from Sweden. Despite advances in rapid diagnosis and availability of treatment of HSE, approximately three of every four patients die or are left with serious neurological impairment.
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Affiliation(s)
- Heiður Mist Dagsdóttir
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Magnús Gottfreðsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland ; Department of Infectious Diseases, Landspítali University Hospital, Reykjavik, Iceland
| | - Már Kristjánsson
- Department of Infectious Diseases, Landspítali University Hospital, Reykjavik, Iceland
| | - Arthur Löve
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland ; Department of Virology, Landspítali University Hospital, Reykjavik, Iceland
| | | | - Sigurður Guðmundsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland ; Department of Infectious Diseases, Landspítali University Hospital, Reykjavik, Iceland
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Herpes simplex virus encephalitis: Clinical manifestations, diagnosis and outcome in 106 adult patients. J Clin Virol 2014; 60:112-8. [DOI: 10.1016/j.jcv.2014.03.010] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 02/24/2014] [Accepted: 03/15/2014] [Indexed: 11/22/2022]
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Abstract
PURPOSE OF REVIEW Acyclovir (ACV) is the first-line treatment for the management of herpes simplex virus 1 (HSV-1) and 2 (HSV-2) diseases. Long-term administration of the drug for the treatment of chronic infections in the immunocompromised host can lead to the development of ACV-resistance. This review provides an update of the mutations linked to drug-resistance and issues to be considered in the management of HSV infections refractory to antiviral therapy. RECENT FINDINGS Recent data have shown that HSV drug-resistance should be taken into account not only in immunocompromised individuals but also in immunocompetent persons when HSV infections involve 'immune-privileged sites'. Thus, drug-resistance typing is recommended in cases of ACV unresponsive herpetic keratitis and herpes simplex encephalitis. Several issues regarding HSV drug-resistance were highlighted by recent studies. Phenotypic and genotypic antiviral resistance may vary not only from different compartments but also over time, highlighting the importance of characterizing longitudinal HSV isolates from all sites. Combination therapy should be considered when viruses with distinct phenotype/genotype are identified at one or at distinct body sites. SUMMARY Surveillance of HSV drug-resistance is highly recommended in immunocompromised patients and in immunocompetent individuals with infections implicating 'immune-privileged sites' to rationally adapt antiviral treatment.
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Schepers K, Hernandez A, Andrei G, Gillemot S, Fiten P, Opdenakker G, Bier JC, David P, Delforge ML, Jacobs F, Snoeck R. Acyclovir-resistant herpes simplex encephalitis in a patient treated with anti-tumor necrosis factor-α monoclonal antibodies. J Clin Virol 2014; 59:67-70. [DOI: 10.1016/j.jcv.2013.10.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/16/2013] [Accepted: 10/22/2013] [Indexed: 11/30/2022]
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Abstract
Viral encephalitis causes an altered level of consciousness, which may be associated with fever, seizures, focal deficits, CSF pleocytosis, and abnormal neuroimaging. Potential pathogens include HSV, VZV, enterovirus, and in some regions, arboviruses. Autoimmune (eg, anti-NMDA receptor) and paraneoplastic encephalitis are responsible for some cases where no pathogen is identified. Indications for ICU admission include coma, status epilepticus and respiratory failure. Timely initiation of anti-viral therapy is crucial while relevant molecular and serological test results are being performed. Supportive care should be directed at the prevention and treatment of cerebral edema and other physiological derangements which may contribute to secondary neurological injury.
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Affiliation(s)
- Andreas H Kramer
- Department of Critical Care Medicine and Clinical Neurosciences, Foothills Medical Center, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB T2N 2T9, Canada.
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