Cellular localization of poliovirus RNA in the spinal cord during acute paralytic poliomyelitis

Neuropathology of viral infections of the central nervous system

Many viral infections of the nervous system cause stereotyped pathologic features and overlapping clinical and imaging features. Neuroimaging usually offers neuroanatomical localization of the pathology, degree of involvement of the nervous system, and response to therapy during follow up in a few instances. Neuroimaging is a useful adjunct for diagnosis.

Viruses and rickettsiae

In this review I shall try to provide a brief, up-to-date, account of the neuropathology of those viral and rickettsial diseases that are particularly prevalent in tropical regions. These diseases are not, however, exclusive to the tropics. Some, such as AIDS, are common in temperate regions as well, though others are closer to being exclusively tropical, such as some of the arthropod-borne (ARBO) virus encephalides. The latter are dependent for their dissemination on an existence during part of their infectious cycle in insects which are, in turn, climatically and seasonally sensitive. This necessarily limits their geographical distribution. Factors that influence some of the other diseases are less closely dependent on climate and geography and reflect more the social or cultural conditions under which people live. Thus, diseases that depend for their spread on forms of human behavior such as promiscuity or drug abuse (AIDS), or poor hygiene and living conditions (polio, rickettsial diseases) or on contact with domestic and other animals (rabies) may occur in a more widespread distribution, for the tropics are not the only places that afford opportunities for these diseases to flourish. I shall select for discussion aspects of the pathology of these diseases that are currently undergoing investigation but will aim to present these against the backdrop of more established aspects of their pathology. Recent reviews of the pathology of viral encephalitis can be found in Hamilton and Wiley (33) and Esiri and Kennedy (20) and of HIV-1 infection in Price & Sidtis (78) and Scaravilli (85).

Widespread, restricted low-level measles virus infection of brain in a case of subacute sclerosing panencephalitis

In situ reverse transcriptase-polymerase chain reaction amplification with labeled-probe hybridization (in situ RT-PCR/LPH) was used to detect measles virus RNA within formalin-fixed, paraffin-embedded brain tissue sections from a patient who died with subacute sclerosing panencephalitis (SSPE). Many more infected neurons and oligodendrocytes were detected by in situ RT-PCR/LPH than by immunohistochemistry or by in situ hybridization alone. In addition, infection of vascular endothelial cells was demonstrated only by in situ RT-PCR/LPH. The observation that many cells contained only a few copies of viral RNA without detectable antigen is consistent with a persistent viral infection of the central nervous system. In situ RT-PCR/LPH, combining the sensitivity of PCR with the tissue localization of in situ hybridization, should prove useful in further studies to detect nucleic acids in situ in the central nervous system.