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Sehl-Ewert J, Schwaiger T, Schäfer A, Hölper JE, Klupp BG, Teifke JP, Blohm U, Mettenleiter TC. Clinical, neuropathological, and immunological short- and long-term feature of a mouse model mimicking human herpes virus encephalitis. Brain Pathol 2021; 32:e13031. [PMID: 34709694 PMCID: PMC9048517 DOI: 10.1111/bpa.13031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/13/2021] [Accepted: 10/04/2021] [Indexed: 12/15/2022] Open
Abstract
Herpes simplex encephalitis (HSE) is one of the most serious diseases of the nervous system in humans. However, its pathogenesis is still only poorly understood. Although several mouse models of predominantly herpes simplex virus 1 (HSV-1) infections mimic different crucial aspects of HSE, central questions remain unanswered. They comprise the specific temporofrontal tropism, viral spread within the central nervous system (CNS), as well as potential molecular and immunological barriers that drive virus into latency while only rarely resulting in severe HSE. We have recently proposed an alternative mouse model by using a pseudorabies virus (PrV) mutant that more faithfully represents the striking features of human HSE: temporofrontal meningoencephalitis with few severely, but generally only moderately to subclinically affected mice as well as characteristic behavioral abnormalities. Here, we characterized this animal model using 6- to 8-week-old female CD-1 mice in more detail. Long-term investigation over 6 months consistently revealed a biphasic course of infection accompanied by recurring clinical signs including behavioral alterations and mainly mild meningoencephalitis restricted to the temporal and frontal lobes. By histopathological and immunological analyses, we followed the kinetics and spatial distribution of inflammatory lesions as well as the underlying cytokine expression in the CNS over 21 days within the acute phase of infection. Affecting the temporal lobes, the inflammatory infiltrate was composed of lymphocytes and macrophages showing a predominantly lymphocytic shift 15 days after infection. A strong increase was observed in cytokines CXCL10, CCL2, CCL5, and CXCL1 recruiting inflammatory cells to the CNS. Unlike the majority of infected mice, strongly affected animals demonstrated extensive temporal lobe edema, which is typically present in severe human HSE cases. In summary, these results support the validity of our animal model for in-depth investigation of HSE pathogenesis.
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Affiliation(s)
- Julia Sehl-Ewert
- Department of Experimental Animal Facilities and Biorisk Management, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Theresa Schwaiger
- Institute of Immunology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany.,ViraTherapeutics GmbH, Rum, Austria
| | - Alexander Schäfer
- Institute of Immunology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Julia E Hölper
- Institute of Immunology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany.,Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Barbara G Klupp
- Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Jens P Teifke
- Department of Experimental Animal Facilities and Biorisk Management, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Ulrike Blohm
- Institute of Immunology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Thomas C Mettenleiter
- Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
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Manzano GS, Danish HH, Chu CJ, Kimchi EY. Child Neurology: Intractable Epilepsy and Transient Deficits in a Patient With a History of Herpes Simplex Virus Encephalitis. Neurology 2021; 96:679-681. [PMID: 33495374 DOI: 10.1212/wnl.0000000000011606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Giovanna S Manzano
- From the Department of Neurology, Massachusetts General Hospital, Boston.
| | - Husain H Danish
- From the Department of Neurology, Massachusetts General Hospital, Boston
| | - Catherine J Chu
- From the Department of Neurology, Massachusetts General Hospital, Boston
| | - Eyal Y Kimchi
- From the Department of Neurology, Massachusetts General Hospital, Boston
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3
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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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Liu Y, Zhou W. Clinical features and surgical treatment of epilepsy after viral encephalitis. BRAIN SCIENCE ADVANCES 2019. [DOI: 10.1177/2096595819896177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Encephalitis is an acute inflammatory process of the brain parenchyma, which is often caused by viral infection. It is an vital cause of acute symptomatic seizures and subsequent epilepsy. The incidence of unprovoked and recurrent seizures after previous infections of the central nervous system is high and accounts for 1%~5% of the cases of epilepsy. Viral encephalitis (VE) is directly caused by viral infection. The occurrence of seizures after VE is associated with poor prognosis. In survivors of VE, among other neurological sequelae, the risk of developing epilepsy is increased 10-fold. The risk of severe neurological sequelae after VE is particularly high in very young children. Studies on seizure occurrence, possible underlying mechanisms, clinical characteristics, and clinical treatment (especially surgical treatment) of VE have yielded only limited detailed data. We reviewed the most recent literature on the clinical features and surgical treatment of post-VE epilepsy.
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Affiliation(s)
- Yiou Liu
- Department of Epilepsy Center, Tsinghua University Yuquan Hospital, Beijing 100040, China
| | - Wenjing Zhou
- Department of Epilepsy Center, Tsinghua University Yuquan Hospital, Beijing 100040, China
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5
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Iwai Y, Nishimura K, Fukushima T, Ito T, Watanabe Y, Noro M, Kuwabara S. An Adult Case of Herpes Simplex Virus-associated Granulomatous Encephalitis. Intern Med 2019; 58:1491-1494. [PMID: 30626834 PMCID: PMC6548933 DOI: 10.2169/internalmedicine.2046-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Brain granuloma occurs under certain conditions. Herpes simplex virus (HSV) causes granulomatous encephalitis in children; however, it has been rarely reported in adults. A 74-year-old man with a history of herpes simplex encephalitis suffered recurrent seizures. Brain magnetic resonance imaging revealed a mass lesion and resection was performed. A polymerase chain reaction using a brain biopsy specimen was positive for HSV DNA; thus, the patient was diagnosed with HSV-associated granulomatous encephalitis. After administering acyclovir, the patient showed improvement. HSV can cause granulomatous encephalitis in adults, and acyclovir can be used for its treatment.
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Affiliation(s)
- Yuta Iwai
- Department of Neurology, Matsudo City General Hospital, Japan
| | | | | | - Takashi Ito
- Department of Neurology, Matsudo City General Hospital, Japan
| | | | - Masahiro Noro
- Department of Pathology, Matsudo City General Hospital, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
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6
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Liu Y, Zhou W. Clinical features and surgical treatment of epilepsy after viral encephalitis. BRAIN SCIENCE ADVANCES 2019. [DOI: 10.26599/bsa.2019.9050002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Childs L, Lim G, Thompson A, Bates TR, Kho LK, Phatouros C. A rare suspected case of chronic nodular granulomatous herpes simplex encephalitis in an adult. BJR Case Rep 2018; 4:20170114. [PMID: 31489214 PMCID: PMC6711280 DOI: 10.1259/bjrcr.20170114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/24/2018] [Accepted: 02/27/2018] [Indexed: 11/09/2022] Open
Abstract
Herpes simplex encephalitis is the most common sporadic viral encephalitis in the
western world, HSV-1 (herpes simplex virus) being the mostly commonly implicated
serotype. The disease is usually monophasic, although patients may relapse
weeks, months or years after initial infection. This chronic granulomatous
inflammatory process is almost exclusively described in children and rarely
forms discrete enhancing parenchymal nodules. We present the clinical and
radiological features of an unusual case of chronic nodular granulomatous herpes
encephalitis with enhancing “mass-like” nodules in an adult. To
the author’s knowledge, this is the first reported case of macroscopic
“mass-like” nodular granuloma formation in an adult.
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Affiliation(s)
- Lucy Childs
- Neurological Imaging and Intervention Service Western Australia (NIISwa), Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Guan Lim
- Neurological Imaging and Intervention Service Western Australia (NIISwa), Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Andrew Thompson
- Neurological Imaging and Intervention Service Western Australia (NIISwa), Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Timothy R Bates
- Stroke Unit, Swan District Hospital, Midland, WA, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Lay Kun Kho
- Department of Neurology, Royal Perth Hospital, Perth, WA, Australia
| | - Constantine Chris Phatouros
- Neurological Imaging and Intervention Service Western Australia (NIISwa), Sir Charles Gairdner Hospital, Nedlands, WA, Australia
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Taskin BD, Tanji K, Feldstein NA, McSwiggan-Hardin M, Akman CI. Epilepsy surgery for epileptic encephalopathy as a sequela of herpes simplex encephalitis: case report. J Neurosurg Pediatr 2017; 20:56-63. [PMID: 28452654 DOI: 10.3171/2017.3.peds16632] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Herpes simplex virus (HSV) encephalitis can manifest with different clinical presentations, including acute monophasic illness and biphasic chronic granulomatous HSV encephalitis. Chronic encephalitis is much less common, and very rare late relapses are associated with intractable epilepsy and progressive neurological deficits with or without evidence of HSV in the cerebrospinal fluid. The authors report on an 8-year-old girl with a history of treated HSV-1 encephalitis when she was 13 months of age and focal epilepsy when she was 2 years old. Although free of clinical seizures, when she was 5, she experienced behavioral and academic dysfunction, which was later attributed to electrographic focal seizures and worsening electroencephalography (EEG) findings with electrical status epilepticus during slow-wave sleep (ESES). Following a right temporal lobectomy, chronic granulomatous encephalitis was diagnosed. The patient's clinical course improved with the resolution of seizures and EEG abnormalities.
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Affiliation(s)
- Birce Dilge Taskin
- Department of Pediatric Neurology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey; and
| | - Kurenai Tanji
- Department of Pathology and Cell Biology, Division of Neuropathology
| | | | | | - Cigdem I Akman
- Department of Neurology, Division of Child Neurology, Columbia University Medical Center, New York
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Serrao F, D'Andrea V, Romagnoli C, Vento G, Papacci P, Costa S. Intrauterine infection caused by herpes simplex virus type-1 in the setting of recurrent maternal infection. J OBSTET GYNAECOL 2016; 36:698-9. [PMID: 27146023 DOI: 10.3109/01443615.2016.1154509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Francesca Serrao
- a Department of Paediatrics, Division of Neonatology , Catholic University of Sacred Heart , Rome , Italy
| | - Vito D'Andrea
- a Department of Paediatrics, Division of Neonatology , Catholic University of Sacred Heart , Rome , Italy
| | - Costantino Romagnoli
- a Department of Paediatrics, Division of Neonatology , Catholic University of Sacred Heart , Rome , Italy
| | | | - Patrizia Papacci
- a Department of Paediatrics, Division of Neonatology , Catholic University of Sacred Heart , Rome , Italy
| | - Simonetta Costa
- a Department of Paediatrics, Division of Neonatology , Catholic University of Sacred Heart , Rome , Italy
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Chronic herpes simplex type-1 encephalitis with intractable epilepsy in an immunosuppressed patient. Infection 2015; 44:121-5. [PMID: 26187268 DOI: 10.1007/s15010-015-0822-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/06/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Chronic herpes simplex virus type-1 encephalitis (HSE-1) is uncommon. Past reports focused on its association with prior documented acute infection. Here, we describe a patient with increasingly intractable epilepsy from chronic HSE-1 reactivation without history of acute central nervous system infection. CASE PRESENTATION A 49-year-old liver transplant patient with 4-year history of epilepsy after initiation of cyclosporine developed increasingly frequent seizures over 3 months. Serial brain magnetic resonance imaging showed left temporoparietal cortical edema that gradually improved despite clinical decline. Herpes simplex virus type-1 (HSV-1) DNA was detected in cerebrospinal fluid by polymerase chain reaction. Cerebrospinal fluid HSV-1&2 IgM was negative. Seizures were controlled after acyclovir treatment, and the patient remained seizure free at 1-year follow-up. CONCLUSION Chronic HSE is a cause of intractable epilepsy, can occur without a recognized preceding acute phase, and the clinical course of infection may not directly correlate with neuroimaging changes.
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11
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Schutz PW, Fauth CT, Al-Rawahi GN, Pugash D, White VA, Stockler S, Dunham CP. Granulomatous herpes simplex encephalitis in an infant with multicystic encephalopathy: a distinct clinicopathologic entity? Pediatr Neurol 2014; 50:392-6. [PMID: 24485930 DOI: 10.1016/j.pediatrneurol.2013.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 12/01/2013] [Accepted: 12/07/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Herpes simplex virus encephalitis can manifest as a range of clinical presentations including classic adult, neonatal, and biphasic chronic-granulomatous herpes encephalitis. METHOD We report an infant with granulomatous herpes simplex virus type 2 encephalitis with a subacute course and multicystic encephalopathy. CASE A 2-month-old girl presented with lethargy and hypothermia. Computed tomography scan of the head showed multicystic encephalopathy and calcifications. Cerebrospinal fluid analysis by polymerase chain reaction testing for herpes simplex virus 1 and 2, enterovirus, and cytomegalovirus was negative. Normal cerebrospinal fluid interferon-α levels argued against Aicardi-Goutières syndrome. The patient died 2 weeks after presentation. At autopsy, multicystic encephalopathy was confirmed with bilateral gliosis, granulomatous inflammation with multinucleated giant cells, and calcifications. Bilateral healing necrotizing retinitis suggested a viral etiology, but retina and brain were free of viral inclusions and immunohistochemically negative for herpes simplex virus-2 and cytomegalovirus. However, polymerase chain reaction analysis showed herpes simplex virus-2 DNA in four cerebral paraffin blocks. Subsequent repeat testing of the initial cerebrospinal fluid sample using a different polymerase chain reaction assay was weakly positive for herpes simplex virus-2 DNA. CONCLUSION Granulomatous herpes simplex virus encephalitis in infants can present with subacute course and result in multicystic encephalopathy with mineralization and minimal cerebrospinal fluid herpes simplex virus DNA load. Infectious etiologies should be carefully investigated in the differential diagnosis of multicystic encephalopathy with mineralization, in particular if multinucleated giant cells are present.
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Affiliation(s)
- Peter W Schutz
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.
| | - Clarissa T Fauth
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada; Department of Pathology, Red Deer Regional Hospital, Red Deer, Canada
| | - Ghada N Al-Rawahi
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada; Department of Pathology and Laboratory Medicine, Children's and Women's Health Centre of British Columbia, Vancouver, Canada
| | - Denise Pugash
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Valerie A White
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada; Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Sylvia Stockler
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Christopher P Dunham
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada; Department of Pathology and Laboratory Medicine, Children's and Women's Health Centre of British Columbia, Vancouver, Canada
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12
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Guan Y, Zhou J, Luan G, Liu X. Surgical Treatment of Patients with Rasmussen Encephalitis. Stereotact Funct Neurosurg 2014; 92:86-93. [DOI: 10.1159/000355901] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 09/23/2013] [Indexed: 11/19/2022]
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13
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Chronic granulomatous herpes encephalitis in a child with clinically intractable epilepsy. Case Rep Pediatr 2012; 2012:849812. [PMID: 22919528 PMCID: PMC3420097 DOI: 10.1155/2012/849812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 06/07/2012] [Indexed: 01/29/2023] Open
Abstract
Most patients with herpes simplex virus Type I encephalitis experience an acute, monophasic illness. Chronic encephalitis is much less common, and few late relapses are associated with intractable seizure disorders. A 10-year-old boy was admitted to our institution for intractable epilepsy as part of an evaluation for epilepsy surgery. His history was significant for herpes meningitis at age 4 months. At that time, he presented to an outside hospital with fever for three days, with acyclovir treatment beginning on day 4 of his 40-day hospital course. He later developed infantile spasms and ultimately a mixed seizure disorder. Video electroencephalogram showed a Lennox-Gastaut-type pattern with frequent right frontotemporal spikes. Imaging studies showed an abnormality in the right frontal operculum. Based on these findings, he underwent a right frontal lobectomy. Neuropathology demonstrated chronic granulomatous inflammation with focal necrosis and mineralizations. Scattered lymphocytes, microglial nodules and nonnecrotizing granulomas were present with multinucleated giant cells. Immunohistochemistry for herpes simplex virus showed focal immunoreactivity. After undergoing acyclovir therapy, he returned to baseline with decreased seizure frequency. This rare form of herpes encephalitis has only been reported in children, but the initial presentation of meningitis and the approximate 10-year-time interval in this case are unusual.
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14
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Adamo MA, Abraham L, Pollack IF. Chronic granulomatous herpes encephalitis: a rare entity posing a diagnostic challenge. J Neurosurg Pediatr 2011; 8:402-6. [PMID: 21961549 DOI: 10.3171/2011.7.peds10393] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Herpesviruses can cause an acute, subacute, or chronic disease state in both immunocompetent and immunocompromised individuals. Herpes simplex virus (HSV) encephalitis is most often an acute monophasic disease process. Rarely, however, it may progress to a chronic state, and more rarely still to a granulomatous encephalitis. Prior studies have suggested that antiviral immunity with Toll-like receptors determines susceptibility to herpesviruses. The authors report the case of a 14-year-old girl with a remote history of treated HSV encephalitis, who had intractable seizures and worsening MR imaging changes that were concerning for either a neoplastic or an inflammatory process. She was found to have granulomatous herpes simplex encephalitis and had a low cytokine response to Toll-like receptor 3 stimulation.
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Affiliation(s)
- Matthew A Adamo
- Division of Neurosurgery, Albany Medical Center, Albany, New York, USA
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15
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Brown WD, Bearer EL, Donahue JE. Chronic active herpes simplex type 2 encephalitis in an asymptomatic immunocompetent child. J Child Neurol 2010; 25:901-8. [PMID: 20179002 PMCID: PMC3376078 DOI: 10.1177/0883073809353449] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A unique form of chronic, active, granulomatous herpes simplex type 2 encephalitis is described in an asymptomatic, immunocompetent 8-year-old girl who acquired the virus as a neonate. The extensive, bilateral cerebral parenchymal involvement was discovered incidentally. Diagnosis was confirmed by a combination of serial neuroimaging, brain biopsy, and quantitative polymerase chain reaction targeted to DNA sequences in the glycoprotein G gene, allowing differentiation between herpes simplex virus types 1 and 2. The clinical course over a 5-year period, treatment with intermittent intravenous steroids, and daily valacyclovir, diagnostic imaging, and laboratory studies are reviewed in detail. This form of herpes simplex virus type 2 encephalitis hasn't been described previously and is significant because of its prolonged indolent course, absence of neurological findings or suggestive history, and benign behavior in this child, who is now 14 years old. The authors believe this entity can be unsuspected and underdiagnosed in the general pediatric population, especially in those with a prior maternal history of herpes simplex virus type 2 infection.
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Affiliation(s)
- William D. Brown
- Warren Alpert Medical School at Brown University, Providence, RI, Department of Pediatrics and Department of Neurology, Hasbro Children’s Hospital/Rhode Island Hospital, Providence, RI
| | - Elaine L. Bearer
- Warren Alpert Medical School at Brown University, Providence, RI, Department of Pathology, University of New Mexico Medical School, Albuquerque, NM
| | - John E. Donahue
- Warren Alpert Medical School at Brown University, Providence, RI, Department of Pathology (Neuropathology) and Clinical Neurosciences (Neurology), Rhode Island Hospital, Providence, RI
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Abstract
Viral encephalitis presents with seizures not only in the acute stage but also increases the risk of late unprovoked seizures and epilepsy. Acute symptomatic and late unprovoked seizures in different viral encephalitides are reviewed here. Among the sporadic viral encephalitides, Herpes simplex encephalitis (HSE) is perhaps most frequently associated with epilepsy, which may often be severe. Seizures may be the presenting feature in 50% patients with HSE because of involvement of the highly epileptogenic frontotemporal cortex. The occurrence of seizures in HSE is associated with poor prognosis. In addition, chronic and relapsing forms of HSE have been described and these may be associated with antiepileptic drug-resistant seizures. Among the epidemic (usually due to flaviviruses) viral encephalitides, Japanese encephalitis (JE) is most common and is associated with acute symptomatic seizures, especially in children. The reported frequency of acute symptomatic seizures in JE is 7-46%. Encephalitis due to other flaviviruses such as equine, St. Louis, and West Nile viruses may also manifest with acute symptomatic seizures. In Nipah virus encephalitis, seizures are more common in relapsed and late-onset encephalitis in comparison to acute encephalitis (4% vs. 1.8%). Other viruses like measles, varicella, mumps, influenza, and entero-viruses may cause seizures depending on the area of brain involved. There is no comprehensive data regarding late unprovoked seizures in different viral encephalitides. Prospective studies are required to document the risk of late unprovoked seizures and epilepsy following viral encephalitis due to different viruses as well as to determine the clinical characteristics, course, and outcome of post-encephalitic epilepsy.
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Affiliation(s)
- Usha Kant Misra
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. ,
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17
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De Tiège X, Rozenberg F, Héron B. The spectrum of herpes simplex encephalitis in children. Eur J Paediatr Neurol 2008; 12:72-81. [PMID: 17870623 DOI: 10.1016/j.ejpn.2007.07.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 07/05/2007] [Accepted: 07/10/2007] [Indexed: 11/19/2022]
Abstract
Clinical and basic science research carried out in recent years into herpes simplex encephalitis (HSE) have shown that the concept of a "classical" picture of HSE in children is now outdated and that our current knowledge of the disease is probably only the tip of an iceberg. Indeed, increasing evidence supports the existence of a wider range of pathophysiological mechanisms, clinical presentations and disease progressions in paediatric HSE. This paper reviews the clinical, biological and radiological data available and redefines the spectrum of HSE in children. Full understanding of the condition should improve the management of suspected cases and decrease the morbidity and the mortality associated with this disease.
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Affiliation(s)
- Xavier De Tiège
- Department of Paediatric Neurology, ULB-Hôpital Erasme, Brussels, Belgium.
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18
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Bauer J, Elger CE, Hans VH, Schramm J, Urbach H, Lassmann H, Bien CG. Astrocytes are a specific immunological target in Rasmussen's encephalitis. Ann Neurol 2007; 62:67-80. [PMID: 17503512 DOI: 10.1002/ana.21148] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The current histopathological criteria of Rasmussen's encephalitis (RE) include the presence of T-cell-dominated inflammation, microglial activation, neuronal loss, and astrocytic activation. An in vitro study, however, suggested glutamate receptor 3 (GluR3) antibody-mediated astrocytic loss. Therefore, we investigated astrocytic apoptosis and loss in situ. METHODS Histochemical, immunohistochemical, terminal deoxynucleotidyltransferase-mediated biotin-dUTP nick end labeling and in situ hybridization techniques were applied to paraffin sections of 20 RE cases, 6 healthy control subjects, and 6 paraneoplastic encephalomyelitis, 10 Ammon's horn sclerosis, and 5 focal cortical dysplasia cases. RESULTS Astrocytic apoptosis and subsequent loss of these cells is a specific feature of RE. Such lesions are not found in the control groups. In RE, astrocytic apoptosis and loss was present both in cortical and in white matter areas. Astrocytes in these tissues showed major histocompatibility complex class I expression. Furthermore, granzyme-B(+) lymphocytes were found in close apposition to astrocytes bordering astrocyte-deficient lesions. Granzyme-B(+) granules in these lymphocytes were polarized and faced the astrocytic membranes. No evidence was found for an antibody-mediated destruction. INTERPRETATION We suggest a specific attack by cytotoxic T lymphocytes as a possible mechanism responsible for astrocytic degeneration in RE. The loss of astrocytes might play a role in neuronal dysfunction, seizure induction, and enhancement of neuronal cell death.
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Affiliation(s)
- Jan Bauer
- Division of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Spitalgasse 4, A-1090 Vienna, Austria.
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Viñas JMP, Gonzalez MJM, Ribes AG, Expósito RG, Bragado FG. Postencephalitic chronic granulomatous disease. Pediatr Neurol 2006; 35:297-9. [PMID: 16996409 DOI: 10.1016/j.pediatrneurol.2006.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Revised: 03/28/2006] [Accepted: 05/11/2006] [Indexed: 11/17/2022]
Abstract
This report details the evolution of a case of herpes simplex encephalitis to chronic granuloma in a 13-year old female who, at the age of 8, suffered herpes simplex virus type 1 encephalitis. Eight months later, she developed an intracranial hypertension syndrome with the onset of a new lesion in the necrosed zone of her right temporal lobe, with no viral presence in the cerebrospinal fluid. The histologic characteristics were those of chronic granuloma with multinucleated giant cells and calcifications. Initially treated for neurosarcoidosis, the patient remained steroid-dependent for 4 years and the steroids could only be withdrawn by treatment with Infliximab. This type of evolutive pattern has probably been completely overlooked until now; it can only be accurately diagnosed by biopsy. It was initially mistaken for neurosarcoidosis.
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Leen WG, Weemaes CM, Verbeek MM, Willemsen MA, Rotteveel JJ. Chronic herpes simplex virus encephalitis in childhood. Pediatr Neurol 2006; 35:57-61. [PMID: 16814088 DOI: 10.1016/j.pediatrneurol.2005.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Revised: 09/02/2005] [Accepted: 12/19/2005] [Indexed: 10/24/2022]
Abstract
Although herpes simplex virus is a major cause of acute encephalitis in childhood, chronic herpes simplex virus encephalitis has only rarely been reported. This report presents a case of chronic herpes simplex virus encephalitis in a 6-year-old female. Diagnosis was based on the detection of herpes simplex virus deoxyribonucleic acid by polymerase chain reaction in combination with the cerebrospinal fluid/serum ratio of herpes simplex virus-specific immunoglobulin G, the presence of herpes simplex virus-specific oligoclonal immunoglobulin G bands in cerebrospinal fluid, and calcifications in the temporal regions found on cerebral computed tomographic scan. Prolonged antiviral therapy was beneficial to later mental development.
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Affiliation(s)
- Wilhelmina G Leen
- Department of Pediatric Neurology, University Medical Centre St Radboud, Nijmegen, The Netherlands
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21
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Love S, Koch P, Urbach H, Dawson TP. Chronic Granulomatous Herpes Simplex Encephalitis in Children. J Neuropathol Exp Neurol 2004; 63:1173-81. [PMID: 15581185 DOI: 10.1093/jnen/63.11.1173] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Herpes simplex encephalitis is usually a monophasic acute illness but can cause chronic disease, particularly in children. Little information is available as to the histological substrate. We report the findings in 3 children. In 2 children, herpes encephalitis had occurred during the first 2 years, but both later developed intractable epilepsy that led to neurosurgery. The biopsies showed chronic granulomatous inflammation with foci of mineralization. One child made a good post-operative recovery. The other was found post-operatively to have herpes simplex virus type 1 (HSV-1) DNA and elevated titers of HSV IgM antibodies in the CSE He was given acyclovir but after initial improvement developed hemiparesis, with extensive signal change on MRI. Repeat biopsy revealed florid granulomatous inflammation with necrosis. The third patient was an infant who had had a cutaneous facial HSV-2 eruption soon after birth. This was treated with topical acyclovir, after which she remained well until 2 months, when she presented with a relatively non-specific illness, developed blisters of the right hand and foot, and died a few days later. Necropsy revealed severe granulomatous encephalitis, most extensive in the temporal lobe and insula, and associated with mineralization. Our findings indicate that herpes simplex encephalitis in children can be complicated by chronic granulomatous inflammation with mineralization. This pattern of disease may be an under-recognized complication of herpes simplex infection during the first few years of life.
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Affiliation(s)
- Seth Love
- Department of Neuropathology, Institute of Clinical Neurosciences, Frenchay Hospital, Bristol, United Kingdom.
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22
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Oliveira A, Hodges H, Rezaie P. Excitotoxic lesioning of the rat basal forebrain with S-AMPA: consequent mineralization and associated glial response. Exp Neurol 2003; 179:127-38. [PMID: 12618119 DOI: 10.1016/s0014-4886(02)00012-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Regional depositions of calcium within the basal ganglia, cortex, cerebellum, and white matter and at perivascular sites have been observed in several pathological conditions. These generally indicate signs of ongoing apoptosis or necrotic processes, whereby the activation of glutamate receptors causes a rise in intracellular calcium levels leading to mineralization of neurons, and ultimately to cell death. The selective degeneration of cholinergic neurons in the basal forebrain is a major neuropathological component of Alzheimer's disease, and may result in abnormal deposition of calcium. In experimental models, selective lesions of the basal forebrain can be induced by intraparenchymal infusions of excito- or immunotoxins targeting cholinergic neurons. Excitotoxic lesions are often accompanied by calcium deposition within affected areas. In a previous study we also noted the presence of unusual deposition in areas close to the site of injections following unilateral S-AMPA-induced lesions of the basal forebrain (T. Perry, H. Hodges, and J. A. Gray, 2001, Brain Res. Bull. 54, 29-48). In this paper, we have characterized these deposits histologically and evaluated the microglial (CD11b) and astrocytic (GFAP) responses at 8 and 16 weeks following lesioning of the nucleus basalis magnocellularis with S-AMPA. The resulting deposits were heterogeneous in morphology and composed primarily of calcium. Small granular deposits were detected around blood vessels, whereas larger calcospherites were situated within the parenchyma. These deposits were more widely dispersed at 16 weeks postlesioning, affected neighboring nuclei, and displayed a progressive increase in size and frequency of occurrence. However, calcification within these regions was differentially associated with microglial and astrocytic reactivity at the two time points. Both microglial and astrocytic responses were pronounced at 8 weeks, whereas at 16 weeks, astrocytic reactivity prevailed and the microglial response was markedly attenuated. Importantly, the pattern of reactivity for microglia detected at 8 weeks was specifically localized to vulnerable nucleated areas prior to their substantial accumulation of calcium deposits, which was clearly evident by 16 weeks. We suggest that the initial microglial response could be used as a selective predictor of tissue necrosis and subsequent calcification, and that astrocytes, which form a glial scar in the affected tissues, may contribute toward the buildup of calcium deposits. The functional relevance of these findings is discussed.
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Affiliation(s)
- Alcyr Oliveira
- Department of Psychology, Institute of Psychiatry, King's College London, DeCrespigny Park, London, UK.
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