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Mendez Valdez MJ, Kim E, Bhatia S, Saad AG, Sidani C, Daggubati L, Chandar J, Seetharam D, Desgraves J, Ingle S, Luther E, Ivan M, Komotar R, Shah AH. Outcomes of HSV-1 encephalitis infection in glioblastoma: An integrated systematic analysis. Microb Pathog 2023:106211. [PMID: 37343897 DOI: 10.1016/j.micpath.2023.106211] [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: 03/04/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Herpes Simplex Virus-1 (HSV-1) is a neurotropic DNA virus with neural latency and stereotypic viral encephalitis. It has been reported to conceal underlying glioblastoma (GBM) due to similar radiographic imaging and clinical presentation. Limited data exist on the co-occurrence of GBM and HSV-1. To better describe the pathophysiology of HSV-1 superinfections in GBM, we performed a comprehensive review of GBM cases with superimposed HSV-1. METHODS A comprehensive literature search of six electronic databases with apriori search criteria was performed to identify eligible cases of GBM with HSV-1. Relevant clinic-radiographic data were collected, Kaplan-Meier estimates, Fisher's exact test, and logistic regression analyses were used. RESULTS We identified 20 cases of HSE in GBM with an overall survival (OS) of 8.0 months. The median age of presentation was 63 years (range: 24-78 years) and the median interval between GBM or HSE diagnosis was 2 months (range: 0.05-25 months). HSE diagnosis before GBM diagnosis was a predictor for improved survival (HR: 0.06; 95% CI: [0.01-0.54]; p < 0.01). There is a significant reduction in OS in patients with concomitant HSE and GBM compared to the cancer genome atlas (TCGA) cohort (median OS: 8 months vs. 14.2 months; p < 0.05). Finally, HSV does not directly infect GBM cells but indirectly activates a local immune response in the tumor microenvironment. CONCLUSIONS Superimposed HSE in GBM may contribute to a significant reduction in OS compared to uninfected controls, potentially activating proto-oncogenes during active infection and latency. Preoperative HSE may induce an antiviral immune response, which may serve as a positive prognostic factor. Prompt antiviral treatment upon co-occurrence is necessary.
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Affiliation(s)
- Mynor J Mendez Valdez
- University of Miami Leonard M. Miller School of Medicine, Department of Neurological Surgery, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA.
| | - Enoch Kim
- Nova Southeastern University College of Osteopathic Medicine, 3200 S University Dr, Davie, FL, 33328, USA.
| | - Shovan Bhatia
- University of Miami Leonard M. Miller School of Medicine, Department of Neurological Surgery, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA.
| | - Ali G Saad
- University of Miami Leonard M. Miller School of Medicine, Department of Neurological Surgery, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA.
| | - Charif Sidani
- University of Miami Leonard M. Miller School of Medicine, Department of Neurological Surgery, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA.
| | - Lekhaj Daggubati
- University of Miami Leonard M. Miller School of Medicine, Department of Neurological Surgery, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA.
| | - Jay Chandar
- Florida International University Herbert Wertheim College of Medicine, 11200 SW 8th Street AHC2, Miami, FL, 33199, USA.
| | - Deepa Seetharam
- University of Miami Leonard M. Miller School of Medicine, Department of Neurological Surgery, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA.
| | - Jelisah Desgraves
- University of Miami Leonard M. Miller School of Medicine, Department of Neurological Surgery, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA.
| | - Shreya Ingle
- University of Miami Leonard M. Miller School of Medicine, Department of Neurological Surgery, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA.
| | - Evan Luther
- University of Miami Leonard M. Miller School of Medicine, Department of Neurological Surgery, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA.
| | - Michael Ivan
- University of Miami Leonard M. Miller School of Medicine, Department of Neurological Surgery, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA.
| | - Ricardo Komotar
- University of Miami Leonard M. Miller School of Medicine, Department of Neurological Surgery, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA.
| | - Ashish H Shah
- University of Miami Leonard M. Miller School of Medicine, Department of Neurological Surgery, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA.
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Abstract
After establishing latent infection, some viruses can be reactivated by the alteration of host immunological conditions. First, we reviewed viruses that can cause neuronal damage by reactivation. Then we focused on the herpes simplex virus (HSV). The reactivation leads to neuronal damages through two possible mechanisms; "reactivation of a latent herpes virus" by which viruses can cause direct virus neurotoxicity, and "post-infectious immune inflammatory response" by which a focal reactivation of HSV leads to an inflammatory reaction. The former is radiologically characterized by cortical lesions, the latter is characterized by subcortical white matter lesions. We experienced a female, who underwent the right posterior quadrantectomy and then developed recurrent herpes encephalitis caused by herpes simplex reactivation, which pathologically demonstrated inflammation in the white matter, suggesting a post-infectious immune inflammatory response. The patient was successfully treated with immunosuppressants. The reactivation of the HSV is extremely rare in Japan. Neurologists should recognize this condition because this disorder will increase as epilepsy surgery gains more popularity.
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Affiliation(s)
- Tomoyo Shimada
- Department of Neurology, Juntendo University School of Medicine
| | - Taiji Tsunemi
- Department of Neurology, Juntendo University School of Medicine
- Epilepsy Center, Juntendo University School of Medicine
| | - Yasushi Iimura
- Department of Neurosurgery, Juntendo University School of Medicine
- Epilepsy Center, Juntendo University School of Medicine
| | - Hidenori Sugano
- Department of Neurosurgery, Juntendo University School of Medicine
- Epilepsy Center, Juntendo University School of Medicine
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Sa’adeh I, Saadh MJ. Multifocal glioblastoma multiform with “encephalitis-like presentation” : a case report. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00407-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Abstract
Background
Glioblastoma multiform is the most common and aggressive type of primary malignant tumor that affects the central nervous system in adults. It clinically presents with seizures, headache, and/or progressive focal neurological deficits. Radiologically, glioblastoma multiform appears as a single distinguishable, large heterogeneous lesion affecting the cerebrum with characteristic central necrosis, marginal enhancement, and surrounding vasogenic edema. This article describes a patient that exhibited an atypical clinical presentation of multifocal glioblastoma multiform with misleading early radiological features that simulated herpetic encephalitis.
Results
A 66-year-old female that presented with left-sided hemiparesis and left partial motor seizures underwent multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) scans. A cerebrospinal fluid (CSF) polymerase chain reaction (PCR) test was also performed to screen for herpes simplex virus 1 (HSV-1).
Conclusions
The early stages of glioblastoma may manifest as symptoms typical to encephalitis, which can delay diagnosis and treatment. Therefore, early diagnosis and identification of atypical glioblastoma multiform presentations, as reported in this article, are essential.
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McLaughlin DC, Achey RL, Geertman R, Grossman J. Herpes simplex reactivation following neurosurgery: case report and review of the literature. Neurosurg Focus 2020; 47:E9. [PMID: 31370030 DOI: 10.3171/2019.5.focus19281] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/13/2019] [Indexed: 11/06/2022]
Abstract
Herpes simplex encephalitis is a common viral encephalitis associated with significant morbidity and mortality if not diagnosed and treated early. Neurosurgery may be an impetus for viral reactivation, either from direct nerve manipulation or high-dose steroids often administered during cases. The authors present the 40th known case of herpes simplex virus (HSV) encephalitis following neurosurgical intervention and review the previously reported cases. In their review, the authors observed positive HSV polymerase chain reaction (PCR), which had initially been negative in several cases. In cases in which there is high suspicion of HSV, it may be prudent to continue antiviral therapy and retest CSF for HSV PCR. Antiviral therapy significantly reduces mortality associated with HSV encephalitis.
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Affiliation(s)
| | - Rebecca L Achey
- 2Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - Robert Geertman
- 1Department of Neurosurgery, MetroHealth Medical Center, Cleveland; and
| | - Jonah Grossman
- 1Department of Neurosurgery, MetroHealth Medical Center, Cleveland; and
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Mutti C, Curti E, Ciliento R, Melpignano A, Florindo I, Zinno L, Sasso E, Parrino L, Pavesi G, Vaudano AE. Herpes Simplex Virus 1 encephalitis with normal cerebrospinal fluid after brain radiotherapy in a patient with glioblastoma. A case report and review of literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:327-330. [PMID: 31125013 PMCID: PMC6776207 DOI: 10.23750/abm.v90i2.8218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 11/23/2022]
Abstract
Herpes simplex virus encephalitis (HSE) is the most common cause of letal encephalitis and its prevalence appears higher among oncologic patients who undergo brain radiotherapy (RT). We describe a case of 76-year-old woman with glioblastoma multiforme (GBM) who developed HSE shortly after brain RT. Cerebrospinal fluid analysis (CSF) was normal and the diagnosis was driven by brain MRI and EEG. Prompt introduction of antiviral therapy improved the clinical picture. We highlight the importance of EEG and brain MRI for the diagnosis and suggest the possibility of antiviral profilaxys in oncologic patients who undergo brain RT. (www.actabiomedica.it)
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Depression and glioblastoma, complicated concomitant diseases: a systemic review of published literature. Neurosurg Rev 2018; 43:497-511. [PMID: 30094499 DOI: 10.1007/s10143-018-1017-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/09/2018] [Accepted: 07/26/2018] [Indexed: 01/27/2023]
Abstract
Glioblastoma multiforme (GBM) is the most common primary brain cancer. Depression is a common co-morbidity of this condition. Despite this common interaction, relatively little research has been performed on the development of GBM-associated depression. We performed a literary search of the PubMed database for articles published relating to GBM and depression. A total of 85 articles were identified with 46 meeting inclusion criteria. Depression significantly impacts care, decreasing medication compliance, and patient survival. Diagnostically, because depression and GBM share intricate neuro-connectivity in a way that effect functionality, these diseases can be mistaken for alternative psychological or pathological disorders, complicating care. Therapeutically, anti-depressants have anti-tumor properties; yet, some have been shown to interfere with GBM treatment. One reason for this is that the pathophysiological development of depression and GBM share several pathways including altered regulation of the 5-HT receptor, norepinephrine, and 3':5'-cyclic monophosphate. Over time, depression can persist after GBM treatment, affecting patient quality of life. Together, depression and GBM are complicated concomitant diseases. Clinicians must be aware of their co-existence. Because of overlapping molecular pathways involved in both diseases, careful medication selection is imperative to avoid potential adverse interactions. Since GBMs are the most common primary brain cancer, physicians dealing with this disease should be prepared for the development of depression as a potential sequela of this condition, given the related pathophysiology and the known poor outcomes.
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