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Hussain MS, Gupta G, Samuel VP, Almalki WH, Kazmi I, Alzarea SI, Saleem S, Khan R, Altwaijry N, Patel S, Patel A, Singh SK, Dua K. Immunopathology of herpes simplex virus-associated neuroinflammation: Unveiling the mysteries. Rev Med Virol 2024; 34:e2491. [PMID: 37985599 DOI: 10.1002/rmv.2491] [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: 10/04/2023] [Revised: 10/21/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023]
Abstract
The immunopathology of herpes simplex virus (HSV)-associated neuroinflammation is a captivating and intricate field of study within the scientific community. HSV, renowned for its latent infection capability, gives rise to a spectrum of neurological expressions, ranging from mild symptoms to severe encephalitis. The enigmatic interplay between the virus and the host's immune responses profoundly shapes the outcome of these infections. This review delves into the multifaceted immune reactions triggered by HSV within neural tissues, intricately encompassing the interplay between innate and adaptive immunity. Furthermore, this analysis delves into the delicate equilibrium between immune defence and the potential for immunopathology-induced neural damage. It meticulously dissects the roles of diverse immune cells, cytokines, and chemokines, unravelling the intricacies of neuroinflammation modulation and its subsequent effects. By exploring HSV's immune manipulation and exploitation mechanisms, this review endeavours to unveil the enigmas surrounding the immunopathology of HSV-associated neuroinflammation. This comprehensive understanding enhances our grasp of viral pathogenesis and holds promise for pioneering therapeutic strategies designed to mitigate the neurological ramifications of HSV infections.
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Affiliation(s)
- Md Sadique Hussain
- School of Pharmaceutical Sciences, Jaipur National University, Jaipur, Rajasthan, India
| | - Gaurav Gupta
- Centre for Global Health Research, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Kuthambakkam, India
- School of Pharmacy, Graphic Era Hill University, Dehradun, India
- School of Pharmacy, Suresh Gyan Vihar University, Jaipur, India
| | - Vijaya Paul Samuel
- Department of Anatomy, RAK College of Medicine, RAK Medical and Health Sciences, Ras Al Khaimah, United Arab Emirates
| | - Waleed Hassan Almalki
- Department of Pharmacology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Imran Kazmi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sami I Alzarea
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Shakir Saleem
- Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Ruqaiyah Khan
- Department of Basic Health Sciences, Deanship of Preparatory Year for the Health Colleges, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Najla Altwaijry
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Samir Patel
- Department of Pharmaceutical Chemistry and Analysis, Ramanbhai Patel College of Pharmacy, Charotar University of Science and Technology, Changa, Gujarat, India
| | - Archita Patel
- Department of Pharmaceutical Chemistry and Analysis, Ramanbhai Patel College of Pharmacy, Charotar University of Science and Technology, Changa, Gujarat, India
| | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia
| | - Kamal Dua
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Broadway, New South Wales, Australia
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2
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Dissaux N, Neyme P, Kim-Dufor DH, Lavenne-Collot N, Marsh JJ, Berrouiguet S, Walter M, Lemey C. Psychosis Caused by a Somatic Condition: How to Make the Diagnosis? A Systematic Literature Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1439. [PMID: 37761400 PMCID: PMC10529854 DOI: 10.3390/children10091439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND First episode of psychosis (FEP) is a clinical condition that usually occurs during adolescence or early adulthood and is often a sign of a future psychiatric disease. However, these symptoms are not specific, and psychosis can be caused by a physical disease in at least 5% of cases. Timely detection of these diseases, the first signs of which may appear in childhood, is of particular importance, as a curable treatment exists in most cases. However, there is no consensus in academic societies to offer recommendations for a comprehensive medical assessment to eliminate somatic causes. METHODS We conducted a systematic literature search using a two-fold research strategy to: (1) identify physical diseases that can be differentially diagnosed for psychosis; and (2) determine the paraclinical exams allowing us to exclude these pathologies. RESULTS We identified 85 articles describing the autoimmune, metabolic, neurologic, infectious, and genetic differential diagnoses of psychosis. Clinical presentations are described, and a complete list of laboratory and imaging features required to identify and confirm these diseases is provided. CONCLUSION This systematic review shows that most differential diagnoses of psychosis should be considered in the case of a FEP and could be identified by providing a systematic checkup with a laboratory test that includes ammonemia, antinuclear and anti-NMDA antibodies, and HIV testing; brain magnetic resonance imaging and lumbar puncture should be considered according to the clinical presentation. Genetic research could be of interest to patients presenting with physical or developmental symptoms associated with psychiatric manifestations.
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Affiliation(s)
- Nolwenn Dissaux
- Centre Hospitalier Régional et Universitaire de Brest, 2 Avenue Foch, 29200 Brest, France
- Unité de Recherche EA 7479 SPURBO, Université de Bretagne Occidentale, 29200 Brest, France
| | - Pierre Neyme
- Fondation du Bon Sauveur d’Alby, 30 Avenue du Colonel Teyssier, 81000 Albi, France
| | - Deok-Hee Kim-Dufor
- Centre Hospitalier Régional et Universitaire de Brest, 2 Avenue Foch, 29200 Brest, France
| | - Nathalie Lavenne-Collot
- Centre Hospitalier Régional et Universitaire de Brest, 2 Avenue Foch, 29200 Brest, France
- Laboratoire du Traitement de l’Information Médicale, Inserm U1101, 29200 Brest, France
| | - Jonathan J. Marsh
- Graduate School of Social Service, Fordham University, 113 West 60th Street, New York, NY 10023, USA
| | - Sofian Berrouiguet
- Centre Hospitalier Régional et Universitaire de Brest, 2 Avenue Foch, 29200 Brest, France
- Unité de Recherche EA 7479 SPURBO, Université de Bretagne Occidentale, 29200 Brest, France
| | - Michel Walter
- Centre Hospitalier Régional et Universitaire de Brest, 2 Avenue Foch, 29200 Brest, France
- Unité de Recherche EA 7479 SPURBO, Université de Bretagne Occidentale, 29200 Brest, France
| | - Christophe Lemey
- Centre Hospitalier Régional et Universitaire de Brest, 2 Avenue Foch, 29200 Brest, France
- Unité de Recherche EA 7479 SPURBO, Université de Bretagne Occidentale, 29200 Brest, France
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Yadav B, Chaurasia D, Kharel A, Dhungana K. Anti-N-methyl-D-aspartate Receptor Autoimmune Encephalitis: A Case Report. JNMA J Nepal Med Assoc 2022; 60:962-964. [PMID: 36705182 PMCID: PMC9795094 DOI: 10.31729/jnma.7307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/05/2022] [Indexed: 11/06/2022] Open
Abstract
Anti-N-methyl-D-aspartate receptor encephalitis is a form of autoimmune encephalitis with acute or subacute neuropsychiatric symptoms. Despite this fact, due to a couple of factors, this condition remains insufficiently acknowledged and is an under-recognised clinical scenario. We describe a case of a patient presenting with fever, headache and altered sensorium along with a history of disorientation, episodes of abnormal body movements and loss of consciousness in the later phase. She was initially thought to have Status epilepticus with tuberculous meningoencephalitis but her cognitive functions did not improve despite appropriate treatment. She displayed features away from the usual course of disease leading to suspicions of Autoimmune Encephalitis and Anti-N-methyl- D-aspartate receptor reports later confirmed the diagnosis. Methylprednisolone and Intravenous Immunoglobulin was started empirically and she was discharged in stable health with stabilised emotional and cognitive function with Azathioprine and Levetiracetam continued. Our findings suggested early diagnosis and prompt immunotherapy treatment beneficial for the outcome. Keywords ase reports; encephalitis; immunotherapy; methylprednisolone.
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Affiliation(s)
- Bikash Yadav
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal,Correspondence: Mr Bikash Yadav, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal. , Phone: +977-9813058483
| | - Dhiraj Chaurasia
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Abhiyan Kharel
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Krishna Dhungana
- Department of Neuromedicine, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
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Facer L, Pham T, Rogers D. Lost in descent: Complications of cryptorchidism. Radiol Case Rep 2022; 18:161-168. [PMID: 36345463 PMCID: PMC9636006 DOI: 10.1016/j.radcr.2022.10.022] [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: 10/02/2022] [Accepted: 10/06/2022] [Indexed: 11/23/2022] Open
Abstract
Cryptorchidism is a relatively common and important clinical entity and can lead to an array of downstream complications if it is not corrected in a timely manner, most notably with the development of testicular germ cell tumors. However, beyond the development of malignancy, there are other rare complications associated with cryptorchid testicular germ cell tumors which are more commonly seen in females with ovarian germ cell tumors, including torsion, rupture, and paraneoplastic syndromes. Presented is an instructive case (with literature review) of a patient who presented with NMDA encephalitis due to a torsed mixed germ cell tumor of an undescended testis, which subsequently ruptured leading to growing teratoma syndrome.
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Affiliation(s)
- Lauren Facer
- Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, 1A081, Salt Lake City, UT 84132, USA
| | - Theresa Pham
- Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, 1A081, Salt Lake City, UT 84132, USA
| | - Douglas Rogers
- Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, 1A081, Salt Lake City, UT 84132, USA,Department of Abdominal Imaging, University of Utah, Salt Lake City, UT, USA,Corresponding author.
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5
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NMDA Autoimmune Encephalitis and Severe Persistent Hypokalemia in a Pregnant Woman. Brain Sci 2022; 12:brainsci12020221. [PMID: 35203984 PMCID: PMC8869825 DOI: 10.3390/brainsci12020221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/28/2022] [Accepted: 02/02/2022] [Indexed: 12/10/2022] Open
Abstract
Introduction: For more than a decade, NMDAR autoimmune encephalitis has been studied and treated as a neurological condition, and good results have been achieve through immune therapies. Apart from being well represented in the CNS, NMDA receptors are currently known of and being studied in multiple non-neuronal cells with potential clinical significance. The association of NMDAR autoimmune encephalitis with pregnancy is rare, and hypokalemia is not mentioned. Methods: We present the case of a 30-year-old woman with NMDAR autoimmune encephalitis in her 17th week of pregnancy associated with persistent hypokalemia that had no apparent cause and resisted Kalium chloride supplementation. A diagnostic work-up including clinical, laboratory, and imagistic examinations, was performed. The case was monitored between May and September 2016 at Neurology, SCJUT. Results: Severe hypokalemia with normal serum sodium levels persisted throughout the course of clinical manifestation of anti-NMDAR autoimmune encephalitis. Conclusions: NMDAR autoimmune encephalitis is under-diagnosed in its atypical clinical variants, and this disease’s association with hypokalemia is not mentioned in the literature. Still, it is of clinical importance because it attests to the implications of other organs/systems in the general autoimmune process of NMDAR encephalitis, and it might change the way we address certain psychiatric disorders by searching underlying organic conditions.
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6
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Anti-NMDA Receptor Encephalitis: A Challenge in Psychiatric Settings. J Psychiatr Pract 2022; 28:78-83. [PMID: 34989350 DOI: 10.1097/pra.0000000000000602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis is a condition that was only identified relatively recently. It often presents in psychiatric settings, with clinical presentations that may overlap with those of other psychiatric disorders such as psychoses secondary to schizophrenia, substance use, or brief delusional disorder. It often presents in women of child bearing age and has a relatively high mortality rate. The treatment approach for anti-NMDA receptor encephalitis is considerably different from that used for other psychiatric and neurological conditions. Early recognition, correct diagnosis, and appropriate management of the condition are of vital importance to the prognosis, including reducing mortality rate, admissions to intensive care units, recurrence, complications of the disease and in some cases, irreversible hippocampal damage. We present a case that highlights the typical presentation of anti-NMDA receptor encephalitis in a young woman and discuss management and outcome.
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7
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Gomez DF, Gomez JM, Jaramillo-Velasquez D, Hakim F, Pedraza C, Reyes E. The first recorded case of herpes simplex virus encephalitis followed by anti-NMDA receptor autoimmune encephalitis after resection of meningioma. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101046] [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] Open
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8
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Subeh GK, Lajber M, Patel T, Mostafa JA. Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Detailed Review of the Different Psychiatric Presentations and Red Flags to Look for in Suspected Cases. Cureus 2021; 13:e15188. [PMID: 34178509 PMCID: PMC8225684 DOI: 10.7759/cureus.15188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Anti-N-methyl-D-aspartate receptor encephalitis is a rare autoimmune disorder that involves N-methyl-D-aspartate (NMDA) receptors. It is the most common autoimmune encephalitis, and early detection and treatment are crucial for morbidity-free recovery. Distinguishing this disorder from a primary psychiatric illness is quite challenging as this disorder classically presents with psychiatric manifestations that often resemble schizophrenic psychosis. Therefore, this review intended to scope the psychiatric manifestations this disorder could present with and dissect how they differ from primary psychiatric disorders. A PubMed database search was done. The results yielded were analyzed; eventually, 50 papers were used to review the different signs and symptoms the disease can present with, including common and rare disease presentations. Diagnostic challenges and helpful clinical clues to recognize the disorder were reviewed as well.
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Affiliation(s)
- Ghasaq K Subeh
- College of Medicine, University of Baghdad, Baghdad, IRQ.,Internal Medicine, Al-Karama Teaching Hospital, Baghdad, IRQ.,Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mehreen Lajber
- Medical Education, Bacha Khan Medical College, Mardan, PAK.,Medical Education, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Talha Patel
- Emergency Department, East Lancashire Hospitals NHS Trust, Blackburn, GBR.,Emergency, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Jihan A Mostafa
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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9
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Das M, Patra AK, Chakravarty PJ. Nonparaneoplastic anti-NMDA receptor autoimmune encephalitis presenting as psychosis: A case report. Indian J Psychiatry 2021; 63:209-210. [PMID: 34194074 PMCID: PMC8214117 DOI: 10.4103/psychiatry.indianjpsychiatry_63_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/08/2020] [Accepted: 04/17/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Marami Das
- Department of Neurology, Gauhati Medical College, Guwahati, Assam, India
| | - Anil Kumar Patra
- Department of Neurology, Gauhati Medical College, Guwahati, Assam, India
| | - Pranjal Jyoti Chakravarty
- Department of Psychiatry, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India. E-mail:
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10
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Naguy A, Moodliar-Rensburg S, Alamiri B. Autoimmune encephalitis- A new psychiatric masquerader! Asian J Psychiatr 2020; 54:102253. [PMID: 32634710 DOI: 10.1016/j.ajp.2020.102253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Ahmed Naguy
- Al-Manara CAP Centre, Kuwait Centre for Mental, Health (KCMH), Jamal Abdul-Nassir St, Shuwaikh, Kuwait.
| | - Seshni Moodliar-Rensburg
- Learning Disability Milton Keynes University Hospital, Milton Keynes, Buckinghamshire, United Kingdom
| | - Bibi Alamiri
- KCMH, Kuwait; Tufts University, Medford, United States
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11
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Miyagi H, Le C, Dennis M, Crispen P. A case of anti-N-methyl-D-aspartate receptor encephalitis in renal-cell carcinoma. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820961905] [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]
Affiliation(s)
| | - Candie Le
- Department of Urology, University of Florida, USA
| | | | - Paul Crispen
- Department of Urology, University of Florida, USA
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12
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Khoodoruth MAS, Chut-Kai Khoodoruth WN, Alshawwaf MKM. Anti- N-methyl-D-aspartate receptor encephalitis in a young female with subclinical hypothyroidism associated with anti-thyroid peroxidase and anti-thyroglobulin antibodies: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20949780. [PMID: 32913651 PMCID: PMC7443984 DOI: 10.1177/2050313x20949780] [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: 04/07/2020] [Accepted: 07/20/2020] [Indexed: 01/02/2023] Open
Abstract
Anti-N-methyl-D-aspartate receptor encephalitis is a
life-threatening medical emergency that can be clinically misperceived as
Hashimoto’s encephalopathy. We present a case of
anti-N-methyl-D-aspartate receptor encephalitis in an otherwise
healthy young female with subclinical hypothyroidism without an associated
ovarian teratoma. She was first misdiagnosed as Hashimoto’s encephalopathy due
to delirium and behavioral changes, seizures, psychosis, and increased amount of
thyroid peroxidase and thyroglobulin antibodies in serum. Final diagnosis was
established by third week following presentation with the detection of
anti-N-methyl-D-aspartate receptor antibodies in her
cerebrospinal fluid. After treatment with intravenous immunoglobulin,
methylprednisolone, and amisulpride, she recovered significantly with minimal
sequelae at 3-week follow-up.
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13
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Alkayali T, Bell S, Bass C, Lattanzio N, Kraitman N. Not Your Average Seizure: A Case of N-Methyl-D-Aspartate Receptor Encephalitis and Review of Literature. Cureus 2020; 12:e9068. [PMID: 32714709 PMCID: PMC7377656 DOI: 10.7759/cureus.9068] [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] [Indexed: 11/17/2022] Open
Abstract
Encephalitis is an inflammatory process of the brain that is most commonly related to infectious etiology; nonetheless, autoimmune encephalitis has been an increasingly identified entity that can cause it as well and should be considered. N-methyl-D-aspartate (NMDA) receptor encephalitis is a recently identified process but remains less recognized than autoimmune encephalitis. We report a case of an 18-year old female who initially presented with seizures and later developed behavioral symptoms of agitation, crying, screaming, and emotional lability. Ultimately, she was found to have NMDA receptor encephalitis related to ovarian paraneoplastic teratoma. The patient was treated with anti-epileptics and intravenous immunoglobulin and underwent oophorectomy that lead to her recovery. This case highlights the importance of early recognition of NMDA receptor encephalitis to facilitate appropriate investigations and management.
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