A Systematic Review on the Role of Adjunctive Corticosteroids in Herpes Simplex Virus Encephalitis: Is Timing Critical for Safety and Efficacy?

Ramos-Estébanez, Ciro; Lizárraga, Karlo J.; Merenda, Amedeo

doi:10.3851/imp2683

Cited by 60 publications

(29 citation statements)

References 58 publications

(116 reference statements)

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“…A retrospective analysis of a larger number of patients with HSE showed that administration of adjunctive glucocorticoids was an independent predictor of a better neurological outcome . Also, a recent review of animal and clinical studies suggests a benefit of adjunctive corticosteroids therapy in HSE . However, clear evidences are still lacking to translate this approach into clinical practice.…”

Section: Immunomodulatory Strategies Against Herpes Simplex Virus Encmentioning

confidence: 99%

Innate immune response during herpes simplex virus encephalitis and development of immunomodulatory strategies

Piret

Boivin

2015

Reviews in Medical Virology

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Herpes simplex viruses are large double-stranded DNA viruses. These viruses have the ability to establish a lifelong latency in sensory ganglia and to invade and replicate in the CNS. Apart from relatively benign mucosal infections, HSV is responsible for severe illnesses including HSV encephalitis (HSE). HSE is the most common cause of sporadic, potentially fatal viral encephalitis in Western countries. If left untreated, the mortality rate associated with HSE is approximately 70%. Despite antiviral therapy, the mortality is still higher than 30%, and almost 60% of surviving individuals develop neurological sequelae. It is suggested that direct virus-related and indirect immune-mediated mechanisms contribute to the damages occurring in the CNS during HSE. In this manuscript, we describe the innate immune response to HSV, the development of HSE in mice knock-out for proteins of the innate immune system as well as inherited deficiencies in key components of the signaling pathways involved in the production of type I interferon that could predispose individuals to develop HSE. Finally, we review several immunomodulatory strategies aimed at modulating the innate immune response at a critical time after infection that were evaluated in mouse models and could be combined with antiviral therapy to improve the prognosis of HSE. In conclusion, the cerebral innate immune response that develops during HSE is a "double-edged sword" as it is critical to control viral replication in the brain early after infection, but, if left uncontrolled, may also result in an exaggerated inflammatory response that could be detrimental to the host.

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Section: Immunomodulatory Strategies Against Herpes Simplex Virus Encmentioning

confidence: 99%

Innate immune response during herpes simplex virus encephalitis and development of immunomodulatory strategies

Piret

Boivin

2015

Reviews in Medical Virology

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“…[24] Corticosteroids Corticosteroids as an adjunct treatment for HSE are still controversial. One study showed that corticosteroids increase patient benefit [25] but they are not routinely recommended [3,16,26] as a large prospective randomised trial is still needed. However, steroid administration is recommended in situations where HSE patients show severe cerebral edema that could result in severe brain swelling, coning and death and lumbar puncture is to be avoided.…”

Section: Antiviral Therapymentioning

confidence: 99%

A review with comments on herpes simplex encephalitis in adults

Zuo¹,

Tang²,

Chen³

2017

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“…Steroids have also been suggested for treatment in HSVE given the strong inflammatory cascade and immune response seen with the infection. Case reports of concomitant or delayed administration of corticosteroids compared with acyclovir alone have showed favorable outcomes, 16 and a randomized trial evaluating their timing and utility is underway (German Trial of Acyclovir and Corticosteroids in Herpes-Simplex-Virus-Encephalitis [GACHE]). 17…”

Section: Treatmentmentioning

confidence: 99%

Infectious Meningitis and Encephalitis

Piquet

Lyons

2016

Semin Neurol

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The clinician who is evaluating a patient with a suspected central nervous system infection often faces a large differential diagnosis. There are several signs, symptoms, geographical clues, and diagnostic testing, such as cerebrospinal fluid abnormalities and magnetic resonance imaging abnormalities, which can be helpful in identifying the etiological agent. By taking a systematic approach, one can often identify life-threatening, common, and/or treatable etiologies. Here the authors describe some of the pearls and pitfalls in diagnosing and treating acute infectious meningitis and encephalitis.

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A Systematic Review on the Role of Adjunctive Corticosteroids in Herpes Simplex Virus Encephalitis: Is Timing Critical for Safety and Efficacy?

Abstract: Experimental and clinical observations suggest a benefit from adjunctive steroid therapy in HSVE. Nevertheless, current evidence is not yet sufficient to endorse this approach as a standard of practice.

Cited by 60 publications

References 58 publications

Innate immune response during herpes simplex virus encephalitis and development of immunomodulatory strategies

Innate immune response during herpes simplex virus encephalitis and development of immunomodulatory strategies

A review with comments on herpes simplex encephalitis in adults

Infectious Meningitis and Encephalitis

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