CNS Diseases Associated with Varicella Zoster Virus and Herpes Simplex Virus Infection: Pathogenesis and Current Therapy

Barnes, David W.; Whitley, Richard J.

doi:10.1016/s0733-8619(18)30998-8

Cited by 82 publications

(62 citation statements)

References 87 publications

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“…Although data on these outcomes are conflicting (11,46,122,134,161) (6). With modern antiviral therapy using acyclovir or vidarabine, mortality has been reduced to 10 to 57%, but up to 86% of the survivors still suffer neurologic sequelae (6).…”

Section: Enterovirusesmentioning

confidence: 99%

“…When it is left untreated, mortality is 70%, with sequelae in the majority of survivors. With acyclovir treatment, mortality is now 13 to 19% and morbidity is 44 to 62% (6). Aseptic meningitis without encephalitis also occurs, typically during primary genital infection with HSV type 2.…”

Section: Enterovirusesmentioning

confidence: 99%

“…The frequency has been reported to be 0.1 to 0.75% in cases of chicken pox. The mortality is low (0.5%), and the majority of children recover completely (6). A less frequent, but more severe complication is postinfectious meningoencephalitis or cerebritis, which is attributable to host response reactions.…”

Section: Enterovirusesmentioning

confidence: 99%

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Role of the virology laboratory in diagnosis and management of patients with central nervous system disease

1989

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A number of viruses cause acute central nervous system disease. The two major clinical presentations are aseptic meningitis and the less common meningoencephalitis. Clinical virology laboratories are now more widely available than a decade ago; they can be operated on a modest scale and can be tailored to the needs of the patients they serve. Most laboratories can provide diagnostic information on diseases caused by enteroviruses, herpesviruses, and human immunodeficiency virus. Antiviral therapy for herpes simplex virus is now available. By providing a rapid diagnostic test or isolation of the virus or both, the virology laboratory plays a direct role in guiding antiviral therapy for patients with herpes simplex encephalitis. Although there is no specific drug available for enteroviruses, attention needs to be paid to these viruses since they are the most common cause of nonbacterial meningitis and the most common pathogens causing hospitalization for suspected sepsis in young infants in the United States during the warm months of the year. When the virology laboratory maximizes the speed of viral detection or isolation, it can make a significant impact on management of these patients. Early viral diagnosis benefits patients with enteroviral meningitis, most of whom are hospitalized and treated for bacterial sepsis or meningitis or both; these patients have the advantage of early withdrawal of antibiotics and intravenous therapy, early hospital discharge, and avoidance of the risks and costs of unnecessary tests and treatment. Enteroviral infection in young infants also is a risk factor for possible long-term sequelae. For compromised patients, the diagnostic information helps in selecting specific immunoglobulin therapy. Good communication between the physician and the laboratory will result in the most benefit to patients with central nervous system viral infection.

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Section: Enterovirusesmentioning

confidence: 99%

Section: Enterovirusesmentioning

confidence: 99%

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Role of the virology laboratory in diagnosis and management of patients with central nervous system disease

1989

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“…Neonatal herpes simplex infections usually demonstrate significant meningeal inflammation, perivascular cellular infiltration and multiple necrotic foci, followed by microglial and astrocytic proliferation. While in older children the limbic and paralimbic cortex are predominantly involved and haemorrhagic necrosis often seen [30], neonatal HSV-infection is rarely haemorrhagic. Temporal and frontal lobes are spared, and lesions can be demonstrated within the deep and periventricular white matter with a variable degree of brain swelling.…”

Section: Viral Infectionmentioning

confidence: 99%

Neonatal brain infections

Schneider

2011

Pediatr Radiol

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Infections of the brain in the neonatal period differ considerably from infections in the older child, due to a variety of age-specific factors that are related not only to the child, but also to the mother, and to specific pathogenic organisms. It has been recognized that clinical and neurological signs are often non-specific, sometimes scarce, and seldom correlate with the extent of neuroimaging findings, thus warranting early imaging to ensure timely therapy and improved outcome.

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“…Primary varicella zoster virus (VZV) infection is associated with complications in the central nervous system (CNS) in 0.1-0.75% of cases (Barnes and Whitley 1986). It has recently been recognized that VZV is a risk factor for arterial ischaemic stroke (AIS) in childhood, especially in the 12 months after clinical chickenpox (Ichiyama et al 1990, Sebire et al 1999.…”

mentioning

confidence: 99%

Post‐varicella intracranial haemorrhage in a child

Danchaivijitr

Miravet

Saunders

et al. 2006

Develop Med Child Neuro

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We report a case of a 7‐month‐old male with primary intracranial haemorrhage 2 months after infection with varicella zoster virus (VZV). His initial clinical course was complicated by seizures and right hemiparesis; when last seen at 22 months the only positive finding was of left hand preference. Although the literature has recently established the association of arterial ischaemic stroke and VZV infection, primary intracranial haemorrhage has been reported only in one case. The child reported here had anterior interhemispheric haemorrhage due to a focal arteritis of the left anterior cerebral artery. The vascular abnormality was transient and had radiological features compatible with either a focal arteritis or vasospasm as a direct result of blood surrounding the vessels. We postulate that direct invasion of VZV caused extensive inflammation of the vessel wall and aggressive tissue penetration resulting in necrotizing angiitis and intracranial haemorrhage. We suggest that VZV infection should be considered a potential risk factor for intracranial haemorrhage in children.

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CNS Diseases Associated with Varicella Zoster Virus and Herpes Simplex Virus Infection: Pathogenesis and Current Therapy

Cited by 82 publications

References 87 publications

Role of the virology laboratory in diagnosis and management of patients with central nervous system disease

Role of the virology laboratory in diagnosis and management of patients with central nervous system disease

Neonatal brain infections

Post‐varicella intracranial haemorrhage in a child

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