Cytomegalovirus encephalitis in a non-immunocompromised patient: CSF diagnosis by<i>in situ</i>hybridization cells

Pantoni, Leonardo; Inzitari, Domenico; Colao, Maria Grazia; Mayo, Eugenia; Marini, P.; F, Mazzota

doi:10.1111/j.1600-0404.1991.tb04903.x

Cited by 27 publications

(15 citation statements)

References 9 publications

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“…In fact, both cases are lethal, in spite of their specific antiviral therapy, ganciclovir and acyclovir [25, 26]. On the contrary, the prognosis of the first group is very favourable, both in the cases treated with antiviral drugs, adenine arabinoside, ganciclovir and acyclovir [5, 6, 8, 11, 17, 26, 27, 28], and in those cases not treated with antiviral drugs [6, 29]. In fact, only 3 cases out of 14 presented some sequelae.…”

Section: Discussionmentioning

confidence: 99%

“…Focal neurological syndromes appear to be more typical in healthy adults [6]. In immunocompetent hosts, the diagnosis of a CMV-related neurologic syndrome is generally based on direct evidence from the CSF, virus isolation, positive PCR [6, 14, 15, 16], demonstration of CMV DNA by in situ hybridization of CSF cells [17]and specific intrathecal antibody production [16]. Seroconversion may be used to diagnose primary infection in immunocompetent patients [16].…”

Section: Discussionmentioning

confidence: 99%

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Cytomegalovirus Meningoencephalitis with Paroxysmal Course in Immunocompetent Adults: A New Nosographical Entity

Devetag¹,

Boscariolo²

2000

Eur Neurol

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An immunocompetent adult developed cytomegalovirus (CMV) meningoencephalitis with paroxysmal neurologic symptoms of a self-limited nature and with a favourable outcome. Consistent with known cases in the clinical literature, two clinical forms of CMV meningoencephalitis will be identified: a monophasic form and a paroxysmal form. The clinical, diagnostic and therapeutic aspects of the two types will be analysed, and a pathogenetic hypothesis for the paroxysmal type will be proposed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus Meningoencephalitis with Paroxysmal Course in Immunocompetent Adults: A New Nosographical Entity

Devetag¹,

Boscariolo²

2000

Eur Neurol

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“…Algunos de ellos antes de conocerse la infección por VIH 1,[6][7][8][9][10][11] . Han sido descritos diferentes patrones clínicos siendo el predominante un cuadro rápidamente progresivo de fiebre, cefaleas, trastornos de conciencia de grado variable, constatándose en algunos, déficits focales neurológicos, crisis epilépticas o sindrome meníngeo.…”

Section: Discusionunclassified

“…El compromiso del sistema nervioso central (SNC) por CMV en adultos inmunocompetentes es excepcional existiendo pocas referencias en la literatura, menos aún con comprobación anátomo-patológica de la enfermedad 1,[6][7][8][9][10][11] .…”

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Encefalitis a citomegalovirus en un paciente inmunocompetente: análisis clinico, neuropatologico y ultraestructural

Salamano

Gervaz

Mañana

et al. 2001

Arq. Neuro-Psiquiatr.

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RESUMEN -Las encefalitis por citomegalovirus en pacientes inmunocompetentes son excepcionales, siendo un patógeno reconocido en pacientes inmunodeprimidos (SIDA, transplantados). Se reporta el caso clínico de una encefalitis por Citomegalovirus en un adulto joven, sin evidencia de enfermedad inmunosupresora, cuyo diagnóstico fue posible mediante la detección de ADN viral en la biopsia cerebral. Se describen además las singularidades clínicas de este caso y los hallazgos de la anatomía patológica y de la microscopía electrónica comparándolos con los reportados en pacientes inmunodeprimidos.PALABRAS LLAVES: encefalitis, citomegalovirus, inmunocompetencia, infecciones del sistema nervioso central. Cytomegalovirus encephalitis in an immunocompetent patient: clinical, neuropathological and ultrastructural analysisABSTRACT -Cytomegalovirus encephalitis is rarely diagnosed in immunocompetent patients. It is more frequent among immunocompromised hosts. We present a case of a young male patient without evidence of immunosupression who had a cytomegalovirus encephalitis. The diagnosis was made by detection of viral DNA in cerebral tissue obtained by biopsy. Neuropathologic and ultrastructural changes are described and compared with the descriptions in immunocompromised patients.

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“…Histologically, CMV meningoencephalitis may present as microglial nodules (22,25,31), necrosis of parenchyma (31), and hemorrhagic vasculitis (16). Spinal cord involvement may manifest as necrotizing myelopathy with perifocal demyelination (31) or as meningoradiculitis with vascular involvement (2,8,31), both causing ascending paralysis and loss of sensitivity.…”

mentioning

confidence: 99%

Foscarnet penetrates the blood-brain barrier: rationale for therapy of cytomegalovirus encephalitis

Hengge¹,

Brockmeyer²,

Maleßa³

et al. 1993

Antimicrob Agents Chemother

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Foscarnet (phosphonoformate) is a potent virustatic drug against herpes-like viruses and is widely used in the therapy of cytomegalovirus infections in immunosuppressed patients. To obtain data on its penetration across the blood-brain barrier, we determined concentrations of foscarnet in cerebrospinal fluid and in plasma specimens from 26 patients with human immunodeficiency virus (stages 2 to 6 by Walter Reed Army Institute of Research classification) after a single infusion of 90 mg of foscarnet per kg of body weight and at steady state by electrochemical detection by high-pressure liquid chromatography. Penetration coefficients were correlated with the integrity of the blood-brain barrier. After a single infusion of foscarnet, levels in plasma ranged from 297 to 1,775 ,i.g/ml (990 to 5,920 ,umol/liter), with a mean of 766 + 400 ,ug/ml. Corresponding levels in cerebrospinal fluid were 57 to 225 ,ug/ml (190 to 750 ,umol/liter), with a mean of 131 + 52 ,ug/ml. The penetration coefficient was 0.05 to 0.72 (mean, 0.23 + 0.16). At steady state, mean foscarnet levels in plasma were 464 + 219 ,ug/ml (1,553 ,umollliter) and mean levels in cerebrospinal fluid were 308 ± 155 ,ug/ml (1,023 ,umol/liter). The penetration coefficient was 0.66 ± 0.11. Although penetration coefficients were highly variable after a single administration and at steady state, the concentrations of foscarnet attained in cerebrospinal fluid are sufficient for complete inhibition of cytomegalovirus replication in vitro. In conclusion, we show that foscarnet seems to be the drug of choice for the treatment of cytomegalovirus encephalitis, because it penetrates the blood-brain barrier and is found in the cerebrospinal fluid in virustatic concentrations. Foscarnet might be considered for additive therapy for human immunodeficiency virus encephalitis in combination with zidovudine or dideoxyinosine.

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Cytomegalovirus encephalitis in a non-immunocompromised patient: CSF diagnosis byin situhybridization cells

Cited by 27 publications

References 9 publications

Cytomegalovirus Meningoencephalitis with Paroxysmal Course in Immunocompetent Adults: A New Nosographical Entity

Cytomegalovirus Meningoencephalitis with Paroxysmal Course in Immunocompetent Adults: A New Nosographical Entity

Encefalitis a citomegalovirus en un paciente inmunocompetente: análisis clinico, neuropatologico y ultraestructural

Foscarnet penetrates the blood-brain barrier: rationale for therapy of cytomegalovirus encephalitis

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