Herpes Simplex Encephalitis: From Virus to Therapy

Rozenberg, Flore; Deback, Claire; Agut, Henri

doi:10.2174/187152611795768088

Cited by 66 publications

(53 citation statements)

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“…Although rare (i.e., < 1 % in the immunocompetent), viral resistance to aciclovir has emerged, particularly among patients with immunocompromise [113], and may be encountered in as many as 30 % of patients who have undergone bone marrow transplantation, who appear to be the highest-risk group. Treatment resistance should be considered in patients CCrl Creatinine clearance; PE Phenytoin equivalents; SE Status epilepticus who are not responding as expected to standard treatment, or when there is evidence of clinical worsening, though it can be difficult to determine whether this represents treatment failure or the natural course of the illness.…”

Section: Antiviral Medicationmentioning

confidence: 99%

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

2016

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Herpetic infections have plagued humanity for thousands of years, but only recently have advances in antiviral medications and supportive treatments equipped physicians to combat the most severe manifestations of disease. Prompt recognition and treatment can be lifesaving in the care of patients with herpes simplex-1 virus encephalitis, the most commonly identified cause of sporadic encephalitis worldwide. Clinicians should be able to recognize the clinical signs and symptoms of the infection and familiarize themselves with a rational diagnostic approach and therapeutic modalities, as early recognition and treatment are key to improving outcomes. Clinicians should also be vigilant for the development of acute complications, including cerebral edema and status epilepticus, as well as chronic complications, including the development of autoimmune encephalitis associated with antibodies to the N-methyl-D-aspartate receptor and other neuronal cell surface and synaptic epitopes. Herein, we review the pathophysiology, differential diagnosis, and clinical and radiological features of herpes simplex virus-1 encephalitis in adults, including a discussion of the most common complications and their treatment. While great progress has been made in the treatment of this life-threatening infection, a majority of patients will not return to their previous neurologic baseline, indicating the need for further research efforts aimed at improving the long-term sequelae.

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Section: Antiviral Medicationmentioning

confidence: 99%

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

2016

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“…The severe CNS diseases associated with primary infection in children might be another priority indication, but the data supporting this assumption need to be strengthened. As a general comment, in the case of CNS disease associated with HHV-6 infection, ganciclovir and foscarnet, either alone or in combination, might be preferred over cidofovir, as the ability of the latter drug to penetrate the blood-brain barrier in humans is controversial (225). No study has yet been performed to define the specific dosing and duration of antiviral therapy.…”

Section: Indications and Management Of Clinical Hhv-6 Treatmentsmentioning

confidence: 99%

Laboratory and Clinical Aspects of Human Herpesvirus 6 Infections

2015

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SUMMARY Human herpesvirus 6 (HHV-6) is a widespread betaherpesvirus which is genetically related to human cytomegalovirus (HCMV) and now encompasses two different species: HHV-6A and HHV-6B. HHV-6 exhibits a wide cell tropism in vivo and, like other herpesviruses, induces a lifelong latent infection in humans. As a noticeable difference with respect to other human herpesviruses, genomic HHV-6 DNA is covalently integrated into the subtelomeric region of cell chromosomes (ciHHV-6) in about 1% of the general population. Although it is infrequent, this may be a confounding factor for the diagnosis of active viral infection. The diagnosis of HHV-6 infection is performed by both serologic and direct methods. The most prominent technique is the quantification of viral DNA in blood, other body fluids, and organs by means of real-time PCR. Many active HHV-6 infections, corresponding to primary infections, reactivations, or exogenous reinfections, are asymptomatic. However, the virus may be the cause of serious diseases, particularly in immunocompromised individuals. As emblematic examples of HHV-6 pathogenicity, exanthema subitum, a benign disease of infancy, is associated with primary infection, whereas further virus reactivations can induce severe encephalitis cases, particularly in hematopoietic stem cell transplant recipients. Generally speaking, the formal demonstration of the causative role of HHV-6 in many acute and chronic human diseases is difficult due to the ubiquitous nature of the virus, chronicity of infection, existence of two distinct species, and limitations of current investigational tools. The antiviral compounds ganciclovir, foscarnet, and cidofovir are effective against active HHV-6 infections, but the indications for treatment, as well as the conditions of drug administration, are not formally approved to date. There are still numerous pending questions about HHV-6 which should stimulate future research works on the pathophysiology, diagnosis, and therapy of this remarkable human virus.

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“…Le foetus et le nouveau-né sont aussi des cibles de ce pouvoir pathogène : infection congénitale due à CMV, herpès néona-tal. La pathogenèse de l'encéphalite herpétique à HSV-1, maladie gravissime mais peu fréquente, n'est pas totalement comprise (Rozenberg et al 2011).…”

Section: Symptômes Et Diagnosticunclassified

Herpèsvirus et herpèsviroses humaines

Agut¹

2011

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Les herpèsvirus sont des virus largement répandus dans la biosphère et infectant un très grand nombre d’espèces animales différentes. Ils appartiennent tous à l’ordre des Herpesvirales et aux trois familles Herpesviridae, Alloherpesviridae, et Malacoherpesviridae. Ils partagent de nombreuses propriétés communes : une structure de virus à ADN enveloppé de grande taille, une capacité à persister indéfiniment de façon silencieuse chez leur hôte après la primo-infection et à se réactiver ensuite pour donner à nouveau une infection lytique, l’établissement d’un équilibre vis-à-vis des mécanismes de défense de l’hôte, et la gravité des symptômes quand ces défenses sont amoindries. Les huit herpèsvirus humains sont les virus herpes simplex de type 1 et 2 (HSV-1, HSV-2), le virus de la varicelle et du zona (VZV), le cytomégalovirus (CMV), le virus Epstein-Barr (EBV) et les herpèsvirus humains HHV-6, -7 et -8, ce dernier étant encore appelé herpèsvirus associé à la maladie de Kaposi (KSHV). Le tropisme cellulaire, qu’il s’agisse de la multiplication active ou de l’état de latence, varie selon l’espèce virale et détermine en partie le pouvoir pathogène de ces virus qui ont un comportement opportuniste. Le diagnostic des infections aiguës repose actuellement essentiellement sur la PCR, en particulier les techniques en temps réel permettant un quantification virale. La prévention des infections humaines par la vaccination se limite au VZV. La chimiothérapie antivirale, fondée sur des inhibiteurs de l’ADN polymérase des herpèsvirus, permet de traiter les infections aiguës mais elle n’est pas efficace sur l’infection latente ou en cas de résistance consécutive à la sélection de mutations du génome viral.

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Herpes Simplex Encephalitis: From Virus to Therapy

Cited by 66 publications

References 0 publications

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

Laboratory and Clinical Aspects of Human Herpesvirus 6 Infections

Herpèsvirus et herpèsviroses humaines

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