Herpesvirus Infections of the Nervous System

Abstract

PURPOSE OF REVIEW This article reviews the spectrum of neurologic disease associated with human herpesvirus infections. RECENT FINDINGS As more patients are becoming therapeutically immunosuppressed, human herpesvirus infections are increasingly common. Historically, infections with human herpesviruses were described as temporal lobe encephalitis caused by herpes simplex virus type 1 or type 2. More recently, however, additional pathogens, such as varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, and human herpesvirus 6 have been identified to cause serious neurologic infections. As literature emerges, clinical presentations of herpesvirus infections have taken on many new forms, becoming heterogeneous and involving nearly every location along the neuraxis. Advanced diagnostic methods are now available for each specific pathogen in the herpesvirus family. As data emerge on viral resistance to conventional therapies, newer antiviral medications must be considered. SUMMARY Infections from the herpesvirus family can have devastating neurologic outcomes without prompt and appropriate treatment. Clinical recognition of symptoms and appropriate advanced testing are necessary to correctly identify the infectious etiology. Knowledge of secondary neurologic complications of disease is equally important to prevent additional morbidity and mortality. This article discusses infections of the central and peripheral nervous systems caused by herpes simplex virus type 1 and type 2, varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, and human herpesvirus 6. The pathophysiology, epidemiology, clinical presentations of disease, diagnostic investigations, imaging characteristics, and treatment for each infectious etiology are discussed in detail.

Infekcinio encefalito diagnostika ir gydymas imunosupresinių būklių metu: klinikinio atvejo pristatymas ir literatūros apžvalga

“…posttransplantation acute limbic en ceph a li tis, PALE), ypaè per pir màsias tris gy dy mo sa vai tes. Bû din gi kli ni ki niai HHV-6 sukel to lim bi nio en ce fa li to simp to mai yra an te rog ra di në amne zi ja ir trau ku li në bûk lë [26]. MRT vaiz duo se ma to mi hipe rin ten si niai sig na lai T2 se ko je kak ti niø ar mo me ni niø skil èiø bal to jo je me dþia go je bei smil ki ni niø sri èiø ir lim binës sis te mos struk tû rø ede ma [8].…”

“…Ne pai sant ne igia mo PGR ty ri mo, esant bû din gai HSV encefalito kli nikai ir vaiz di niams ty ri mams, gy dy mas acik lo vi ru tu rë tø bû ti tae sia mas, o juos me ni në punk ci ja ir lik vo ro PGR ty rimas pa kar to ti ket vir tà li gos die nà [42,43]. Stan dar ti në HSV encefalito gy dy mo acik lo vi ru truk më yra 14-21 diena, ta èiau imu no sup re si niams li go niams gy dy mà ga li ma taes ti at si þvel giant á kli ni ki ná at sa kà ir la bo ra to ri nius duome nis [26,42]. Nors li te ra tû ro je yra duo me nø, kad kor ti -kos te roi dai ga li bû ti su si jae su di des niu ið gy ve na mu mu, vis dël to jø sky ri mas HSV encefalito me tu ið lie ka prieð ta ringas dël ran do mi zuo tø kli ni ki niø ty ri mø trû ku mo.…”

“…de ri niu [44]. CMV en ce fa li to gy dy mas ðiuo de riniu yra efek ty ves nis nei fos kar ne to ar gan cik lo vi ro sky rimas at ski rai, ta èiau svar bu pa brëþ ti, kad toks gy dy mas pasi þy mi di de liu tok sið ku mu, taip pat trûks ta kli ni ki niø ty rimø CMV en ce fa li to gy dy mo efek ty vu mui áro dy ti [25,26].…”

“…Lim bi ná en ce fa li tà siû lo ma gy dy ti gan cik lo vi ro in fu zi ja, ku rio pra di në do zë -5 mg/kg kas 12 val., pa lai ko mo ji -5 mg/kg/d., ar ba fos kar ne to in fuzi ja, ku rio pra di në do zë -60 mg/kg kas 8 val., pa lai ko moji -90-120 mg/kg/d. ; gy dy mas tae sia mas 14-21 die nà, taèiau ga li bû ti ir pra taes tas, at si þvel giant á kli ni ki ná at sa kà bei la bo ra to ri nius duo me nis [26]. Li te ra tû ros duo me ni mis, didë ja HHV-6 at spa ru mas gan cik lo vi rui.…”

“…Li te ra tû ros duo me ni mis, didë ja HHV-6 at spa ru mas gan cik lo vi rui. Esant ne efek tyviam gy dy mui gan cik lo vi ru, re ko men duo ja ma HHV-6 sukel tà en ce fa li tà gy dy ti fos kar ne tu [26,45].…”