Incidence and pathogenesis of clinical relapse after herpes simplex encephalitis in adults

Sköldenberg, Birgit; Aurelius, Elisabeth; Hjalmarsson, Anders; Sabri, Farideh; Forsgren, Marianne; Andersson, Birger; Linde, Annika; Strannegård, Örjan; Studahl, Marie; Hagberg, Lars; Rosengren, Lars

doi:10.1007/s00415-005-0941-6

Cited by 139 publications

(118 citation statements)

References 39 publications

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“…prolonged group are also in accordance with the conventional predictors of poor outcome for HSVE (2,4,5 (3,(7)(8)(9)(10)(11)(12)(13)(14)(15). In the previous studies, the frequency of relapse after HSVE ranged from 5% to 26% (8)(9)(10) (15).…”

Section: Both (Patients 16 19 22 and 23) Of These 8 Patients 2 (supporting

confidence: 83%

“…In the previous studies, the frequency of relapse after HSVE ranged from 5% to 26% (8)(9)(10) (15). According to these studies, a low initial dose of ACV has been reported to be frequently associated with HSVE relapse (9,15).…”

Section: Both (Patients 16 19 22 and 23) Of These 8 Patients 2 (mentioning

confidence: 96%

“…(2,(4)(5)(6). Management (7)(8)(9)(10) and adult patients (3,(11)(12)(13)(14)(15) 1 m 74 0 2 6 52 33 None 0 1 1 1 2 2 m 19 0 10 7 149 120 None 0 1 1 1 Extend ACV indicates extension of the duration of ACV administration. T a b l e 2 .…”

Section: Herpes Simplex Virus (Hsv) Is a Human Herpes Virus That Can mentioning

confidence: 99%

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Predictors of a Prolonged Clinical Course in Adult Patients with Herpes Simplex Virus Encephalitis

et al. 2009

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Section: Both (Patients 16 19 22 and 23) Of These 8 Patients 2 (supporting

confidence: 83%

Section: Both (Patients 16 19 22 and 23) Of These 8 Patients 2 (mentioning

confidence: 96%

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Predictors of a Prolonged Clinical Course in Adult Patients with Herpes Simplex Virus Encephalitis

et al. 2009

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“…However, some have reported that although acyclovir can reduce CNS viral titres to undetectable levels, inflammatory markers remain unaffected (Lund-berg et al, 2008). These reports emphasise the urgent need for alternative anti-inflammatory adjuncts to the treatment of viral encephalitis over and above simply suppression of viral replication and viral cytotoxicity (Skoldenberg et al, 2006), especially since the prevalence for some variants of HSV infection is almost 100% in childhood (Caserta et al, 2001;Johnson, 1982). No differences in water maze testing.…”

Section: Discussionmentioning

confidence: 99%

Viral-like brain inflammation during development causes increased seizure susceptibility in adult rats

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Henderson

et al. 2009

Neurobiology of Disease

100

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Viral infections of the CNS and their accompanying inflammation can cause long-term neurological effects, including increased risk for seizures. To examine the effects of CNS inflammation, we infused polyinosinic: polycytidylic acid, intracerebroventricularly to mimic a viral CNS infection in 14 day-old rats. This caused fever and an increase in the pro-inflammatory cytokine, interleukin (IL)-1β in the brain. As young adults, these animals were more susceptible to lithium-pilocarpine and pentylenetetrazol-induced seizures and showed memory deficits in fear conditioning. Whereas there was no alteration in adult hippocampal cytokine levels, we found a marked increase in NMDA (NR2A and C) and AMPA (GluR1) glutamate receptor subunit mRNA expression. The increase in seizure susceptibility, glutamate receptor subunits, and hippocampal IL-1β levels were suppressed by neonatal systemic minocycline. Thus, a novel model of viral CNS inflammation reveals pathophysiological relationships between brain cytokines, glutamate receptors, behaviour and seizures, which can be attenuated by anti-inflammatory agents like minocycline.

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“…An immune-mediated process has long been suspected in this setting. In one study, 32 consecutive adults with CSF PCR-or serology-proven HSVE who were treated with aciclovir or vidarabine were prospectively followed for relapse, which occurred in 4 patients [168]. However, none of these had HSV PCR positivity in the CSF during the apparent relapse, and markers of neural and glial cell damage (including neuron-specific enolase, S-100, and glial fibrillary acidic protein) were markedly lower in the CSF during relapse than on initial presentation.…”

Section: Immune-mediated Encephalitis and Apparent Hsve Relapsementioning

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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Incidence and pathogenesis of clinical relapse after herpes simplex encephalitis in adults

Cited by 139 publications

References 39 publications

Predictors of a Prolonged Clinical Course in Adult Patients with Herpes Simplex Virus Encephalitis

Predictors of a Prolonged Clinical Course in Adult Patients with Herpes Simplex Virus Encephalitis

Viral-like brain inflammation during development causes increased seizure susceptibility in adult rats

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

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