Management of Viral Central Nervous System Infections: A Primer for Clinicians

Bookstaver, P Brandon; Mohorn, Phillip; Shah, Ansal; Tesh, Lauren D; Quidley, April Miller; Kothari, Ravish; Bland, Christopher M.; Weissman, Sharon

doi:10.1177/1179573517703342

Cited by 69 publications

(72 citation statements)

References 100 publications

(196 reference statements)

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“…HSV-1 was found to be the causative agent in 24% of viral encephalitis patients (16/67 cases) in our study, which is in accordance with the previous reports (Granerod et al 2010;George et al 2014;Bookstaver et al 2017;López-Sánchez et al 2017). We also found that the patients with HSV-1 encephalitis were older than patients with non-HSV-1viral encephalitis; while 69% of patients with HSV-1 encephalitis were older than 50 years, this rate was 33% in patients with non-HSV-1 viral encephalitis.…”

Section: Discussionsupporting

confidence: 92%

Hyponatremia Is Predictive of HSV-1 Encephalitis among Patients with Viral Encephalitis

Başaran

Yavuz

Bali

et al. 2019

Tohoku J. Exp. Med.

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Encephalitis is an inflammatory process involving the brain parenchyma associated with neurologic dysfunction. The main causes of infectious encephalitis are viruses, including Herpes simplex virus type 1 (HSV-1). As the mortality rate of HSV-1 encephalitis could be reduced with early acyclovir treatment, it is imperative to distinguish HSV-1 encephalitis from other type of viral encephalitis as early as possible. However, sophisticated methods for definitive diagnosis of HSV-1 encephalitis are not readily available. We aimed to explore distinctive clinical and laboratory features of HSV-1 encephalitis. All of the adult patients with viral encephalitis hospitalized between 2011-2017 were enrolled, including 16 patients with HSV-1 encephalitis and 51 patients non-HSV-1 viral encephalitis. Determination of viruses in cerebrospinal fluid was performed by PCR tests. Female sex, hyponatremia, and abnormalities in MRI were independently associated with HSV-1 encephalitis (p < 0.05 for each). In particular, hyponatremia (< 135 mEq/L) was found in nine patients with HSV-1 encephalitis (56.3%) and 10 patients with non-HSV-1 viral encephalitis (19.6%) (p = 0.005). As serum sodium is determined easily and quickly in clinical practice, the presence of hyponatremia among patients with viral encephalitis could be helpful for the early diagnosis of HSV-1 encephalitis before cerebrospinal fluid PCR results were available. Moreover, the presence of positive finding in MRI could further support the diagnosis. This is the first study that compared the serum sodium levels among patients between HSV-1 and non-HSV-1 viral encephalitis. We thus propose the diagnostic value of hyponatremia for HSV-1 encephalitis.

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Section: Discussionsupporting

confidence: 92%

Hyponatremia Is Predictive of HSV-1 Encephalitis among Patients with Viral Encephalitis

Başaran

Yavuz

Bali

et al. 2019

Tohoku J. Exp. Med.

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“…Including the few examples listed above, more than one hundred infectious agents (much of them being viruses) have been described as potentially encephalitogenic and an increasing number of positive viral identifications are now made with the help of modern molecular diagnostic methods [8,70,[108][109][110]. However, even after almost two decades into the 21st century and despite tremendous advances in clinical microbiology, the precise cause of CNS viral infections often remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Human Coronaviruses and Other Respiratory Viruses: Underestimated Opportunistic Pathogens of the Central Nervous System?

Desforges

Coupanec

Dubeau

et al. 2019

Viruses

929

997

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Respiratory viruses infect the human upper respiratory tract, mostly causing mild diseases. However, in vulnerable populations, such as newborns, infants, the elderly and immune-compromised individuals, these opportunistic pathogens can also affect the lower respiratory tract, causing a more severe disease (e.g., pneumonia). Respiratory viruses can also exacerbate asthma and lead to various types of respiratory distress syndromes. Furthermore, as they can adapt fast and cross the species barrier, some of these pathogens, like influenza A and SARS-CoV, have occasionally caused epidemics or pandemics, and were associated with more serious clinical diseases and even mortality. For a few decades now, data reported in the scientific literature has also demonstrated that several respiratory viruses have neuroinvasive capacities, since they can spread from the respiratory tract to the central nervous system (CNS). Viruses infecting human CNS cells could then cause different types of encephalopathy, including encephalitis, and long-term neurological diseases. Like other well-recognized neuroinvasive human viruses, respiratory viruses may damage the CNS as a result of misdirected host immune responses that could be associated with autoimmunity in susceptible individuals (virus-induced neuro-immunopathology) and/or viral replication, which directly causes damage to CNS cells (virus-induced neuropathology). The etiological agent of several neurological disorders remains unidentified. Opportunistic human respiratory pathogens could be associated with the triggering or the exacerbation of these disorders whose etiology remains poorly understood. Herein, we present a global portrait of some of the most prevalent or emerging human respiratory viruses that have been associated with possible pathogenic processes in CNS infection, with a special emphasis on human coronaviruses.

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“…[61][62][63] In a year, ~10,000 patients suffer from encephalitis caused due to JE. 64,65 Prions causing…”

Section: • Acute Ve • Postinfectious Encephalomyelitis • Slow Viral Imentioning

confidence: 99%

Viral Encephalitis: A Hard Nut to Crack

Shukla

Gangwar

Rastogi

et al. 2019

Annals of the National Academy of Medical Sciences (India)

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Viral encephalitis is inflammation of brain that manifests as neurological complication of viral infections. There are quite a good number of viruses, for example, human herpes virus, Japanese encephalitis, and enteroviruses that can result in such a dreadful condition. Geographical location, age, gender, immune status, and climatic conditions also contribute to the establishment of this disease in an individual. Clinical signs and symptoms include fever, headache, altered level of consciousness, changed mental status, body ache, seizures, nausea, and vomiting. Effective management of this disease relies on timely diagnosis that in turn depends on apt and suitable investigation techniques. Traditional investigations have thinned out these days owing to the fact that advanced molecular technologies have been introduced to the diagnostic field. Treatment of viral encephalitis mainly involves symptomatic relieve from fever, malaise, myalgia along with measures to reduce viral load in the patient. This review mentions about all the possible aspects of viral encephalitis starting from etiology to the management and preventive measures that include immunization and vector control.

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Management of Viral Central Nervous System Infections: A Primer for Clinicians

Cited by 69 publications

References 100 publications

Hyponatremia Is Predictive of HSV-1 Encephalitis among Patients with Viral Encephalitis

Hyponatremia Is Predictive of HSV-1 Encephalitis among Patients with Viral Encephalitis

Human Coronaviruses and Other Respiratory Viruses: Underestimated Opportunistic Pathogens of the Central Nervous System?

Viral Encephalitis: A Hard Nut to Crack

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