Viral Encephalitis: Etiology, Clinical Features, Diagnosis and Management

Ferrari, Sergio; Toniolo, Antonio; Monaco, Salvatore; Luciani, Filippo; Cainelli, Francesca; Baj, Andreina; Temesgen, Zelalem; Vento, Sandro

doi:10.2174/1874279300903010001

Cited by 15 publications

(20 citation statements)

References 112 publications

(79 reference statements)

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“…20 A high mortality rate (19.3%) has been reported from Taiwan in children below 5 years of age. 21 Besides EV 71, there are reports of other EVs as a cause of encephalitis from various parts of the world. In a prospective study conducted in south India, 4.7% patients with a clinical signs of acute encephalitis syndrome (AES) were positive for EV 75.…”

Section: Epidemiologymentioning

confidence: 99%

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Enteroviral encephalitis in children: clinical features, pathophysiology, and treatment advances

Jain

Patel

Bhatt

2014

Pathogens and Global Health

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Enteroviruses (EVs) have emerged as one of the important etiological agents as a causative organism for encephalitis, especially in children and adults. After the first report of EV encephalitis cases in 1950s, there have been increasing reports of regular outbreaks of EV encephalitis worldwide. Enteroviruses are RNA viruses of the family Picornaviridae that consists of more than 100 serotypes, which are characterized by a single positive-strand genomic RNA. The clinical features are pleomorphic and can be accompanied by mucocutaneous manifestations or isolated encephalitis only. The incidence of encephalitis in EV infection is reported to be about 3% and is associated with high mortality and morbidity. A number of newer therapeutic agents have been used in EV encephalitis with variable results. This review will focus on clinical features, pathophysiology, and newer treatment modality in EV encephalitis.

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Section: Epidemiologymentioning

confidence: 99%

“…16 Unfavorable outcomes (death or neurological sequelae) of enteroviral encephalitis have been associated with younger age (,4 years), high peak leukocyte counts (.13 000/mm 3 ), seizures, skin rash, myoclonic jerks, lower CSF viral yield rate, and EV 71 infection. 21 …”

mentioning

confidence: 99%

Enteroviral encephalitis in children: clinical features, pathophysiology, and treatment advances

Jain

Patel

Bhatt

2014

Pathogens and Global Health

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“…This condition is usually caused by bacteria or viruses. HSV-1, VZV, EBV, HIV are often cause of enchepalitis [8]. In developing countries-like Indonesia, children acquired the infection in the first years of life.…”

Section: Discussionmentioning

confidence: 99%

“…Viruses reach CNS through neuronal or hematogenous paths [9]. Pathological finding can be seen in acute condition of viral encephalitis, there are infiltration of mononuclear inflammatory cells in the meningens surrounding the wall of vessels [8]. Clinical presentation of EBV meningoencephalitis includes fever, headaches, altered consciousness, meningeal signs, fever, seizure and bizarre behavior [5,10,11].…”

Section: Discussionmentioning

confidence: 99%

Meningoencephalitis Caused by Epstein-barr Virus in Adult with Lung Tuberculosis

Widayanti¹,

Tjoa²,

Tasia³

et al. 2017

JNSK

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Epstein-Barr virus (EBV) infections usually cause mild symptoms and resolves spontaneously, however the virus may cause severe complications such as neurological diseases, malignant diseases and myocarditis. Determining a diagnosis requires molecular, serological and imaging procedures. The therapeutic modalities for EBV-related severe organ damage including central nervous system manifestations are still uncertain. We report a 31-year-old man with lung tuberculosis with EBV meningoencephalitis presenting with prolonged fever and altered consciousness. Cranial imaging was consistent with meningoencephalitis characteristics. The diagnosis was made by EBV-DNA amplification in cerebrospinal fluid samples. In this case report, we aim to describe a meningoencephalitis caused by EBV in adult with underlying other organ infection.have antibodies to the virus [1,2]. Central nervous system (CNS) involvement in primary EBV infection in adults is rare, with less than 8% of cases found. EBV was found as a causative agent in 2 to 5% of viral encephalitis and meningitis cases [3].Involvement of EBV in CNS includes encephalitis, meningitis, cerebellitis, myelitis, plexitis and acute disseminated encephalomyelitis [2,[4][5][6]. This case report aims to describe a patient with lung tuberculosis showing symptoms and signs of meningoencephalitis caused by EBV. Case ReportA 31-year-old man was admitted to the emergency room with a history of unconsciousness since the day before admission. He previously had 6 days of fluctuating fever and headache. The patient had some behavioral changes since six days before admission such as deliriousness, incoherence and anxiousness. There were involuntary movements in both his hands. He was diagnosed with miliary type lung tuberculosis (TB) 3 months ago. He was given a regimen of antituberculosis drugs which he consumed for only two months before stopping for one month.On admission, he was sopor (Glasgow Coma Scale E2M5V2) and his vital signs recorded were blood pressure 110/70 mmHg, heart rate 70x/minute, respiratory rate 32x/minute, and temperature 37oC. There was crackles in right lung examination. In the neurologic examination there was nuchal rigidity, positive Kernig sign, hemiparesis in right extremities, and positive Babinski sign.Initial investigations including hematologic, liver function, renal function and random plasma glucose did not show any abnormalities, except for a decrease in serum sodium 123 mmol/L. Anti-HIV test was negative, with normal CD4 count, CD 8 count and CD4:CD8 ratio. Serology test for syphilis were normal. Blood culture was negative for bacteria.The chest X-ray revealed no abnormality at this admission. Contrast-enhanced CT scan conducted on admission was consistent with meningoencephalitis characteristics and hydrocephalus sign was noted. He was diagnosed with TB meningoencephalitis and lung tuberculosis with history incompliance to TB therapy. He was treated with ceftriaxone, the same antituberculosis drug regimen and dexamethasone therapy with tapering...

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“…The common agents of viral encephalitis include herpes simplex virus 1, varicella zoster virus, EV, Epstein-Barr virus, human herpesvirus 6, and measles virus3536. However, an etiological diagnosis was reached in less than 50% of the cases despite the use of modern microbiological and radiological methods3537. The list of uncommonly observed etiological agents for pediatric encephalitis remained far from complete.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and genetic characteristics of Saffold cardiovirus in China from 2009 to 2012

Zhang

et al. 2015

Sci Rep

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The epidemiology and clinical features of the Saffold cardiovirus (SAFV) remain ambiguous. The present study was designed to systematically and intensively investigate the epidemiological features of SAFV in pediatric patients in China. Three cohorts of pediatric patients were recruited from 2009 to 2012. Cohort 1 comprised patients with acute respiratory tract infections. Cohort 2 comprised patients with diarrhea. Cohort 3 comprised hand, foot, and mouth disease (HFMD) patients. A total of 115 patients (1.6%) among 6052 (17/1647, 12/2013, and 86/2392 in cohorts 1, 2, and 3, respectively) were SAFV-positive. The samples from 82 SAFV-positive patients were successfully sequenced, and four genotypes were identified: 8 SAFV-1, 41 SAFV-2, 29 SAFV-3, and 4 SAFV-6. A significantly higher detection rate was found in the HFMD patients than in other two cohorts (both P <0.001). A higher frequency of severe clinical outcome and nervous system manifestation were also observed in the SAFV-positive HFMD patients. Additionally, 6 (3.5%) cerebrospinal fluid and 7 (2.2%) serum samples from the HFMD-associated encephalitis patients were SAFV-positive. Based on the VP1 sequences, all four genotypes displayed distinct geographical clustering. SAFV infection might be associated with a wide clinical spectrum and contribute to HFMD.

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Viral Encephalitis: Etiology, Clinical Features, Diagnosis and Management

Cited by 15 publications

References 112 publications

Enteroviral encephalitis in children: clinical features, pathophysiology, and treatment advances

Enteroviral encephalitis in children: clinical features, pathophysiology, and treatment advances

Meningoencephalitis Caused by Epstein-barr Virus in Adult with Lung Tuberculosis

Prevalence and genetic characteristics of Saffold cardiovirus in China from 2009 to 2012

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