acyclovir and Encephalitis--Viral

The aim of this study was to systematically evaluate the efficacy and prognosis of acyclovir combined with naloxone in the treatment of patients with viral encephalitis (VE).. PubMed, Web of Science, Embase, CNKI, and WanFang Data were searched for relevant literature published between 2000 and 2021. Meta-analysis was performed using Stata16.0 software. The treatment group was treated with acyclovir combined with naloxone, and the control group was treated with acyclovir alone.. A total of 12 studies with 986 participants were included. Compared with the control group, the treatment group could not only significantly improve the treatment response rate (OR = 5.53, 95% CI: 3.50, 8.74;. A combination of acyclovir and naloxone can reduce the inflammatory response and shorter the time to symptom relief and disappearance, which is worthy of clinical promotion.

Topics: Acyclovir; Drugs, Chinese Herbal; Encephalitis, Viral; Humans; Naloxone; Prognosis

Central nervous system infection caused by Human Herpesvirus 6 (HHV-6) is well known in immunocompromised; however, data regarding immunocompetent patients is limited to case series. We describe a 29-year-old immunocompetent pregnant woman with meningoencephalitis due to HHV-6 and review current literature. HHV-6 should be kept in mind in patients with meningoencephalitis of unknown etiology.

Topics: Acyclovir; Adult; Ampicillin; Ceftriaxone; Encephalitis, Viral; Female; Herpesvirus 6, Human; Humans; Immunocompetence; Immunocompromised Host; Meningoencephalitis; Pregnancy; Roseolovirus Infections

Topics: Acute Disease; Acyclovir; Antiviral Agents; Brain; Encephalitis, Herpes Simplex; Encephalitis, Viral; Humans; Magnetic Resonance Imaging; Polymerase Chain Reaction

Acute hemicerebellitis, marked by headache with or without cerebellar signs, is a rare clinical entity involving a unilateral cerebellar hemisphere. The pathogenesis of acute hemicerebellitis remains unclear, and the disease rarely occurs in adults. Here, we report an 18-year-old woman who presented with a lack of coordination of the right hand and leg lasting longer than one week, following a pulsatile headache. A neurological examination disclosed ocular dysmetria, right-sided limb ataxia and slight truncal ataxia. Cerebrospinal fluid analysis showed mononuclear pleocytosis. The serology and autoimmune studies were unremarkable. Brain magnetic resonance imaging (MRI) revealed a focal signal change in the right cerebellar hemisphere and vermis. Acute hemicerebellitis was diagnosed, and the patient was treated with intravenous methylprednisolone sodium succinate and acyclovir. Subsequently, the headache resolved, and the cerebellar signs were markedly improved. Twenty days after admission, she became asymptomatic and brain MRI showed resolution of cerebellar hyperintensity on the right side. In conclusion, we identified only 6 additional patients with adult-onset acute hemicerebellitis from previous reports, highlighting the importance of recognizing this rare clinical entity. Its clinical outcome is usually favorable, but in the acute phase, attention should be directed toward clinical symptoms that are suggestive of increased intracranial pressure.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Age of Onset; Antiviral Agents; Cerebellar Diseases; Encephalitis, Viral; Female; Glucocorticoids; Headache; Humans; Intracranial Hypertension; Magnetic Resonance Imaging; Methylprednisolone Hemisuccinate; Treatment Outcome

Herpes zoster infection occurs owing to reactivation of varicella zoster virus and classically manifests as a vesicular eruption involving a single dermatome. Disseminated herpes zoster - defined as having greater than twenty vesicles outside the primary or adjacent dermatome - is uncommon and typically occurs in immunocompromised individuals. Central nervous system complications during or following a zoster outbreak are exceedingly rare. Encephalitis is reported to affect only 0.1-0.2% of patients and occurs more often in disseminated cases and in outbreaks involving those dermatomes in close proximity to the central nervous system. We present an elderly woman with disseminated herpes zoster and altered mental status who was subsequently diagnosed with varicella zoster virus encephalitis and describe the characteristics of patients with disseminated zoster who developed varicella zoster virus encephalitis.

Topics: Acyclovir; Aged; Antiviral Agents; Encephalitis, Viral; Female; Glucocorticoids; Herpes Zoster; Herpesvirus 3, Human; Humans; Prednisone; Virus Activation

Viral encephalitis causes an altered level of consciousness, which may be associated with fever, seizures, focal deficits, CSF pleocytosis, and abnormal neuroimaging. Potential pathogens include HSV, VZV, enterovirus, and in some regions, arboviruses. Autoimmune (eg, anti-NMDA receptor) and paraneoplastic encephalitis are responsible for some cases where no pathogen is identified. Indications for ICU admission include coma, status epilepticus and respiratory failure. Timely initiation of anti-viral therapy is crucial while relevant molecular and serological test results are being performed. Supportive care should be directed at the prevention and treatment of cerebral edema and other physiological derangements which may contribute to secondary neurological injury.

Topics: Acyclovir; Adrenal Cortex Hormones; Anticonvulsants; Antiviral Agents; Brain Diseases; Brain Edema; Consciousness Disorders; Encephalitis; Encephalitis, Viral; Encephalomyelitis, Acute Disseminated; Glasgow Coma Scale; Guillain-Barre Syndrome; Hashimoto Disease; Humans; Intensive Care Units; Paraneoplastic Syndromes, Nervous System; Seizures; Status Epilepticus; Viremia

Encephalitis and postinfectious encephalitis represent two important conditions for the neurologist, both in terms of their presentations as neurologic emergencies and their potential to cause death or serious neurologic impairment. This article reviews the major infectious and noninfectious causes of encephalitis and discusses postinfectious encephalitis as an indirect effect of systemic illness.. Encephalitis caused by herpes simplex virus type 1 and West Nile virus are of major importance. In addition, within the past few years we have gained improved understanding of the neurologic syndromes caused by varicella-zoster virus, the recognition of enterovirus 71 as a significant human pathogen, and the realization that encephalitis may also occur by autoimmune mechanisms requiring immunosuppressive therapy. We have also learned that postinfectious encephalitis may be recurrent rather than monophasic, and that children and adults initially diagnosed with postinfectious encephalitis may later develop classic multiple sclerosis.. Encephalitis and postinfectious encephalitis present as neurologic emergencies requiring prompt diagnosis and initiation of treatment. Important concerns are to identify infectious conditions requiring antibiotic or antiviral therapy and postinfectious or other autoimmune encephalitides requiring immunosuppression.

Topics: Acyclovir; Adolescent; Antiviral Agents; Brain Diseases; Encephalitis; Encephalitis, Herpes Simplex; Encephalitis, Varicella Zoster; Encephalitis, Viral; Enterovirus Infections; Fatal Outcome; Female; Hashimoto Disease; Humans; Leukoencephalitis, Acute Hemorrhagic; Magnetic Resonance Imaging; Male; Middle Aged; West Nile Fever; Young Adult

Topics: Acyclovir; Aphasia; Brain; Encephalitis, Viral; Fever; Herpes Simplex; Humans; Infant; Male; Seizures; Simplexvirus; Tomography, X-Ray Computed; Treatment Outcome; Vomiting

Progressive outer retinal necrosis is a necrotizing herpetic retinopathy usually seen in immunocompromised patients. The authors describe two patients with this disease who initially had findings suggestive of an optic neuropathy. Vision declined after treatment with methylprednisolone, after which fundus examination became consistent with progressive outer retinal necrosis. These cases underscore the importance of careful examination of the retinal periphery before management of any presumed optic neuropathy with steroids.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cytomegalovirus Infections; Cytomegalovirus Retinitis; Diagnostic Errors; Diplopia; Disease Progression; Encephalitis, Viral; Female; Foscarnet; Herpes Zoster; Humans; Magnetic Resonance Imaging; Methylprednisolone; Middle Aged; Necrosis; Optic Neuritis; Paresis; Prednisone; Retina

Topics: Acyclovir; Antiviral Agents; Diagnosis, Differential; Encephalitis, Viral; Herpes Simplex; Humans; Infusions, Intravenous; Japan; Prognosis

Topics: Acyclovir; Antiviral Agents; Diagnostic Imaging; Encephalitis, Viral; Encephalomyelitis, Acute Disseminated; Humans; Limbic Encephalitis; Mental Disorders

A previously healthy 30-year-old woman was admitted to our hospital because of impaired consciousness after convulsion. A temporary diagnosis of herpes simplex encephalitis was made, and intravenous acyclovir (ACV) therapy (250 mg four times daily in normal saline over 2 hours) was started. Three days later, she became confused, and was having hallucinations, dysarthria and generalized painful seizures occurred without focal neurologic deficit. Whether the neuropsychiatric symptoms were related to herpes simplex encephalitis or acyclovir neurotoxity was initially unclear. The brain MRI and lumbar puncture findings were initially normal, but abnormal FLAIR lesions appeared later. ACV-associated encephalopathy was considered. ACV was discontinued, and she recovered from the neurological disorder within 24 hours. Although blood levels of acyclovir were not determined, it is unlikely that they were in a toxic range, in view of her normal renal function.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Brain Diseases; Dysarthria; Encephalitis, Viral; Epilepsy, Generalized; Female; Hallucinations; Humans; Kidney Diseases; Magnetic Resonance Imaging

Herpes simplex encephalitis is one of the most common and serious sporadic encephalitides of immunocompetent adults. Herpes simplex virus 2 (HSV-2) infections of the central nervous system usually manifest as subacute encephalitis, recurrent meningitis, myelitis, and forms resembling psychiatric syndromes.. To report and discuss magnetic resonance imaging (MRI) findings and clinical features in atypical brainstem encephalitis and facial palsy associated with HSV-2.. Neurology department of a tertiary referral center.. A 37-year-old woman was admitted to the hospital with fever, diplopia, left hemiparesis, sensory change in the face and limbs, personality changes, frontal dysexecutive syndrome, and a stiff neck. Brain MRI showed multifocal high-signal intensities in the pons, midbrain, and frontal lobe white matter on T2-weighted and fluid-attenuated inversion recovery images. Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) amplification analysis was positive for HSV-2. Acyclovir therapy was started, and the encephalitic symptoms disappeared with a negative conversion of HSV-2 PCR in the CSF. However, after the discontinuation of acyclovir therapy, peripheral facial palsy occurred on the left side. A possible relapse or delayed manifestation of the HSV-2 infection was suspected, and the acyclovir therapy was restarted. A complete remission was achieved 3 days after the treatment. She was discharged without any neurologic sequelae.. We describe a patient who developed atypical encephalitis due to HSV-2 and peripheral facial palsy, which could also be related to the HSV-2. This case suggests that HSV-2 should be considered among the possible causes of atypical or brainstem encephalitis and that the PCR amplification method of the CSF can help reveal the possible cause of HSV-2.

Topics: Acyclovir; Adult; Antiviral Agents; Bell Palsy; Brain Stem; Cerebrospinal Fluid; Encephalitis, Viral; Female; Herpesviridae Infections; Herpesvirus 2, Human; Humans; Magnetic Resonance Imaging; Polymerase Chain Reaction; Recurrence

Varicella zoster virus (VZV) encephalitis is associated with large or small vessel vasculopathy. We report the case of a 67-year-old woman with a history of non-Hodgkin's lymphoma and cancers of the breast and colon, who presented with a zosteriform rash and Brown-Sequard syndrome. Despite 10 days therapy with intravenous acyclovir, meningoencephalitis developed and the patient died 15 days after onset of neurological symptoms. Autopsy showed meningoencephalomyelitis with necrotising vasculitis of leptomeningeal vessels, which is a rare complication of VZV, and we review the literature of the nine similar published cases. Polymerase chain reaction of cerebrospinal fluid for VZV was negative 6 days after onset of neurological symptoms, but became positive by day 10. Only one multinucleated giant cell with intranuclear Cowdry type A inclusions was seen within an endothelial cell in a leptomeningeal vessel involved by vasculitis.

Topics: Acyclovir; Aged; Antiviral Agents; Brain; Demyelinating Diseases; DNA, Viral; Encephalitis, Viral; Fatal Outcome; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Meningoencephalitis; Polymerase Chain Reaction; Spinal Cord; Vasculitis, Central Nervous System

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Encephalitis, Japanese; Encephalitis, Viral; Herpes Simplex; Humans; Prognosis; Vidarabine

Topics: Acyclovir; Antiviral Agents; Diagnosis, Differential; Encephalitis, Viral; Herpes Zoster; Herpesvirus 3, Human; Humans; Prognosis; Vidarabine

Topics: Acyclovir; Adolescent; Antiviral Agents; Encephalitis, Viral; Female; Herpes Simplex; Humans; Retinal Necrosis Syndrome, Acute

Herpes simplex virus infection of the central nervous system is still a significant cause of morbidity and often mortality. Changes of central nervous system are results of primary infection or activation of latent HSV-1, HSV-2. Neurological deficits often follow encephalitis herpetica. The application of PCR is prompt and specific diagnosis of herpes simplex virus infections of the brain. Advances in treatment herpes simplex encephalitis with acyclovir have improved outcome.

Topics: Acyclovir; Adult; Antiviral Agents; Brain; Encephalitis, Viral; Female; Humans; Magnetic Resonance Imaging; Simplexvirus

Herpes zoster leukoencephalitis is a rare complication of varicella-zoster virus infection. Associated with high mortality, the majority of cases have been discovered postmortem; today, however, magnetic resonance imaging is being used successfully as an aid in the diagnosis of this disease. The first two reported cases of HIV-infected patients with herpes zoster leukoencephalitis who recovered clinically and showed complete resolution of the magnetic resonance demyelination images after acyclovir treatment are described. In addition, the cases of herpes zoster leukoencephalitis reported in the literature to date are reviewed.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Encephalitis, Viral; Herpes Zoster; Humans; Male

Topics: Acyclovir; Antiviral Agents; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Administration Schedule; Encephalitis, Viral; Female; Herpes Simplex; Humans; Infant; Male; Movement Disorders

To evaluate the utility of an assay based on a polymerase chain reaction (PCR) of cerebrospinal fluid in the management of patients with suspected herpes simplex encephalitis.. A decision model was constructed and used to compare a PCR-based approach with empiric therapy. Inputs required by the model included the sensitivity (96%) and specificity (99%) of PCR (derived from review of the literature), the prevalence of herpes simplex encephalitis (5%, based on the actual prevalence at Barnes Hospital among patients treated empirically with acyclovir), the outcomes for patients with and without herpes simplex encephalitis (derived from clinical studies of the Collaborative Antiviral Study Group and the actual experience at Barnes Hospital), and the average duration of empiric acyclovir therapy for patients with possible herpes simplex encephalitis (5.3 days based on actual experience at Barnes Hospital).. Using these input values, the decision model predicted better outcomes with empiric therapy. However, low rates of inappropriate discontinuation of empiric therapy in patients with herpes simplex encephalitis or improved diagnosis and outcome resulting from a negative PCR assay result in patients without herpes simplex encephalitis led to better outcomes with the PCR-based approach. The PCR-based approach was associated with 9.2 fewer doses of acyclovir per patient.. Based on the decision model using conservative assumptions, a PCR-based approach can yield better outcomes and reduced acyclovir use compared with empiric therapy.

Topics: Acyclovir; Antiviral Agents; Bayes Theorem; Decision Support Techniques; Diagnosis, Differential; Encephalitis, Viral; Herpes Simplex; Humans; Polymerase Chain Reaction; Prevalence; Sensitivity and Specificity; Simplexvirus; Treatment Outcome

Cerebellitis is an uncommon complication of infectious mononucleosis. We describe such a patient with infectious mononucleosis and cerebellitis as a major feature of a more global encephalitis. In the discussion the cerebral complications are reviewed.

Topics: Acyclovir; Adult; Antiviral Agents; Cerebellar Diseases; Cerebellum; Disease-Free Survival; Encephalitis, Viral; Female; Humans; Infectious Mononucleosis

We describe a patient who presented with isolated retrograde amnesia of 2-year duration after recovery from viral encephalitis. The patient was a 29-year-old right-handed male dentist and was admitted to our hospital with a complaint of generalized convulsion. Cerebrospinal fluid (CSF) showed mononuclear pleocytosis. Neuroradiological examinations (X-ray CT, MRI and 123I-IMP SPECT) revealed no significant abnormality. Immunological method showed no specific increase of viral antibody titers. However, with a tentative diagnosis of viral encephalitis, administration of acyclovir was started. After 3 weeks he became comprehensive, and several kinds of neuropsychological tests were performed. His intelligence and immediate memory were normal, and his procedural memory of dentist was intact. On the other hand, he could not recall any information about events, both personal and public, occurred within 2 years before the onset of present illness. His autobiographical memory disorder was also demonstrated using a series of weekly comic. In isolated retrograde amnesia following viral encephalitis like this case, memory of relatively short time duration, acquired prior to the onset of present illness, tend to be disturbed.

Topics: Acyclovir; Adult; Amnesia, Retrograde; Antiviral Agents; Encephalitis, Viral; Humans; Male; Time Factors

Antiviral treatment of herpesvirus infections is rapidly changing since the advent of new drugs with improved oral availability. The efficacy of valaciclovir, the prodrug of aciclovir, and famciclovir, the prodrug of penciclovir, in the treatment of herpes genitalis and acute herpes zoster has been well documented in large clinical trials. Both drugs are effective on zoster-associated pain. Brivudin and sorivudine which are the most active compounds against varicella-zoster virus (VZV) in cell culture have also been successful in the treatment of herpes zoster. Aciclovir is still the standard therapy of severe herpes simplex virus (HSV) and varicella virus infections. In patients treated with aciclovir, the mortality of herpes encephalitis has been reduced to about 25%. The development of resistance against aciclovir and the other nucleoside analogues has not been a problem to date in the treatment of immunocompetent individuals. However, in immunocompromised patients, aciclovir-resistant HSV strains often emerge. In such cases, intravenous foscarnet is the current treatment of choice.

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Antiviral Agents; Arabinofuranosyluracil; Bromodeoxyuridine; Chickenpox; Drug Resistance, Microbial; Encephalitis, Viral; Famciclovir; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpes Zoster; Humans; Immunocompromised Host; Prodrugs; Simplexvirus; Valacyclovir; Valine

Varicella-zoster infection consists of well-recognized cutaneous manifestations. However, in several cases it is complicated with central nervous system disorders. We present a 79-year-old diabetic woman with zoster ophthalmicus, who developed an acute confusional syndrome. EEG, cranial computed tomographic, biochemical and haematologic and liquoral studies were performed. An increased in the CSF-IgG index was founded, and it was related with Varicella-Zoster Herpes antibodies. She was treated with intravenous acyclovir, and her encephalopathy was resolved.

Topics: Acyclovir; Aged; Antiviral Agents; Encephalitis, Viral; Female; Herpes Zoster Ophthalmicus; Humans; Spinal Puncture; Time Factors

As effective therapies for the treatment of herpes simplex encephalitis (HSE) have become available, the virology laboratory has acquired a role of primary importance in the early diagnosis and clinical management of this condition. Several studies have shown that the polymerase chain reaction (PCR) of CSF for the detection of herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2) DNA provides a reliable method for determining an aetiological diagnosis of HSE. The use of PCR in combination with the detection of a specific intrathecal antibody response to HSV currently represents the most reliable strategy for the diagnosis and monitoring of the treatment of adult patients with HSE. The use of these techniques has also led to the identification of atypical presentations of HSV infections of the nervous system and permits the investigation of patients who develop a relapse of encephalitic illness after an initial episode of HSE. A strategy for the optimal use of the investigative laboratory in the diagnosis of HSE and subsequent management decisions is described.

Topics: Acyclovir; Antibody Formation; Antiviral Agents; Biopsy; Brain; Cerebrospinal Fluid; DNA, Viral; Electroencephalography; Encephalitis, Viral; Herpesviridae Infections; Humans; Injections, Intravenous; Magnetic Resonance Imaging; Polymerase Chain Reaction; Tomography, X-Ray Computed

Herpes simplex encephalitis (HSE) is a life-threatening condition with high mortality as well as significant morbidity in survivors. In most cases herpes simplex virus type 1 (HSV-1) is responsible for the diseases, however, the type 2 virus (HSV-2) is involved in 4-6% of cases. Primary HSV infection is identified in only one-third of patients with HSE. The majority of cases are recorded in adults with recurrent HSV infection who are already seropositive for HSV at the onset of symptoms, but only 6-10% of these patients have a history of labial herpes. Acute focal, necrotizing encephalitis with inflammation and swelling of the brain tissue are consistent features of the pathology of HSE. HSV-induced cytolysis certainly damages neurones, oligodendrocytes and astrocytes, but the role of cellular and humoral immunopathology is important. A complex network of cytokines seems to be active in regulating the local immune response and inflammation during and after HSE. Brain biopsy, serological analysis of intrathecal HSV antibodies and detection of HSV-DNA in the cerebrospinal fluid (CSF) are all useful techniques to confirm the aetiology of HSE. Neurodiagnostic tests which support a presumptive diagnosis of HSE include: CSF analysis, electroencephalography, computer-assisted tomography and magnetic resonance imaging. Although aciclovir is the treatment of choice in HSE, mortality and morbidity still remain problematic. Long-term follow-up indicates that intrathecal cellular and humoral activation persist in HSE.

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Clinical Trials as Topic; Diagnosis, Differential; DNA, Viral; Encephalitis, Viral; Herpes Simplex; Humans; Magnetic Resonance Imaging; Middle Aged; Polymerase Chain Reaction; Prognosis; Serologic Tests; Simplexvirus; Survival Rate

This paper focuses on the advances that have been made in our understanding of the pathogenesis, diagnosis, treatment, and prevention of herpes simplex virus (HSV) infections. Insights have been gained into the immune defense mechanisms that may be active in protecting the fetus from HSV infection. An animal model that closely mimics human neonatal HSV disease may permit exploration of novel interventional strategies. Brain biopsy for the diagnosis of HSV encephalitis has been supplanted by polymerase chain reaction detection of HSV DNA in the cerebrospinal fluid and, to a lesser extent, by detection of intrathecal HSV-specific antibodies. Prolonged immune activation within the nervous system following HSV encephalitis has been demonstrated and may implicate immune activation in the pathogenesis of HSV-induced neurologic damage. The continuing emergence of antiviral drug resistance further underscores the need for new strategies for treatment and prevention of HSV infections.

Topics: Acyclovir; Child; Encephalitis, Viral; Herpes Simplex; Humans; Polymerase Chain Reaction; Vaccines, Synthetic

Topics: Acyclovir; Antiviral Agents; Diagnosis, Differential; Encephalitis, Viral; Female; Herpes Genitalis; Herpesvirus 2, Human; Humans; India; Infant, Newborn; Infectious Disease Transmission, Vertical

Topics: Acute Disease; Acyclovir; Adult; Child; Diagnosis, Differential; Encephalitis, Arbovirus; Encephalitis, Tick-Borne; Encephalitis, Viral; Encephalomyelitis; Glucocorticoids; Herpes Simplex; Humans; Immunoglobulins; Infant; Subacute Sclerosing Panencephalitis

Viral encephalitis is a devastating condition for which delayed treatment is associated with increased morbidity and mortality. Clinical audits indicate substantial scope for improved detection and treatment. Improvement strategies should ideally be tailored according to identified needs and barriers to change. The aim of the study is to evaluate the effectiveness and cost-effectiveness of a tailored intervention to improve the secondary care management of suspected encephalitis.. The study is a two-arm cluster randomised controlled trial with allocation by postgraduate deanery. Participants were identified from 24 hospitals nested within 12 postgraduate deaneries in the United Kingdom (UK). We developed a multifaceted intervention package including core and flexible components with embedded behaviour change techniques selected on the basis of identified needs and barriers to change. The primary outcome will be a composite of the proportion of patients with suspected encephalitis receiving timely and appropriate diagnostic lumbar puncture within 12 h of hospital admission and aciclovir treatment within 6 h. We will gather outcome data pre-intervention and up to 12 months post-intervention from patient records. Statistical analysis at the cluster level will be blind to allocation. An economic evaluation will estimate intervention cost-effectiveness from the health service perspective.. Controlled Trials: ISRCTN06886935.

Topics: Acyclovir; Adult; Child; Clinical Protocols; Cost-Benefit Analysis; Encephalitis, Viral; Humans; Quality Improvement; Spinal Puncture; Time Factors

Focal viral encephalitis in childhood is a rare but life-threatening disease. Animal experiments and case reports suggest a positive effect of an additional therapy with interferon-beta on the course of the disease. Therefore, we initiated a prospective, double-blind placebo-controlled study to investigate the benefit of a combination therapy of Aciclovir (ACV) and recombinant interferon-beta (rIFN-beta) in juvenile focal viral encephalitis. - Initial inclusion criterium was suspicion of focal viral encephalitis. Diagnosis was proven by demonstration of characteristic focal lesions in cerebral imaging or virological evidence of HSV in cerebrospinal fluid. Patients were treated with ACV plus rIFN-beta or ACV plus placebo. Neurological outcome was determined 21 days and 3 months after onset of the disease. - Initially 59 patients were enrolled in the study. Encephalitis was proven in 14 patients (7 ACV + rIFN-beta, 7 ACV + placebo). The study groups were balanced in terms of important prognostic criteria. 10 patients (5 ACV + rIFN-beta, 5 ACV + placebo) were cured or had slight defects, 4 patients (2 ACV + rIFN-beta, 2 ACV + placebo) showed moderate to severe defects. There was no significant difference in favour of the additive therapy with rIFN-beta.

Topics: Acyclovir; Adolescent; Antiviral Agents; Child; Child, Preschool; Double-Blind Method; Drug Therapy, Combination; Encephalitis, Viral; Female; Focal Infection; Herpes Simplex; Humans; Infant; Interferon-beta; Male; Nervous System; Recombinant Proteins; Recovery of Function; Treatment Outcome

No standardized therapy has been established for viral encephalitis except for herpes simplex encephalitis. Not a few neurologists, however, have had an impression that administration of corticosteroids ameliorated neurological impairment and induced better prognosis in some patients with viral encephalitis. Five patients with aseptic meningitis and 9 patients with viral encephalitis, who were moderately to severely ill, were examined for cerebrospinal fluid (CSF) parameters before and after short-term intravenous administration of corticosteroids. In all of the patients with aseptic meningitis, severe headache and nausea disappeared rapidly with this treatment, which was accomplished via anti-inflammatory effects of corticosteroids. By contrast, 5 of the patients with viral encephalitis responded well to intravenous corticosteroids, whereas the remaining 4 patients did not, three of whom showed poor prognosis. The CSF containing more than 15% of CD4+CD26+ memory helper T cells guaranteed good response to corticosteroid therapy. It appeared that viral encephalitis with severe inflammation had poor prognosis irrespective of attempted therapy including intravenous corticosteroids. The CSF of patients who responded well to corticosteroid treatment showed a significant reduction in CD4+CD29+ helper-inducer T cells in the course of the illness. This finding indicates that autoimmune mechanisms may be involved in the pathogenesis of neurological impairment in a part of patients with viral encephalitis.

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Autoimmunity; Betamethasone; Dexamethasone; Drug Therapy, Combination; Encephalitis, Viral; Humans; Meningitis, Aseptic; T-Lymphocytes, Helper-Inducer

Aciclovir-induced neurotoxicity results from the accumulation of aciclovir and its metabolite 9-carboxymethoxymethylguanine (CMMG). It occurs predominantly in older patients with impaired renal function and is characterised by a combination of confusion and psychiatric changes. Seizures, myoclonus and dysarthria may also occur. Critically, peritoneal dialysis has little effect on reversing the toxic effects of aciclovir. We describe a woman in her 70s with renal failure who developed confusion and seizures after receiving aciclovir. She was ultimately diagnosed with aciclovir-induced neurotoxicity, confirmed by an elevated serum CMMG concentration. This condition is likely to be underdiagnosed and the neurologist's primary challenge is differentiating aciclovir-induced neurotoxicity from viral encephalitis.

Topics: Acyclovir; Aged; Antiviral Agents; Confusion; Encephalitis, Viral; Female; Humans; Neurotoxicity Syndromes; Seizures

Pseudorabies virus (PRV) was thought to only infect animals. Recent studies have shown that it can also infect human.. We report a case of pseudorabies virus encephalitis and endophthalmitis, diagnosed 89 days after onset, confirmed with intraocular fluid metagenomic next generation sequencing (mNGS) after the result of two cerebrospinal fluid (CSF) mNGS tests were negative. Although treatment with intravenous acyclovir, foscarnet sodium, and methylprednisolone improved the symptoms of encephalitis, significant diagnostic delay resulted in permanent visual loss.. This case suggests that pseudorabies virus (PRV) DNA in the intraocular fluid may have a higher positivity than that in the CSF. PRV may persist in the intraocular fluid for an extended period and may thus require extended antiviral therapy. Patients with severe encephalitis and PRV should be examined with the focus on pupil reactivity and light reflex. A fundus examination should be performed in patients with a central nervous system infection, specifically, those in a comatose state, to help reduce eye disability.

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; Blindness; Delayed Diagnosis; DNA, Viral; Encephalitis, Viral; Endophthalmitis; Foscarnet; Herpesvirus 1, Suid; High-Throughput Nucleotide Sequencing; Humans; Male; Metagenomics; Methylprednisolone; Middle Aged; Pseudorabies

Herpes simplex encephalitis is a life-threatening disease of the central nervous system caused by herpes simplex viruses (HSVs). Following standard of care with antiviral acyclovir treatment, most patients still experience various neurological sequelae. Here we characterize HSV-1 infection of human brain organoids by combining single-cell RNA sequencing, electrophysiology and immunostaining. We observed strong perturbations of tissue integrity, neuronal function and cellular transcriptomes. Under acyclovir treatment viral replication was stopped, but did not prevent HSV-1-driven defects such as damage of neuronal processes and neuroepithelium. Unbiased analysis of pathways deregulated upon infection revealed tumour necrosis factor activation as a potential causal factor. Combination of anti-inflammatory drugs such as necrostatin-1 or bardoxolone methyl with antiviral treatment prevented the damages caused by infection, indicating that tuning the inflammatory response in acute infection may improve current therapeutic strategies.

Topics: Acyclovir; Antiviral Agents; Encephalitis, Viral; Herpes Simplex; Herpesvirus 1, Human; Humans; Organoids

Refractory hypotension is a life-threatening condition that can result from various causes. We report a rare case of refractory hypotension following herpes simplex virus type 1 encephalitis that was successfully treated with hormone therapy.. The patient was a 66-year-old male who was admitted to the hospital because of fever, chills, convulsions, and impaired consciousness. He developed respiratory failure and was intubated. Cerebrospinal fluid metagenomic sequencing confirmed herpes simplex virus type 1 infection. He received piperacillin-tazobactam for anti-infection, acyclovir for antiviral therapy, and dexamethasone for anti-inflammatory therapy. He had repeated episodes of hypotension despite fluid resuscitation and vasopressor therapy.. The diagnosis of herpes simplex virus type 1 encephalitis complicated by refractory hypotension was based on the patient's epidemiological history, clinical manifestations, laboratory tests, and imaging studies. Cerebrospinal fluid examination was the most important diagnostic method, which could detect viral nucleic acids. Head magnetic resonance imaging showed a large recent lesion in the right temporal-parietal and insular lobes.. The treatment of refractory hypotension mainly included anti-infection, antiviral, anti-inflammatory, and hormone therapy. Hormone therapy used methylprednisolone shock treatment until tapering withdrawal. Other treatments included fluid resuscitation, vasopressors, anticonvulsants, etc.. The patient's blood pressure stabilized after receiving methylprednisolone shock treatment, and his mean arterial pressure increased from 73 mm Hg to 92 mm Hg within 24 hours. Three months later, the patient's blood pressure was normal without medication, and he had a good social and physical recovery.. This case illustrates the possible role of hormone therapy in restoring blood pressure in patients with refractory hypotension following viral encephalitis. It suggests that adrenal insufficiency or autonomic dysfunction may be involved in the pathophysiology of this condition. Further studies are needed to confirm the efficacy and safety of hormone therapy in this setting.

Topics: Acyclovir; Aged; Anti-Inflammatory Agents; Antiviral Agents; Encephalitis, Herpes Simplex; Encephalitis, Viral; Hormones; Humans; Hypotension; Male; Methylprednisolone

An 84-year male was brought in the emergency after a road traffic accident leading to polytrauma with deteriorating consciousness. Prolonged unexplained unconsciousness led to cerebrospinal fluid examination. The polymerase chain reaction (PCR) of cerebrospinal fluid (CSF) was found to be positive for HSV-1 DNA. The patient was started on intravenous acyclovir and the consciousness level of the patient improved gradually. In this case, encephalitis was not suspected initially, because of the multiple traumatic injuries that needed management. Moreover, no features suggestive of encephalitis were present at the time of presentation, except for the non-specific symptom of drowsiness at the time of the accident. The patient was also diabetic and had chronic kidney disease as predisposing factors. It was primarily encephalitis which led to impaired consciousness that resulted in the road traffic accident in a very unlikely situation, i.e., hit by an ambulance inside the hospital. The reasons to suspect herpes simplex virus encephalitis (HSE) in this case were unexplained worsening level of consciousness, CSF findings suggestive of viral encephalitis along with highly deranged alanine aminotransferase (ALT) levels. This case highlights the importance of keeping a high index of suspicion for viral encephalitis in patients with risk factors, even in such a scenario of polytrauma. Key Words: Herpes simplex virus, Polytrauma, Viral encephalitis, Polymerase chain reaction.

Topics: Acyclovir; DNA, Viral; Encephalitis, Herpes Simplex; Encephalitis, Viral; Humans; Male; Simplexvirus

Topics: Acyclovir; Adult; Antimetabolites, Antineoplastic; Antiviral Agents; Cytarabine; Encephalitis, Viral; Female; Herpesvirus 6, Human; Humans; Leukemia, Myeloid, Acute

Topics: Acute Disease; Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Cerebellar Ataxia; Cerebellar Diseases; Child; Consciousness Disorders; COVID-19; COVID-19 Drug Treatment; COVID-19 Nucleic Acid Testing; Drainage; Encephalitis, Viral; Headache; Humans; Hydrocephalus; Male; Nasopharynx; Neuroimaging; SARS-CoV-2

To describe the clinical manifestations and treatment outcomes of patients with VZV meningitis and encephalitis consulting at two medical centers in Lebanon.. Retrospective study of patients with VZV meningitis and/or encephalitis confirmed by positive cerebrospinal fluid (CSF) VZV PCR.. Twenty patients were identified (13 males). The average age was 49.7±22.2 years. The most common complaint was headache (n=17/20). Common comorbidities included hypertension (n=7/20) and diabetes mellitus (n=5/20). Immunosuppression was reported in two patients. Vesicles were only observed in eight patients. Altered mental status, focal neurological deficits, and fever were documented in six, two, and four patients respectively. All patients had CSF leukocytosis with lymphocytic predominance, normal CSF/serum glucose ratio, and high CSF protein. Eighteen patients had brain CT scans showing no relevant findings. Two of 12 patients with brain MRI had focal abnormalities. Unilateral temporal slow waves were observed in three of four patients who underwent electroencephalograms. Four patients had encephalitis and 16 had meningitis. Eighteen patients received an antiviral therapy. Treatment either included intravenous acyclovir or oral valacyclovir. The encephalitis and meningitis groups had comparable mean duration of treatment (13.5±6.6 vs. 12.2±5.4, respectively). All admitted patients showed clinical cure with no reported neurological sequelae.. VZV infection should be suspected in any patient with signs and symptoms of viral meningitis or encephalitis, irrespective of age, immune status, presence or absence of vesicles, fever, or neck stiffness.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Cerebrospinal Fluid; Comorbidity; Electroencephalography; Encephalitis, Viral; Female; Herpesvirus 3, Human; Humans; Lebanon; Leukocytosis; Magnetic Resonance Imaging; Male; Meningitis, Viral; Middle Aged; Neuroimaging; Retrospective Studies; Tertiary Care Centers; Tomography, X-Ray Computed; Treatment Outcome; Valacyclovir; Varicella Zoster Virus Infection; Young Adult

The standard for diagnosing meningoencephalitis includes cerebrospinal fluid (CSF) culture and viral polymerase chain reaction (PCR). Approval of the FilmArray® BioFire® Meningitis/Encephalitis (ME) panel has reduced time to detection of several pathogens and improved diagnostic sensitivity. The objective of this study was to determine the impact on intravenous (IV) acyclovir duration of the ME panel compared to previously utilized CSF studies within a large health system with a central laboratory. A multicenter quasi-experimental cohort study of adult and pediatric patients was conducted (n = 208). The primary endpoint was duration of IV acyclovir, which was decreased (41.6 v. 30.8 hours; P < 0.01) with the ME panel. Secondary outcomes including test-turnaround time (TAT) and the impact of utilizing a central laboratory were explored. Subgroup analyses demonstrated that number of daily couriers from hospital to the central laboratory (0 versus 7 versus 3 versus 2 couriers) and hospital distance from the central laboratory (0 versus 1-10 versus 11-20 versus 21-30 miles) significantly impacted TAT (P < 0.01). While duration of IV acyclovir for the entire healthcare system was reduced, the duration at individual sites was not impacted by number of couriers or distance from the central laboratory.

Topics: Acyclovir; Administration, Intravenous; Adult; Age Factors; Algorithms; Antiviral Agents; Child; Child, Preschool; Disease Management; Encephalitis, Viral; Female; Humans; Male; Meningitis, Viral; Multiplex Polymerase Chain Reaction; Prognosis; Retrospective Studies; Time Factors; Treatment Outcome

Although infectious mononucleosis due to Epstein-Barr virus (EBV) is a common disease among young individuals, central nervous system (CNS) complications are rare. In this report, we describe a case of CNS complications caused by EBV in a previously healthy young woman. She presented to our hospital with a 9-day history of headache and sore throat, followed by the development of fever and facial edema 6 days prior to admission. On Day 2 of admission, she was confused (Glasgow Coma Scale score: 10 points) and had fever, muscle weakness in her right arm and leg, stiff neck, and roving eye movement. We detected EBV in a cerebrospinal fluid (CSF) sample using a polymerase chain reaction (PCR) test. The magnetic resonance imaging of her brain revealed dural enhancement and right parietal and temporal lobe lesions. She was treated with acyclovir and high-dose steroid therapy. She responded well to treatment, recovered without neurologic sequelae, and was discharged home on Day 12. Our experience suggests that PCR detection of EBV DNA in CSF may be useful in diagnosing EBV encephalitis and that prognosis may be associated with an area of the brain that is affected and the time from symptom onset to starting treatment.

Topics: Acyclovir; Antiviral Agents; Brain; DNA, Viral; Drug Therapy, Combination; Encephalitis, Viral; Epstein-Barr Virus Infections; Glasgow Coma Scale; Glucocorticoids; Herpesvirus 4, Human; Humans; Magnetic Resonance Imaging; Polymerase Chain Reaction; Treatment Outcome; Young Adult

Enteroviruses are one of the most important causes of viral encephalitis in the neonatal period. However, the non-specificity of the symptoms presented renders its diagnosis challenging. Intracranial MRI has been reported to be a very useful imaging modality that can detect the characteristic white matter lesions around the periventricular regions. In this study, we report a case of a patient with neonatal encephalitis who presented with normal white blood cell counts in the initial cerebrospinal fluid analysis. A lumbar puncture retap identified pleocytosis, and polymerase chain reaction assays detected enterovirus 71 in the blood and stool samples. Furthermore, MRI revealed atypical disseminated cortical and subcortical white matter lesions on diffusion weighted images, and neuroradiological re-evaluation showed necrotic changes 2 weeks later. This unique case expands our knowledge of the spectrum of neurological disorders due to enterovirus 71 infection in neonatal period.

Topics: Acyclovir; Antiviral Agents; Cerebral Cortex; Diffusion Magnetic Resonance Imaging; Encephalitis, Viral; Enterovirus A, Human; Enterovirus Infections; Humans; Infant, Newborn; Male; Neuroimaging; Spinal Puncture; White Matter

Herpes simplex virus (HSV)-1 encephalitis has significant morbidity partly because of an over-exuberant immune response characterized by leukocyte infiltration into the brain and increased blood-brain barrier (BBB) permeability. Determining the role of specific leukocyte subsets and the factors that mediate their recruitment into the brain is critical to developing targeted immune therapies. In a murine model, we find that the chemokines CXCL1 and CCL2 are induced in the brain following HSV-1 infection. Ccr2 (CCL2 receptor)-deficient mice have reduced monocyte recruitment, uncontrolled viral replication, and increased morbidity. Contrastingly, Cxcr2 (CXCL1 receptor)-deficient mice exhibit markedly reduced neutrophil recruitment, BBB permeability, and morbidity, without influencing viral load. CXCL1 is produced by astrocytes in response to HSV-1 and by astrocytes and neurons in response to IL-1α, and it is the critical ligand required for neutrophil transendothelial migration, which correlates with BBB breakdown. Thus, the CXCL1-CXCR2 axis represents an attractive therapeutic target to limit neutrophil-mediated morbidity in HSV-1 encephalitis.

Topics: Acyclovir; Animals; Astrocytes; Blood-Brain Barrier; Chemokine CXCL1; Encephalitis, Viral; Female; Herpesvirus 1, Human; Mice, Inbred C57BL; Neurons; Neutrophil Infiltration; Neutrophils; Permeability; Receptors, Interleukin-8B; Transendothelial and Transepithelial Migration

To analyze the clinical efficacy of naloxone combined with acyclovir in the treatment of children viral encephalitis and the impacts on inflammatory factors IL-1 and IL-6.. 96 children with viral encephalitis were retrospectively analyzed. They were treated from July 2013 to January 2014 in our hospital. They were divided into control group (45 cases treated with acyclovir) and observation group (51 cases treated with acyclovir combined with naloxone). Both groups were treated with comprehensive measures. Changes of the content of serum IL-1 and IL-6 in the two groups before and after treatment were monitored by enzyme-linked immunosorbent assay (ELISA). Signs, recovery time of clinical symptoms, total effective rate, occurrence of adverse reactions and adverse reactions after treatment of children in the two groups were compared.. Levels of serum IL-1 and IL-6 of children in the control group and the observation group decreased after treatment, and the decrease was greater in the observation group (p<0.05). Signs and recovery time of clinical symptoms of the observation group were significantly shorter than that of the control group (p<0.05). Indexes of serum in the observation group were significantly lower than those of the control group after treatment (p<0.05). The total effective rate of the observation group was significantly higher than that of the control group (p<0.05). The prevalence of adverse reactions and sequelae in the observation group were lower than those in the control group (p<0.05).. In the treatment of children, viral encephalitis has naloxone combined with ganciclovir had a more significant effect on the decrease of levels of serum IL-1 and IL-6; naloxone combined with acyclovir in the treatment of children viral encephalitis had better effects, lower adverse reactions and lower prevalence of sequelae compared with sole medication, which is worth clinical promotion.

Topics: Acyclovir; Antiviral Agents; Child, Preschool; Drug Therapy, Combination; Encephalitis, Viral; Female; Humans; Injections, Intravenous; Interleukin-1; Interleukin-6; Male; Naloxone

We report the case of a patient who presented with viral encephalitis and a pulmonary infection complicated with bilateral acute retinal necrosis after direct contact with diseased swine. Next-generation sequencing of the cerebrospinal fluid and vitreous humor detected pseudorabies virus (PRV) simultaneously. Intravenous acyclovir and dexamethasone treatment improved the symptoms of encephalitis, and vitrectomy surgery with silicone oil tamponade was used to treat the retinal detachment. This case implies that PRV can infect humans; thus, self-protection is imperative when there is contact with animals.

Topics: Acyclovir; Adult; Animals; Anti-Inflammatory Agents; Antiviral Agents; Cerebrospinal Fluid; Dexamethasone; Encephalitis, Viral; Herpesvirus 1, Suid; Humans; Lung Diseases; Male; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Silicone Oils; Swine; Swine Diseases; Vitrectomy; Vitreous Body; Zoonoses

Acute necrotizing encephalopathy (ANE) is a severe neurologic complication caused by influenza virus that has been infrequently reported in adult population. The diagnosis is made on epidemiological, clinical, and neuroimaging suspicion, but is rarely confirmed by microbiological findings in samples from the central nervous system (CNS), thus making it difficult to define the mechanism of pathogenesis of influenza-associated encephalitis/encephalopathies (IAE). We report a microbiologically documented case of ANE caused by influenza A/H3N2, in a previously healthy adult patient infected during a flu epidemic in Asturias (Spain). Direct viral invasion of the CNS was demonstrated with the isolation of the virus in a brain biopsy.

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Brain; Dexamethasone; Encephalitis, Viral; Fatal Outcome; Humans; Immunocompetence; Influenza A Virus, H3N2 Subtype; Influenza, Human; Male; Middle Aged; Tomography, X-Ray Computed; Treatment Failure

Topics: Acyclovir; Benserazide; Drug Combinations; Drug Therapy, Combination; Encephalitis, Viral; Female; Humans; Levodopa; Magnetic Resonance Imaging; Parkinsonian Disorders; Substantia Nigra; Young Adult

We report a case of cytomegalovirus encephalitis in a hematopoietic stem cell transplant recipient. A previously uncharacterized V787E mutation in UL54 was identified in cerebrospinal fluid but not plasma specimens. For the V787E recombinant virus, the half maximal effective concentrations for ganciclovir, foscarnet, and cidofovir were 8.6-, 3.4- and 2.9-fold higher than for wild-type virus, and the replicative capacity was lower. The introduction of a bulkier and negatively charged glutamate residue at position 787 could destabilize the finger domain of UL54 DNA polymerase. Viral genotyping of cerebrospinal fluid is warranted in subjects with cytomegalovirus encephalitis, owing to the low penetration of antivirals in this compartment.

Topics: Acyclovir; Antibiotic Prophylaxis; Antiviral Agents; Cerebrospinal Fluid; Cytomegalovirus; Cytomegalovirus Infections; Drug Resistance, Multiple, Viral; Encephalitis, Viral; Female; Graft Rejection; Hematopoietic Stem Cell Transplantation; Humans; Immediate-Early Proteins; Immunosuppression Therapy; Middle Aged; Mutation; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Viral Proteins

Bilateral independent periodic lateralised epileptiform discharges (BIPLEDs) in electroencephalograms (EEGs) are commonly caused by anoxic encephalopathy and central nervous system infections. They are associated with coma and high mortality and are thus markers of poor prognosis. We present a case of encephalitis who presented with BIPLEDs in EEG. Though the clinical, EEG and MRI features closely resembled herpes simplex encephalitis, further investigations proved it to be Epstein-Barr virus (EBV) encephalitis. Despite the presence of BIPLEDs in the EEG, the patient had a rapid clinical response to therapy with acyclovir. We emphasise that BIPLEDs may not always indicate poor prognosis especially in the setting of EBV encephalitis.

Topics: Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Electroencephalography; Encephalitis, Viral; Herpesvirus 4, Human; Humans; Magnetic Resonance Imaging; Male; Seizures

Patients with 'suspected viral encephalitis' are frequently empirically treated with intravenous aciclovir. Increasing urea and creatinine are 'common', but rapidly progressive renal failure is reported to be 'very rare'.. To describe the clinical course and outcome of cases of aciclovir-induced acute kidney injury (AKI) encountered by the Liaison Neurology Service at AMNCH and to highlight the importance of surveillance and urgent treatment of this iatrogenic complication.. Retrospectively and prospectively collected data from the Liaison Neurology Service at AMNCH on patients who received IV aciclovir for suspected viral encephalitis and developed AKI were analysed. Aciclovir-induced AKI was defined by a consultant nephrologist in all cases as a rise in serum creatinine of > 26 μmol/L in 48 h or by ≥ 1.5 times the baseline value. Renal function, haematocrit, and fluid balance were monitored following AKI onset.. Data from 10 patients were analysed. Median time to AKI onset was 3.5 days (range: 1-6 days). Aciclovir was stopped or the dose adjusted. All patients recovered with IV normal saline, aiming for a urine output > 100-150 ml/h. The interval between first rise in creatinine and return to normal levels varied between 5 and 19 days.. Liaison neurologists and general physicians need to be aware that aciclovir may cause AKI attributed to distal intra-tubular crystal nephropathy. Daily fluid balance and renal function monitoring are essential because AKI may arise even with intensive pre-hydration. Prognosis is good if identified early and actively treated.

Topics: Acute Kidney Injury; Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Encephalitis, Viral; Female; Humans; Male; Middle Aged; Prognosis; Retrospective Studies; Young Adult

Eczema herpeticum is a dermatological emergency causing a mortality of up to 10% if untreated. It frequently presents in a localised form and rarely disseminates via haematogenous spread with pulmonary, hepatic, ocular and neurological manifestations. Although it commonly appears on a background of atopic dermatitis, many other dermatological conditions have been described preceding this disease. Eczema herpeticum can be easily mistaken for folliculitis and is often treated accordingly with antibacterial drugs; therefore patients will often deteriorate before a diagnosis of eczema herpeticum has been considered.

Topics: Acyclovir; Adult; Antiviral Agents; Dermatitis, Atopic; Diagnosis, Differential; Encephalitis, Viral; Folliculitis; Humans; Kaposi Varicelliform Eruption; Male

Topics: Acyclovir; Antiviral Agents; Cerebrospinal Fluid; Child; Child, Preschool; Encephalitis, Viral; Female; Humans; Male

Topics: Acyclovir; Antiviral Agents; Dengue; Encephalitis, Viral; Endemic Diseases; Female; Humans; Middle Aged

Topics: Acute Disease; Acyclovir; Antiviral Agents; Child; Encephalitis, Viral; Epstein-Barr Virus Infections; Female; Herpesvirus 4, Human; Humans; Outcome Assessment, Health Care

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Child; Dexamethasone; Encephalitis, Viral; Epstein-Barr Virus Infections; Female; Herpesvirus 4, Human; Humans; Magnetic Resonance Imaging; Optic Neuritis

Human herpes virus-6 (HHV-6) reactivation is a well-recognised complication following haematological stem cell transplantation, but it is novel in the context of combination immunomodulatory therapy for autoimmune disease. We report a case of severe anterograde amnesia caused by HHV-6 encephalitis in a young female patient on rituximab, azathioprine and prednisolone for dermatomyositis (DM). The use of targeted biologic treatments for systemic autoimmune connective tissue diseases (CTDs) is increasing, particularly when refractory to conventional management. The anti-CD20 B cell depleting monoclonal antibody, rituximab is now increasingly used, often in combination with conventional immunomodulatory treatments, in certain autoimmune neurological conditions and systemic CTDs including DM. Physicians should be aware of the possibility of HHV-6 in those who develop encephalitis while CD20 B cell deplete, especially in the presence of additional immunomodulatory therapies. Prompt diagnosis and treatment of HHV-6 encephalitis with evidence-based anti-viral therapy may help reduce the extent of irreversible morbidity such as amnesia.

Topics: Acyclovir; Adult; Amnesia, Anterograde; Antiviral Agents; Azathioprine; B-Lymphocytes; Dermatomyositis; Encephalitis, Viral; Female; Herpesvirus 6, Human; Humans; Immunologic Factors; Lymphocyte Depletion; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Prednisolone; Rituximab; Roseolovirus Infections

Viral encephalitis are rare and potentially serious conditions with different etiologist, and not always identifiable. Our aim is to describe the etiological, clinical presentation and neurological outcome of viral encephalitis admitted in Paediatrics Intensive Care Units (PICUs) in Spain.. Observational prospective multicenter study. Children with viral encephalitis admitted to 14 PICUs, for a period of 3 years (2010-2013) were included. Polymerase chain reaction for the etiological diagnosis and neurotropic virus serology in blood and cerebrospinal fluid were used. Personal history, clinical presentation, evolution and neurological status at discharge were recorded.. 80 patients were included with a mean age of 5 years, 70% male. The most relevant clinical symptoms were decreased consciousness (86%), fever (82.4%), seizures (67%), vomiting (42%), headache (27%), agitation (25%) and dis-orientation (23%). The etiologic diagnosis was established in 35%, being more frequent herpes simplex virus and enterovirus. The outcome was discharge without sequelae in 55 patients (69%), mild to moderate sequelae in 19 (23.5%) and severe in 6 (7.5%). Two patients died.. In the Spanish PICU etiological diagnosis was established only in a third of cases of children with suspected acute viral encephalitis. Despite the clinical severity we observed a low mortality and morbidity rate. At discharge from the PICU, most children had no neurological sequelae or were mild.. Etiologia, presentacion clinica y evolucion neurologica de las encefalitis viricas graves en la edad pediatrica (estudio ECOVE).. Introduccion. Las encefalitis viricas son procesos raros y potencialmente graves, con etiologia diversa y no siempre identificable. El objetivo es describir las caracteristicas etiologicas, la presentacion clinica y la evolucion neurologica de las encefalitis viricas que ingresaron en las unidades de cuidados intensivos pediatricos (UCIP) en España. Pacientes y metodos. Estudio prospectivo multicentrico observacional. Se incluyeron los niños ingresados en 14 UCIP con diagnostico de encefalitis virica durante un periodo de tres años (2010-2013). Para el diagnostico etiologico se utilizo reaccion en cadena de la polimerasa y serologia a virus neurotropos en la sangre y el liquido cefalorraquideo. Se registraron los antecedentes personales, la presentacion clinica, la evolucion y la situacion neurologica en el momento del alta. Resultados. Se incluyeron 80 pacientes con edad media de 5 años; el 70%, varones. Los sintomas clinicos mas relevantes fueron disminucion de conciencia (86%), fiebre (82,4%), convulsiones (67%), vomitos (42%), cefalea (27%), agitacion (25%) y desorientacion (23%). Se llego al diagnostico etiologico en un 35%, y los mas frecuentes fueron virus herpes simple y enterovirus. La evolucion fue curacion sin secuelas en 55 pacientes (69%, sobre todo enterovirus, rotavirus y virus respiratorios), secuelas leves-moderadas en 19 (23,5%) y graves en seis (7,5%). Dos pacientes fallecieron. Conclusiones. En las UCIP españolas solo se realizo el diagnostico etiologico en un tercio de los niños con sospecha de encefalitis virica grave. A pesar de la gravedad clinica, hemos observado una tasa de mortalidad y morbilidad baja. La amplia mayoria son dados de alta de la UCIP con ninguna o escasa secuela neurologica.

Topics: Acute Disease; Acyclovir; Adolescent; Antiviral Agents; Brain Damage, Chronic; Child; Child, Preschool; Clarithromycin; Consciousness Disorders; Encephalitis, Viral; Female; Fever; Headache; Humans; Infant; Male; Prospective Studies; Seasons; Seizures; Serologic Tests; Spain; Treatment Outcome; Vomiting

Topics: Acyclovir; Encephalitis, Viral; Humans; Infant, Newborn; Magnetic Resonance Imaging; Male; Parechovirus; Picornaviridae Infections

Topics: Acyclovir; Adult; Brain; Cerebral Angiography; Encephalitis, Viral; Female; Humans; Middle Cerebral Artery

Intravenous acyclovir is the treatment of choice for herpes simplex virus encephalitis. In 2006, the American Academy of Pediatrics updated its dosing recommendations for children aged 3 months to 12 years to receive high-dose acyclovir (60 mg/kg/day). The association between acyclovir dose and toxicity is unclear.. The purpose of our study was to review our institution's experience with standard- and high-dose acyclovir for the empiric treatment of encephalitis.. This retrospective cohort study included patients aged 1 month to 18 years who received acyclovir as empiric treatment for encephalitis between 2005 and 2009 at a tertiary care children's hospital. We excluded patients with baseline renal impairment and those without serum creatinine measurements prior to and during treatment.. The main outcome measure of this study was to compare the occurrence of renal injury or failure between children who received the standard- versus high-dose regimen.. Sixty-one patients were included (n = 32 standard-dose; n = 29 high-dose). There was no statistical difference in change in serum creatinine from baseline between children who received standard- versus high-dose acyclovir (0 vs. 5.1 %; p = 0.79). One child in the standard-dose group and three children in the high-dose group developed renal injury or failure during treatment (3.1 vs. 10.3 %; p = 0.34). Children with renal injury or failure were older, had a longer length of stay, and longer duration of therapy than children without.. The incidence of renal injury or failure was similar between children who received standard-dose and high-dose acyclovir.

Topics: Acyclovir; Adolescent; Antiviral Agents; Child; Child, Preschool; Encephalitis, Viral; Female; Herpes Simplex; Hospitals, Pediatric; Humans; Infant; Male; Renal Insufficiency; Retrospective Studies; Risk Factors; Tertiary Care Centers

In Western populations, especially in France, most severe influenza cases are observed in adults. Some cases are also recorded in children, especially influenza-associated encephalitis. This is contrary to what occurs in Japan where influenza-associated encephalitis is frequent and severe in children. We describe three cases of influenza-associated encephalitis in children who were hospitalized in the pediatric intensive care unit (PICU) during the winter of 2012-2013. The patients did not necessarily show the usual symptoms of influenza and were admitted to the PICU because of their severe neurological symptoms. Two children showed multiple-organ failure, as in the cases reported in Japan. The outcomes ranged from small residual signs to death. These cases remind us that the severe influenza complications that are common in Japan are also seen in France.

Topics: Acyclovir; Brain; Brain Death; Brain Edema; Child, Preschool; Combined Modality Therapy; Electroencephalography; Encephalitis, Viral; Fatal Outcome; Female; Follow-Up Studies; Humans; Hypoxia-Ischemia, Brain; Infant; Influenza A virus; Influenza B virus; Influenza, Human; Magnetic Resonance Imaging; Male; Neurologic Examination; Recurrence; Tomography, X-Ray Computed

Topics: Acyclovir; Antiviral Agents; Brain; Diagnosis, Differential; Electroencephalography; Encephalitis, Viral; Humans; Liver Abscess, Pyogenic; Magnetic Resonance Imaging; Male; Middle Aged; Seizures

A 26-year-old male was admitted because of a fever, headache and disturbance of consciousness with lymph node swelling of the neck two days after developing a rash. A neurological examination revealed restlessness with irritability in response to sensory stimuli, such as an injection. Diffusion-weighted brain magnetic resonance imaging (MRI) revealed a hyperintense ovoid lesion in the splenium of the corpus callosum, which showed a low coefficient in the ADC map: the lesion disappeared after 22 days. An enzyme immunoassay (EIA) of the serum and cerebrospinal IgM were positive for rubella virus. The patient was therefore diagnosed with rubella encephalitis. He recovered gradually and was discharged on day 19 after the onset of symptoms without any sequelae. To our knowledge, this is the first case of rubella encephalitis presenting as clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). Although the exact mechanism underlying the development of rubella encephalitis is not well established, this case indicated that our patient had an immune-mediated secondary encephalitis. According to the survey of the pandemic of rubella from 2012 to April 2013 in Japan, the incidence of rubella encephalitis is thought to be relatively higher than was previously noted. This emphasizes the importance of vaccination for preventing encephalitis.

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Biomarkers; Corpus Callosum; Diffusion Magnetic Resonance Imaging; Encephalitis; Encephalitis, Viral; Humans; Immunoenzyme Techniques; Immunoglobulin M; Infusions, Intravenous; Male; Rubella; Rubella virus; Severity of Illness Index; Treatment Outcome

We to report clinical biological and radiologic features of rubella encephalitis in childhood and assess its prognostic impact. Our retrospective study was conducted in an intensive care unit of a university hospital in Sfax, Tunisia. Twenty-one children (age range, 1-15 years) were included. Median age was 9 years (lower and upper quartiles, 7-11 years). On admission, generalized maculopapular eruption was found in 17 cases (81%). Median Glasgow Coma Scale score was 7 (lower and upper quartiles, 7-8). Twenty patients (95.2%) experienced at least 1 episode of seizures. Sixteen patients (76.2%) developed a status epilepticus. The result for enzyme-linked immunosorbent assay detecting anti-rubella immunoglobulin (M) was positive in the serum and in the cerebrospinal fluid samples for all our patients. Magnetic resonance imaging (MRI) of the brain was performed on admission for 3 patients (14.3%) and within a median of 4 days (lower and upper quartiles, 2-6 days) for 8 patients. The test was normal in 6 cases. Two deaths were recorded (9.5%). Survivors had no neurological sequelae 6 months after intensive care unit discharge.

Topics: Acyclovir; Adolescent; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antibodies, Viral; Antiviral Agents; Brain; Cefotaxime; Child; Child, Preschool; Dexamethasone; Encephalitis, Viral; Female; Follow-Up Studies; Humans; Infant; Intensive Care Units; Male; Retrospective Studies; Rubella; Treatment Outcome; Tunisia

To analyze the electroclinical features, neuroimaging findings, treatment, and outcome of 12 patients with febrile infection-related epilepsy syndrome (FIRES).. This is a retrospective study of 12 children with FIRES with a mean time of follow-up of 6.5 years carried out at the Garrahan Hospital of Buenos Aires between 1997 and 2012.. Eight males and four females had focal status epilepticus preceded by febrile infection with a mean age at presentation of 8.5 years. In the acute period, the treatment included antiepileptic drugs (AEDs) in all cases, immunotherapy in 10 cases, and burst-suppression coma in eight. The ketogenic diet was tried in two, plasmapheresis in one, and rituximab in one. Two patients treated with IVIG and one patient given steroids had a good response, but in this phase only three patients had a prolonged good response to IVIG and a ketogenic diet. No patients died in this period. In the chronic epilepsy phase, all children had seizures arising from neocortical regions. All patients had refractory epilepsy, and most mental retardation, and behavioral disturbances. All received different AEDs and in this phase a third patient was put on a ketogenic diet. One patient was operated without good results. Only two cases had a good outcome after 2 and 10 years of follow-up.. FIRES is a well-defined severe epileptic syndrome, probably in the group of epileptic encephalopathies, characterized by focal or multifocal seizures arising from the neocortical regions with an unknown etiology. Immunoglobulin and the ketogenic diet may be considered a potentially efficacious treatment.

Topics: Acyclovir; Adolescent; Antiviral Agents; Argentina; Child; Child, Preschool; Electroencephalography; Encephalitis, Viral; Female; Follow-Up Studies; Humans; Immunoglobulins, Intravenous; Leukocytosis; Magnetic Resonance Imaging; Male; Retrospective Studies; Seizures, Febrile; Status Epilepticus; Syndrome; Treatment Outcome; Unconsciousness

Topics: Acyclovir; Adult; Antiviral Agents; Diffusion Magnetic Resonance Imaging; Encephalitis, Viral; Herpesvirus 6, Human; Humans; Jaundice; Magnetic Resonance Imaging; Male; Neurologic Examination; Pain; Paresis; Polymerase Chain Reaction; Recovery of Function; Roseolovirus Infections; Tomography, X-Ray Computed; Treatment Outcome

Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease that essentially affects the white matter of the central nervous system. The diagnosis is based on clinical-imaging and developmental findings. Magnetic resonance imaging of the brain is the most useful diagnostic tool. The disease course is usually monophasic and the preferred initial treatment is with corticoids.. We conducted a retrospective study of 18 patients with a presumptive diagnosis of ADEM. Symptoms, imaging findings, progress and treatment were analysed. The definitive diagnosis was established in 12 patients, excluding one patient with positive polymerase chain reaction for herpes simplex virus in cerebrospinal fluid, one with a clinical picture that was consistent but normal magnetic resonance imaging of the brain, and four with an onset that was similar to ADEM whose definitive diagnoses were: Rassmusen's syndrome, haemophagocytic syndrome, brain tumour, and MELAS (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes).. The median age was 31 months with no predominance of either sex. Infection of the upper respiratory tract was the most frequent cause in children over 2 years of age and of the gastrointestinal tract in those under the age of 2. All of them presented altered levels of consciousness and multifocal neurological deficits. The most frequent imaging finding was multifocal alteration of the white matter in both hemispheres. Corticoids were the preferred treatment in most cases. Progression was favourable in nearly all patients except for two, who were left with important sequelae.. ADEM may present at any age, including in infants. There are a number of conditions that can mimic ADEM in the early stages.. Analisis de una serie de casos con diagnostico inicial de encefalomielitis aguda diseminada en el periodo 2000-2010.. Introduccion. La encefalomielitis aguda diseminada (EMAD) es una enfermedad desmielinizante que afecta fundamentalmente a la sustancia blanca del sistema nervioso central. El diagnostico se basa en hallazgos clinicorradiologicos y evolutivos. La resonancia magnetica cerebral es la herramienta diagnostica mas util. El curso suele ser monofasico y el tratamiento inicial de eleccion, los corticoides. Pacientes y metodos. Estudio retrospectivo de 18 pacientes con diagnostico de sospecha inicial de EMAD. Se analizo la sintomatologia, los hallazgos radiologicos, la evolucion y el tratamiento. El diagnostico definitivo se establecio en 12 pacientes, excluyendo un paciente con reaccion en cadena de la polimerasa positiva para el virus herpes simple en el liquido cefalorraquideo, uno con clinica compatible pero resonancia magnetica cerebral normal, y cuatro con inicio similar a EMAD cuyos diagnosticos definitivos fueron: sindrome de Rassmusen, sindrome hemofagocitico, tumor cerebral y MELAS (encefalomiopatia mitocondrial con acidosis lactica y accidentes cerebrovasculares). Resultados. La mediana de edad fue de 31 meses, sin predominio de sexo. La infeccion de la via respiratoria superior fue la causa mas frecuente en niños mayores y la gastrointestinal, en menores de 2 años. Todos presentaron alteracion en el nivel de conciencia y deficits neurologicos multifocales. El hallazgo radiologico mas frecuente fue la alteracion multifocal bihemisferica de la sustancia blanca. Los corticoides fueron el tratamiento de eleccion en la mayoria. La evolucion fue favorable en casi todos los pacientes excepto en dos, que tuvieron secuelas importantes. Conclusiones. La EMAD puede presentarse a cualquier edad, incluyendo lactantes. Hay multiples entidades que pueden simular una EMAD en un inicio.

Topics: Acyclovir; Adolescent; Adrenal Cortex Hormones; Antiviral Agents; Child; Child, Preschool; Diagnosis, Differential; Disease Progression; Encephalitis, Herpes Simplex; Encephalitis, Viral; Encephalomyelitis, Acute Disseminated; Female; Humans; Immunoglobulins, Intravenous; Infant; Lymphohistiocytosis, Hemophagocytic; Magnetic Resonance Imaging; Male; Plasmapheresis; Recovery of Function; Respiratory Tract Infections; Retrospective Studies; Spain; Symptom Assessment

Knowledge on pediatric herpes simplex virus encephalitis is limited. Here we summarize 6 neonates and 32 children diagnosed by polymerase chain reaction (n = 37) or serological studies (n = 1), respectively. Diagnosis was difficult, as only 15 patients presented neurologic symptoms. Moreover, cerebrospinal fluid glucose, protein, and leukocytes were normal in 6 patients. Subsequently, all but 2 showed neurologic symptoms. Diffusion-weighted neuroimaging was the most sensitive early imaging method. Despite acyclovir treatment, 8 patients experienced early relapses, showing movement abnormalities, impaired vigilance, and seizures. Diffuse white matter changes, found in 3 of 5 relapse patients on neuroimaging, and a negative cerebrospinal fluid herpes simplex virus polymerase chain reaction suggested inflammatory processes. All relapse patients were again treated with acyclovir, and 3 responded to additional corticosteroid treatment. Whereas outcome after relapses was poor, overall outcome was good. No child died; 14 were asymptomatic at discharge, and neuroimaging remained normal in 7 of 30 patients studied.

Topics: Acyclovir; Adolescent; Antiviral Agents; Brain; Child; Child, Preschool; Diffusion Magnetic Resonance Imaging; Encephalitis, Viral; Female; Herpes Simplex; Humans; Infant; Infant, Newborn; Male; Nerve Fibers, Myelinated; Prospective Studies; Recurrence; Retreatment; Retrospective Studies; Simplexvirus; Treatment Outcome

We present a 19-year-old woman with severe encephalitis and raised intracranial pressure requiring decompressive craniectomy. Her clinical features were consistent with encephalitis in the context of acute primary Epstein-Barr virus (EBV) infection (infectious mononucleosis). Serology, bone marrow aspirate and PCR of blood and cerebrospinal fluid confirmed the diagnosis. She was treated with corticosteroids and aciclovir. She was critically unwell for 3 weeks, requiring artificial ventilation but eventually made a good recovery. EBV encephalitis is uncommon, making the diagnosis and decisions about clinical management challenging.

Topics: Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Decompressive Craniectomy; Disease Management; Encephalitis, Viral; Epstein-Barr Virus Infections; Female; Humans; Treatment Outcome; Young Adult

Topics: Acyclovir; Aged; Antiviral Agents; Cerebellar Ataxia; Diagnosis, Differential; Encephalitis, Viral; Female; Humans

The authors present the case of an apparently immunocompetent 9-year-old child with probable cytomegalovirus encephalitis. The clinical picture was characterised by fever, frontal headache and behavioural changes, associated with visual and auditory hallucinations. Cerebrospinal fluid (CSF) biochemistry and brain CT were normal. Electroencephalography showed left temporal paroxysmal activity. Diagnosis was based on cytomegalovirus (CMV) DNA detection on the CSF by PCR. Acyclovir and ceftriaxone were given until herpes simplex virus (HSV) and bacterial encephalitis were ruled out. Rapid resolution of fever and complete clinical recovery was observed. Remarkably, anti-CMV serum antibodies were not detected on admission or until 6 months later. This discrepancy led us to question the presence of an impaired specific host humoral response, immune evasion by the virus or a false-positive result for CMV DNA in CSF.

Topics: Acyclovir; Antiviral Agents; Ceftriaxone; Child; Cytomegalovirus; Cytomegalovirus Infections; Diagnosis, Differential; DNA, Viral; Encephalitis, Viral; False Positive Reactions; Female; Humans; Immunocompetence; Infusions, Intravenous; Polymerase Chain Reaction

Severe neurologic complications have been rarely reported during novel pandemic influenza A(H1N1) virus infections. We describe the case of an 10-year-old boy with new onset seizures and proven influenza A(H1N1) 2009 infection showing a reversible hyperintense lesion in the splenium of the corpus callosum on T2-weighted and FLAIR magnetic resonance images without contrast enhancement. Transient splenial lesions have been described in the context of virus encephalopathy and do not require specific treatment.

Topics: Acyclovir; Anticonvulsants; Antiviral Agents; Child; Corpus Callosum; Diffusion Magnetic Resonance Imaging; Drug Therapy, Combination; Encephalitis, Viral; Epilepsy, Tonic-Clonic; Follow-Up Studies; Humans; Image Enhancement; Image Processing, Computer-Assisted; Influenza A Virus, H1N1 Subtype; Influenza, Human; Levetiracetam; Magnetic Resonance Imaging; Male; Oseltamivir; Pandemics; Piracetam; Reverse Transcriptase Polymerase Chain Reaction

To investigate how infants and children with suspected viral encephalitis are currently managed in a UK tertiary children's hospital.. Case notes of all infants and children who received intravenous aciclovir for suspected encephalitis over a 6-month period were reviewed. Suspected viral encephalitis was defined as a child with fever or history of febrile illness and a reduced level of consciousness, irritability or a change in personality or behaviour or focal neurological signs.. Fifty one children were identified. Two had proven herpes simplex encephalitis (HSV) and two had clinically diagnosed viral encephalitis with no cause identified. Forty children had cerebrospinal fluid (CSF) analysis, but basic results were incomplete in 13 cases. CSF was sent for the detection of HSV DNA by PCR in 27 cases. The initial dose of aciclovir was incorrect in 38 cases. The median (range) length of intravenous aciclovir treatment was 4 (1-21) days. Six children were given a full course of aciclovir (10 or more days). For 14 children, there appeared to be no real indication for starting aciclovir. Case note documentation was generally inadequate.. The management of children with suspected viral encephalitis appears haphazard in many cases. Guidelines for the management of children with suspected viral encephalitis are needed.

Topics: Acyclovir; Adolescent; Antiviral Agents; Child; Child, Preschool; DNA, Viral; Drug Administration Schedule; Encephalitis, Herpes Simplex; Encephalitis, Viral; Female; Glasgow Coma Scale; Humans; Infant; Infant, Newborn; Injections, Intravenous; Male; Practice Guidelines as Topic; Retrospective Studies; Simplexvirus; Spinal Puncture; Treatment Outcome

We describe a rare case of Influenza B-associated encephalopathy with hemorrhagic lesions of the corpus callosum. A 12-year-old Caucasian girl presented a 24-h fever followed by partial seizure, secondarily generalized, and disturbance of consciousness. Magnetic resonance imaging on Day 2 of her illness showed two hemorrhagic lesions of the corpus callosum. The Influenza B virus was found on nasopharyngeal swab. Neurologic signs had completely recovered by Day 3. A review of the literature identified a few similar cases; the common features include a relatively older age and prompt and complete recovery from clinical symptoms. This is the first report to describe hemorrhagic lesions of the corpus callosum in influenza.

Topics: Acyclovir; Anticonvulsants; Antiviral Agents; Child; Clonazepam; Corpus Callosum; Encephalitis, Viral; Female; Humans; Influenza B virus; Influenza, Human; Intracranial Hemorrhages; Magnetic Resonance Imaging; Neurologic Examination; Seizures, Febrile

Herpetic encephalitis (HSE) is one of the most severe infections of Central Nervous System (CNS). If not treated, it results in patient's death in 70% cases, although in properly treated cases the mortality rate is 30%. The most endangered group are patients with immunosuppression, including pregnant women and women in the peripartum period. We present a case of a young woman in puerperium period, who developed herpetic encephalitis. Despite proper treatment patient required long term hospitalization in ICU, where she was placed in pharmacological coma. Despite severe course of the disease no neurological sequelae were observed. The aim of this paper was to emphasize the necessity of immediate antiviral therapy with Acyclovir in all cases suspected of HSE. Additionaly HSE may progress rapidly and ICU treatment should be considered.

Topics: Acyclovir; Adult; Antiviral Agents; Encephalitis, Viral; Female; Herpesviridae Infections; Humans; Puerperal Disorders; Young Adult

A 12-year-old boy presented to a community hospital with fever, malaise and fatigue. A polymerase chain reaction test of the cerebrospinal fluid was positive for Epstein-Barr virus. Despite intensive care treatment and antiviral drugs, the patient died 1 month after his initial presentation.. Physical examination, polymerase chain reaction analysis of the cerebrospinal fluid, brain MRI, immunohistochemistry and molecular biological investigations of postmortem brain samples.. Epstein-Barr Virus encephalitis.. Aciclovir, intensive care treatment with intubation, sedation, antiepileptic drugs.

Topics: Acyclovir; Anticonvulsants; Antiviral Agents; Brain; Child; Conscious Sedation; Critical Care; Encephalitis, Viral; Epstein-Barr Virus Infections; Fatal Outcome; Herpesvirus 4, Human; Humans; Immunohistochemistry; Magnetic Resonance Imaging; Male; Polymerase Chain Reaction

The main predictor of outcomes in herpes simplex virus (HSV) encephalitis (HSE) is the delay between hospital admission and initiation of acyclovir. In this study, factors associated with late initiation of acyclovir were identified. The study included adults from northern France whose cerebrospinal fluid (CSF) was positive for HSV by PCR. Late initiation of acyclovir was defined as a delay of >1 day from hospital admission. In total, 184 patients were retrospectively enrolled from January 1991 to December 2002. The median age was 60 years (range: 17-91), and 102 (55.4%) were male. Acyclovir was initiated >1 day after hospital admission in 68 patients (37.0%). According to multivariate analysis, independent risk factors for late initiation of acyclovir were severe underlying disease (Knaus score >or=C) (OR 4.1; 95% CI 1.5-11.7); alcohol abuse (OR 3.4; 95% CI 1.3-8.9); and a delay of >1 day from admission to first brain imaging (OR 8.4; 95% CI 3.9-18.0). In addition, univariate analysis suggested an association between a finding of <10 leukocytes/mm(3) in CSF at admission (OR 2.5; 95% CI 0.7-5.8). These characteristics were found in 26 (14.1%), 23 (12.5%), 66 (35.9%) and 27 (14.7%) patients, respectively. One risk factor was identified in 109 (59.2%) patients, two in 29 (15.8%), and three in six (3.3%). Patients with HSE often present with severe underlying disease, chronic alcohol abuse, or atypical CSF findings, and such factors should not be allowed to delay diagnosis and administration of acyclovir.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Cerebrospinal Fluid; Encephalitis, Viral; Female; France; Herpes Simplex; Humans; Male; Middle Aged; Polymerase Chain Reaction; Retrospective Studies; Simplexvirus; Time Factors; Treatment Outcome; Young Adult

Topics: Acyclovir; Antiviral Agents; Cerebrospinal Fluid; Drug Monitoring; Encephalitis, Viral; Herpes Simplex; Humans; Infant; Plasma; Recurrence; Simplexvirus; Valacyclovir; Valine

A rare case of EBV encephalitis initially diagnosed as Herpes simplex infection is presented to highlight the importance of EBV specific intrathecal ELISA and liquor PCR based differential diagnosis when Herpes simplex encephalitis specific clinical symptoms, neuroimaging signs and electroencephalographic features are present. The case report also suggests that acyclovir treatment might be beneficial for the long term outcome in adult EBV encephalitis patients.

Topics: Acyclovir; Adult; Cerebrospinal Fluid; Diagnosis, Differential; Encephalitis, Herpes Simplex; Encephalitis, Viral; Enzyme-Linked Immunosorbent Assay; Epstein-Barr Virus Infections; Female; Head; Herpesvirus 4, Human; Humans; Polymerase Chain Reaction; Radiography; Treatment Outcome

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Cerebellar Ataxia; Combined Modality Therapy; Encephalitis, Viral; Humans; Immunoglobulins, Intravenous; Infectious Mononucleosis; Male; Methylprednisolone; Nystagmus, Pathologic

We evaluate the frequency of empiric acyclovir administration to patients in the emergency department (ED) who are ultimately diagnosed with encephalitis.. We conducted an explicit retrospective medical record review of consecutive patients discharged with a final diagnosis of herpes simplex encephalitis or viral encephalitis not otherwise specified for the period 1993 to 2003. The frequency of ED administration of empiric acyclovir was measured for patients who met the inclusion criteria of fever, neuropsychiatric abnormality, and cerebrospinal fluid pleocytosis with a negative Gram's stain result in the ED.. Of the 90 patients reviewed, 24 (27%) met the inclusion criteria of fever, neuropsychiatric abnormality, and cerebrospinal fluid pleocytosis with a negative Gram's stain result in the ED. Of these 24 patients, 7 (29%) received empiric acyclovir in the ED, 6 (86%) patients after cerebrospinal fluid results were available, with a median time to administration of 1.5 hours (95% confidence interval [CI] 0 to 3.1 hours). The remaining 17 (71%) patients did not receive acyclovir in the ED, with median times of 16 hours (95% CI 7.5 to 44 hours) before initiation of acyclovir in inpatient settings.. The majority of patients in our institution who were ultimately diagnosed with encephalitis did not receive empiric acyclovir in the ED, despite clinical presentations consistent with encephalitis.

Topics: Acyclovir; Adult; Child; Child, Preschool; Drug Utilization; Emergency Medicine; Emergency Service, Hospital; Encephalitis, Herpes Simplex; Encephalitis, Viral; Female; Humans; Infant; Infant, Newborn; Los Angeles; Male; Medical Audit; Middle Aged; Retrospective Studies

We report a case of subacute-onset isolated parkinsonian syndrome in a 16 years old patient. Epstein-Barr infection was diagnosed according to serologic evidences. Parkinson-like syndrome completely recovered after 60 days. Autoantibodies reacting against a 130 Kda antigens expressed in human neuroblastoma cell line were detected. Pathogenesis and differential diagnosis are briefly discussed. EBV testing could be worthwhile in juvenile, acute-onset, parkinsonism.

Topics: Acute Disease; Acyclovir; Adolescent; Antiviral Agents; Autoantibodies; Blotting, Western; Cell Line, Tumor; Encephalitis, Viral; Epstein-Barr Virus Infections; Humans; Male; Neuroblastoma; Neurons; Parkinsonian Disorders

We report here the case of a three-year-old boy presenting with an optic neuritis during the invasive phase of a chicken pox. This clinical, infrequent picture, can be directly due to the virus or be secondary to an auto-immune mechanism. The examination of the ocular fundus, the profile of the spinal fluid, the MRI and the measure of visual evoked potential allow to reach diagnosis and to identify the type of lesion. There is no consensus on the treatment of this optic neuritis and the current attitude is therapeutic abstention because of a rapid spontaneous improvement. Cerebellitis, meningitis can also be seen during chicken pox. Their evolution is quickly favorable, not requiring additional exam. Encephalitis can result from an auto-immune lesion of the white matter and require then the use of corticoids with antiviral drugs.

Topics: Acyclovir; Antiviral Agents; Ataxia; Chickenpox; Child, Preschool; Electroencephalography; Encephalitis, Viral; Evoked Potentials, Visual; Follow-Up Studies; Fundus Oculi; Humans; Magnetic Resonance Imaging; Male; Myoclonus; Optic Neuritis; Prognosis; Time Factors

To describe a case of limbic encephalitis which initially presented as viral limbic encephalitis and during the clinical evaluation a renal carcinoma was diagnosed.. Patient with history of peripheral paresis of right facial nerve, 1 month after symptoms appearance and treatment, developed fever, vomiting, grand mal seizure, decreased level of consciousness, confusion, hallucinations and agitation. The patient initially presented a clinical picture of viral LE. which confirmed by CSF. MRI brain showed areas with pathological intensity signal in the region of limbic system unilateral. During the clinical evaluation a renal carcinoma was discovered and a nephrectomy has been performed.. Although PLE typically presents as a chronic or subacute disease, it may be fulminant and clinically indistinguishable from an acute HSVE. This association pose the problem of a possible relation between this two syndromes and the correct diagnosis is very important, because there are effective treatments.

Topics: Acute Disease; Acyclovir; Anti-Bacterial Agents; Anticonvulsants; Carcinoma, Renal Cell; Cerebrospinal Fluid; Diagnosis, Differential; Drug Therapy, Combination; Electroencephalography; Encephalitis, Viral; Enoxaparin; Ethambutol; Follow-Up Studies; Herpesvirus 1, Human; Humans; Isoniazid; Limbic Encephalitis; Limbic System; Magnetic Resonance Imaging; Male; Meningoencephalitis; Methylprednisolone; Middle Aged; Nephrectomy; Neuropsychological Tests; Paraneoplastic Syndromes, Nervous System; Phenytoin; Rifampin; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vancomycin

West Nile Virus (WNV) infection is an important cause of encephalitis. Although the medical literature contains examples of WNV encephalitis in susceptible, mainly elderly, immunocompromised hosts, few case reports have described pediatric cases. The authors describe an adolescent with acute lymphocytic leukemia and WNV encephalitis. Surveillance studies indicate an increase in WNV activity. Physicians need to be aware of WNV activity in their community and consider WNV as a potential source of infection.

Topics: Acyclovir; Adolescent; Animals; Antibodies, Viral; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Brain; Ceftazidime; Ceftriaxone; Culicidae; Diagnosis, Differential; Encephalitis, Viral; Fatal Outcome; Humans; Immunoglobulins, Intravenous; Insect Bites and Stings; Magnetic Resonance Imaging; Male; Mercaptopurine; North Carolina; Persistent Vegetative State; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Vancomycin; Vincristine; Virginia; West Nile Fever; West Nile virus

Presented here is the case of an immunocompetent pregnant woman with probable cytomegalovirus encephalitis. The clinical picture was characterized by diffuse headache, drowsiness and the development of an acute confused state. Diagnosis was based on the documentation of recent cytomegalovirus seroconversion with low avidity for the immunoglobulin G class antibodies. Initially, the diagnosis of encephalitis was challenging due to the subtle findings in cerebrospinal fluid and the normal electroencephalograph results. However, repeated tests revealed findings compatible with the diagnosis of encephalitis. Due to the suspicion of herpes simplex encephalitis the patient was treated with acyclovir. Within a few days rapid resolution of the fever and complete recovery were observed. Cytomegalovirus encephalitis should be considered early in the evaluation of pregnant women if appropriate clinical symptoms are present.

Topics: Acyclovir; Adult; Cytomegalovirus Infections; Electroencephalography; Encephalitis, Viral; Female; Gestational Age; Humans; Immunocompetence; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Risk Assessment; Severity of Illness Index; Treatment Outcome

Causes and pathogenesis of psychiatric disorders is poorly understood. Infections by viruses or other agents may disturb neurotransmitters and elicit behavioral abnormalities, and induce long lasting immune reactions, referred to as mild encephalitis (ME). New findings (pathology, biochemistry, imaging) in schizophrenia and bipolar psychoses are compatible with ME hypothesis. In Chorea Sydenham and PANDAS syndrome autoimmune ME seems to explain anxiety-compulsive-hyperactivity symptoms. Add-on-therapy with Cox-II-blockers or valacyclovir improved acute schizophrenia, CSF filtration some cases of therapy resistant psychoses.

Topics: Acyclovir; Antiviral Agents; Brain; Cyclooxygenase Inhibitors; Demyelinating Autoimmune Diseases, CNS; Encephalitis, Viral; Humans; Mental Disorders; Treatment Outcome; Valacyclovir; Valine

The authors present a case of a preterm newborn with congenital infection of herpes simplex virus type 2. The patient was treated with newly recommended high intravenous doses of acyclovir. It can be supposed that it reduces mortality, but the high morbidity continues to be a problem.

Topics: Acyclovir; Encephalitis, Viral; Herpes Simplex; Herpesvirus 2, Human; Humans; Infant, Newborn; Infant, Premature, Diseases

Despite early antiviral treatment, herpes simples virus encephalitis (HSVE) still remains a life-threatening sporadic disease with high mortality and morbidity. In patients and in experimental disease, chronic progressive magnetic resonance imaging (MRI) abnormalities have been found even after antiviral therapy. Secondary autoimmune-mediated and not directly virus-mediated mechanisms might play a key role for the outcome of disease. This study aimed to evaluate a possible beneficial effect of a therapy of acyclovir and corticosteroids versus acyclovir only. In a mouse model of HSVE (intranasal inoculation with 10(5) pfu [plaque-forming units] of HSV-1 strain F), a long-term MRI study was realized. Cranial MRI was performed serially at days 2, 7, 14, 21, 60, and 180 in different therapy groups: 1, saline; 2, acyclovir; 3, acyclovir, subsequently methylprednisolone; 4, sham-infected with saline. Brain viral load peaked at day 7 to decline thereafter to a low baseline value. Viral load in group 1 was significantly higher than in animals with antiviral therapy. In group 4, no viral DNA was detectable. Viral load did not differ significantly between acyclovir and acyclovir/corticosteroid-treated groups, suggesting that the use of corticosteroids in addition to acyclovir does not increase viral burden. MRI findings in untreated and acyclovir-treated animals revealed chronic progressive changes. In contrast, there was a significant reduction of the severity of long-term MRI abnormalities in acyclovir/corticosteroid-treated animals. With respect to abnormal MRI findings, this study demonstrates a clear beneficial effect of an acyclovir and corticosteroid therapy without influencing brain viral load.

Topics: Acyclovir; Animals; Antiviral Agents; Drug Therapy, Combination; Encephalitis, Viral; Female; Glucocorticoids; Herpes Simplex; Magnetic Resonance Imaging; Methylprednisolone; Mice; Mice, Inbred Strains; Viral Load

Herpes simplex virus (HSV) infections of the central nervous system (CNS) can occur within weeks after birth (neonatal HSV disease) or in childhood or adulthood [herpes simplex encephalitis (HSE)]. Most cases of neonatal HSV disease are caused by HSV type 2, whereas virtually all cases of HSE are caused by HSV type 1. Diagnostic advances made during the past decade include the application of polymerase chain reaction (PCR) technology to cerebrospinal fluid from patients with suspected HSV CNS disease to evaluate for the presence of HSV DNA. Although not foolproof, PCR is a powerful diagnostic tool that has supplanted brain biopsy as the modality of choice for diagnosing HSV CNS disease, in no small part because of the invasiveness of brain biopsy. PCR also can provide information regarding the therapeutic response to antiviral therapy. Efforts made during the past decade to improve the outcome of HSV CNS disease have focused on increased doses of intravenous acyclovir administered for longer durations of time. Although advances have been achieved, morbidity and mortality rates from neonatal HSV disease and HSE remain unacceptably high.

Topics: Acyclovir; Antiviral Agents; Central Nervous System Diseases; Encephalitis, Viral; Female; Herpes Simplex; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infectious Disease Transmission, Vertical; Polymerase Chain Reaction; Pregnancy; Pregnancy Complications, Infectious; Risk Factors; Simplexvirus

Corticosteroids are often used in the treatment of acute viral encephalitis, although the efficacy of corticosteroid therapy has not been proven. We examined the effects of high-dose corticosteroid therapy on acute viral encephalitis in 5 patients with progressive disturbances of consciousness. In 3 patients who were treated within 5 days after the onset of illness, pulse therapy dramatically reduced the degree of consciousness disturbance. They became alert within 24 h, and then neurological symptoms gradually improved. Corticosteroid therapy in the other 2 patients, in whom treatment was started more than 3 weeks after the onset of illness, was not as effective, but repeated therapy at 2-week intervals resulted in complete recovery. These findings suggest that high-dose corticosteroid therapy is effective, particularly for disturbances of consciousness, an important prognostic factor in acute viral encephalitis.

Topics: Acute Disease; Acyclovir; Adrenal Cortex Hormones; Adult; Antiviral Agents; Cell Count; Consciousness; Disease Progression; Drug Therapy, Combination; Encephalitis, Viral; Female; Glasgow Coma Scale; Globins; Glucocorticoids; Humans; Male; Methylprednisolone; Middle Aged; Pulse Therapy, Drug

Topics: Acute Kidney Injury; Acyclovir; Adult; Antiviral Agents; Coma; Encephalitis, Viral; Humans; Male

A prospective study of childhood encephalitis was performed in Bangkok from 1996 through 1998. The viral agents identifiable in 26 (65%) of 40 children were dengue virus (8), Japanese encephalitis (6), herpes simplex virus (4), human herpes virus type 6 (3), mumps (2), enterovirus (1), varicella-zoster virus (VZV) (1) and rabies (1).

Topics: Acyclovir; Adolescent; Antibodies, Viral; Antiviral Agents; Child; Child, Preschool; Cohort Studies; Diagnosis, Differential; Encephalitis, Viral; Female; Humans; Infant; Male; Polymerase Chain Reaction; Prospective Studies; Seasons; Thailand

In adults, neurological complications of VZV virus usually occur after herpes zoster infection in patients with AIDS. We report a case of acute and benign cerebellar ataxia after chickenpox in a patient without immunodeficiency.

Topics: Acyclovir; Adult; Cerebellar Ataxia; Chickenpox; Encephalitis, Viral; Humans; Male; Neurologic Examination

Topics: Acyclovir; Antiviral Agents; Drug Therapy, Combination; Encephalitis, Viral; Eye Infections, Viral; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Middle Aged; Prednisolone; Prodrugs; Retinal Necrosis Syndrome, Acute; Tropanes; Vitreous Body

Topics: Acyclovir; Antiviral Agents; Brain Stem; Encephalitis, Viral; Herpes Zoster; Humans; Male; Middle Aged

Topics: Acyclovir; Adult; Antiviral Agents; Brain; Encephalitis, Viral; Female; Follow-Up Studies; Herpes Simplex; Humans; Magnetic Resonance Imaging; Simplexvirus

Topics: Acyclovir; Antiviral Agents; Brain; Encephalitis, Viral; Female; Herpes Simplex; Humans; Magnetic Resonance Imaging; Male

This case report is presented to raise the awareness of the potential risk of reactivation of herpes simplex virus (HSV) encephalitis after intracranial surgery.. The case of an 8-year-old male patient who suffered a reactivation of HSV encephalitis after undergoing amygdalohippocampectomy for complex partial seizures is reported. This patient had previously contracted HSV 1 meningoencephalitis at the age of 16 months. Six years later, a left amygdalohippocampectomy was proposed after the development of intractable partial epilepsy associated with left mesial temporal lesions. During the postoperative period, the patient suffered severe clinical deterioration with partial status epilepticus, aphasia, and hyperthermia, which resolved after intensive antiepileptic treatment supported by acyclovir.. We advise prophylactic pre-, peri-, and postoperative treatment with acyclovir for patients with known histories of HSV encephalitis who undergo intracranial procedures.

Topics: Acyclovir; Antiviral Agents; Child; Encephalitis, Viral; Epilepsies, Partial; Herpesvirus 1, Human; Humans; Magnetic Resonance Imaging; Male; Postoperative Complications; Recurrence; Sclerosis; Temporal Bone

Encephalitis is an uncommon clinical entity compared to traumatic brain injury, and stroke. Many encephalitis survivors have disabling sequelae. There is scant information in the literature addressing outcome following inpatient rehabilitation for encephalitis. Further, it is unclear which of these patients will benefit from acute in-patient rehabilitation.. The purposes of this study are to (1) describe the outcome following in-patient rehabilitation in a cohort of patients with encephalitis, and (2) develop preliminary criteria to guide the selection of patients with encephalitis who may benefit from inpatient rehabilitation.. The demographic, clinical, functional (functional independence measure-FIM) and neuro-psychological data were retrospectively abstracted for eight subjects with a clinical diagnosis of encephalitis aged 5 to 75 years, who were admitted to a brain injury rehabilitation unit between 1990 and 1997.. In the eight subjects, the mean age was 38 years, mean acute hospital stay (ALOS) was 40.3 days, and mean rehabilitation length of stay (RLOS) was 75.9 days. Mean admission FIM (AFIM) was 40.1, mean discharge FIM (DFIM) was 69.9. Mean FIM gain was 29.8 and mean FIM efficiency was 0.39. Adult subjects with an AFIM > 30 at 5 weeks from onset of illness (n = 4) had a FIM LOS efficiency of 0.64 and all four were discharged home. None of the adult subjects with an AFIM < 30 at 5 weeks from onset of illness (n = 3, FIM efficiency = 0.14) were discharged home. A child with an AFIM < 30 (n = 1) had a FIM LOS efficiency of 1.24, made good recovery and was discharged home. FIM LOS efficiency of 0.64 in encephalitis is less, as compared to traumatic brain injury (TBI -1.27) and stroke (1.06).. The results of this study showed that, although subjects with encephalitis make functional gains in rehabilitation, the rate of recovery varies and is generally less than that for TBI and stroke. The study also suggests that FIM scores can be used for screening adult patients after encephalitis for admission to inpatient rehabilitation. Adult patients with an AFIM > 30, 5 weeks post onset of illness are likely to make reasonable progress and be discharged home. If replicated, these results suggest that despite low AFIM scores at 5 weeks from onset of illness (AFIM < 30), children may still make good progress and should be given a trial of in-patient rehabilitation.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Child; Child, Preschool; Cognition Disorders; Encephalitis, Viral; Female; Hospitalization; Humans; Male; Middle Aged; Retrospective Studies; Severity of Illness Index; Treatment Outcome

Herpes simplex virus is the most common cause of acute viral encephalitis in children. Due to the variety of possible clinical manifestations the diagnosis is often overlooked in the early stages of the disease. Anti-viral therapy with acyclovir should be started whenever HSE is suspected. When there is further deterioration under virostatic therapy, a brain biopsy should be performed to verify the diagnosis. But even when the adequate medical therapy is established, massive brain edema and brain shift resulting in tentorial herniation can develop. Up to now the reported mortality of these patients is still around 30%. Here we report on a child with severe necrotizing herpes simplex encephalitis who developed severe tentorial herniation due to a right-sided mass lesion. The patient's status markedly improved after decompressive anterior temporal lobe resection. To our knowledge a similar case has not yet been reported in the literature. We suggest that anterior temporal lobe resection and decompressive craniotomy is of benefit in selected cases with tentorial herniation because both decompression and reduction of infectious material can be achieved.

Topics: Acyclovir; Antiviral Agents; Biopsy; Encephalitis, Viral; Female; Herpes Simplex; Humans; Infant; Magnetic Resonance Imaging; Neurologic Examination; Seizures; Simplexvirus; Temporal Lobe; Tomography, X-Ray Computed

Twenty eight children with herpes simplex encephalitis were followed up for a mean of 5.5 years. Two children died and 26 survived, of whom 16 were left with no neurological sequelae and 10 had persistent neurological sequelae. Mean (SD) Glasgow coma score was significantly lower in the patients with neurological sequelae (7.7 (1.5)) and the patients who died (4.5 (0.7)), compared with the patients without neurological sequelae (11 (1.7)).

Topics: Acyclovir; Adolescent; Age Factors; Antiviral Agents; Child; Child, Preschool; Encephalitis, Viral; Female; Follow-Up Studies; Glasgow Coma Scale; Herpes Simplex; Humans; Infant; Male; Simplexvirus

The development of antiviral therapy increases the need for rapid, sensitive and reliable methods or combination of methods for diagnosis and monitoring herpes simplex encephalitis, HSE.. Evaluation of diagnostic performance of three successively developed HSV PCR assays when combined with a new capture ELISA for HSV intrathecal antibody production (ITT).. During a 3.6 year period a total of 4.206 CSF and serum samples from about 4.140 hospitalized patients with a tentative diagnosis of HSE were analyzed by a new ELISA for ITT. 1.962 CSF samples were examined also by PCR. Clinical signs and symptoms and additional tests were obtained on all ITT and/or PCR positive patients. In 1993 the PCR was a double PCR. In 1994 the PCR was a single PCR with internal inhibition control. Positive samples were confirmed by a different confirmative PCR to increase the specificity. From 1995 the PCR was as in 1994 but samples were no longer divided in the serology routine laboratory.. A total of 33 HSE cases was found (incidence 1.8 HSE per million people). All patients were treated with aciclovir. Three patients died, 9 patients had primary infection, 2 patients had HSE previously, and 2 patients relapsed. Only 11 patients recovered satisfactory. Of all 37 positive ITT 7 were unlikely positive. False positive PCR was seen in 1993 and 1994, due to sample-to-sample contamination during division of samples, but was not seen since 1995 when this procedure was changed. The test results depended on the state of the disease. Thus, the sensitivity, specificity, PPV and NPV for ITT were highest when performed more than 1 week after debut of symptoms whereas these values were highest using PCR within the first week.. Routine PCR diagnosis of HSE type 1 and 2 is a highly sensitive and specific method that should be performed together with serological ITT to cover the whole time span from debut of symptoms to several weeks after hospitalization.

Topics: Acyclovir; Adolescent; Adult; Aged; Antibodies, Viral; Antimetabolites; Antiviral Agents; Blotting, Southern; Child; Encephalitis, Viral; Enzyme-Linked Immunosorbent Assay; Female; Herpes Simplex; Humans; Immunoglobulin G; Infant; Male; Middle Aged; Polymerase Chain Reaction; Prevalence; Sensitivity and Specificity; Simplexvirus

The purpose of the present study was to determine if the quantity of herpes simplex virus (HSV) DNA in the cerebrospinal fluid (CSF) of patients with herpes encephalitis would be useful in establishing the prognosis of the disease and to determine the effect of antiviral therapy on the clearance of viral DNA from the CSF. Quantitation of HSV DNA was done by constructing an internal standard (IS) from the glycoprotein B amplicon which had a 25-bp deletion between primer annealing sites. Each CSF specimen was coamplified with the IS and the ratio of the amount of HSV/amount of IS was compared to the ratios on a standard curve constructed with the same IS plus known amounts of HSV DNA. CSF specimens were available from 16 patients who were treated with intravenous acyclovir, and the amount of HSV DNA ranged from < 25 to 18,000 copies per microliter in CSF obtained before or within 4 days of the initiation of acyclovir therapy. Patients with > 100 copies of HSV DNA per microliter were older, were found by computed tomography to have lesions, and had poorer outcomes than patients with < 100 copies. Follow-up CSF specimens were available from seven patients. In six of these seven patients, the HSV DNA levels decreased during therapy. One patient had a twofold increase in HSV DNA levels after 1 week of therapy and died on day 8. The application of this assay may be helpful in establishing the prognosis and in the monitoring of patients with herpes simplex encephalitis.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Base Sequence; Cerebrospinal Fluid; Child; Child, Preschool; DNA, Viral; Encephalitis, Viral; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Infant; Male; Middle Aged; Molecular Sequence Data; Polymerase Chain Reaction; Prognosis; Time Factors; Treatment Outcome; Viral Envelope Proteins

A previously healthy 7-year-old girl suffered from oral herpetic gingivostomatitis. After four days, oral administration of acyclovir (ACV), 1,000 mg in five divided doses, was started. She became irritable and intermittently delirious next day. Laboratory tests of blood and cerebrospinal fluid (CSF) were within normal limits and EEG showed no abnormality. Brain CT and MRI demonstrated mild asymmetry of the lateral ventricle. SPECT showed low perfusion area in the bilateral thalamus. The titer of IgG and IgM against herpes simplex virus (HSV) was increased in the serum but not in the CSF. A PCR study of HSV DNA was negative in the CSF. ACV was discontinued after 5 days' administration and she recovered from neurological disorders within 48 hours. ACV neurotoxicity is self-limiting and dose-dependent. It may be distinguished from herpes simplex encephalitis by the lack of fever, headache, focal neurologic signs, and abnormal CSF and neuroradiological findings. However, when the differentiation should be difficult, we believe that the administration of ACV can be carefully continued because the potential fatality of HSE is high while ACV neurotoxicity is reversible.

Topics: Acyclovir; Antiviral Agents; Child; Diagnosis, Differential; Encephalitis, Viral; Female; Herpes Simplex; Humans; Psychoses, Substance-Induced; Stomatitis, Herpetic

We reported a 5-year-old boy with acute encephalitis due to suspected herpes simplex infection, who developed confusion, agitation and insomnia during intravenous administration of acyclovir. He recovered from these neuro-psychiatric symptoms two days after the cessation of acyclovir. The same symptoms recurred two days after its re-administration and resolved on the next day of the second cessation of the drug. Electroencephalogram (EEG) showed periodic lateralized epileptiform discharges (PLEDs) on hospital day 16, which disappeared on hospital day 27, suggesting that neurotoxicity of acyclovir may induce PLEDs. Although acyclovir is useful for the treatment of herpes simplex and varicella-zoster virus infections, we have to pay attention to its neurotoxicity.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Child, Preschool; Encephalitis, Viral; Herpes Simplex; Humans; Male; Psychoses, Substance-Induced

Acute retinal necrosis (ARN) syndrome is associated with members of the herpes virus family, but the mechanisms of infection remain unclear. The purpose of this study is to report a unique case of acute retinal necrosis syndrome associated with herpetic encephalitis in order to elucidate possible factors involved in herpetic central nervous system disease.. Case report.. A 64-year-old woman who developed acute herpes simplex virus encephalitis associated with bilateral acute retinal necrosis syndrome after craniotomy for resection of a suprasellar craniopharyngioma is presented. The results of lumbar puncture, magnetic resonance imaging, and ophthalmologic examination are consistent with herpetic infection. The origin of acute retinal necrosis syndrome and the association of acute retinal necrosis syndrome with encephalitis are reviewed.. After craniotomy, we hypothesize reactivation of previously latent herpes simplex virus in the area of the inferior frontal lobe and optic chiasm. Reactivated virus may have migrated to the retina by axonal transport, through the optic nerves, to produce the acute retinal necrosis syndrome.

Topics: Acyclovir; Axonal Transport; Cerebrospinal Fluid; Craniopharyngioma; Craniotomy; Encephalitis, Viral; Eye Infections, Viral; Female; Herpes Simplex; Herpesvirus 2, Human; Humans; Magnetic Resonance Imaging; Middle Aged; Optic Nerve; Pituitary Neoplasms; Retinal Necrosis Syndrome, Acute; Spinal Puncture; Virus Activation; Virus Latency

Topics: Acyclovir; Antibodies, Viral; Antiviral Agents; Consensus Development Conferences as Topic; Encephalitis, Viral; Europe; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Herpesvirus 3, Human; Humans; Polymerase Chain Reaction; Simplexvirus

Protection and therapy of NMRI mice with experimental herpes virus (HSV-1) encephalitis were investigated using heat-killed, lyophilized Propionibacterium avidum KP-40 (PA) and/or the herpes-specific antiviral substance acyclovir (ACL) as immunomodifier. Poly I:C as a potent macrophage activator was used as a reference compound for PA. Survival of experimental HSV-1 infections during 18 days following the inoculation of viruses was used for the evaluation of the effects of immunotherapy. The applied model of HSV-1 infection resulted in a mortality of about 87% of NMRI mice at 7-16 days following the inoculation of the virus. Treatment with ACL or Poly I:C at the day of HSV-1 infection resulted in a lowering of the mortality rate to about 40% (p < 0.05). PA applied 4 days before HSV-1 infection lowered the mortality rate to 27%, while treatment 2 days after infection was less effective and the mortality rate reached 44%, although still being significantly lower (p < 0.01) than in untreated controls. A combined treatment with ACL and PA on the day of HSV-1 infection protected 93% of animals against the development of clinically detectable herpesvirus encephalitis.

Topics: Acyclovir; Adjuvants, Immunologic; Animals; Antiviral Agents; Cells, Cultured; Drug Therapy, Combination; Encephalitis, Viral; Herpes Simplex; Herpesvirus 1, Human; Immunotherapy; Male; Mice; Poly I-C; Propionibacterium; Rabbits

We used a nested polymerase chain reaction assay to quantitate the number of viral copies in cells of CSF of eight patients with herpes simplex virus encephalitis (HSVE). The viral load was monitored in serial CSF samples during the course of disease and correlated to clinical symptoms, radiologic manifestations, efficacy of acyclovir treatment, and overall clinical outcome. Before treatment, HSV type 1 (HSV-1) copies were detected at a mean value of 1,786/10(5) (range, 5 to 8,333/10(5) cells; median, 81/10(5) cells). During therapy, HSV-1 DNA decreased gradually to a mean value of 6 copies/10(5) cells (range, 0 to 33 copies/10(5) cells; median, 0 copies/10(5) cells) within 6 to 21 days and disappeared or was barely detectable before treatment completion in most cases. The HSV-1 burden in the CSF did not clearly correlate with the severity of clinical signs or the degree of cranial imaging findings and overall outcome. Quantitation of HSV-1 copies allows rapid and reliable monitoring of antiviral therapy. The absence of a clear correlation between viral load in the CSF and morbidity may suggest a role for indirect mechanisms of brain injury in HSVE.

Topics: Acyclovir; Antiviral Agents; Cerebrospinal Fluid; DNA, Viral; Encephalitis, Viral; Herpes Simplex; Herpesvirus 1, Human; Humans; Magnetic Resonance Imaging; Polymerase Chain Reaction; Prognosis

Topics: Acyclovir; Adult; Antiviral Agents; Encephalitis, Viral; Fundus Oculi; Herpes Simplex; Humans; Male; Retinal Necrosis Syndrome, Acute; Vision Disorders

Follow up of cognitive sequelae of acute encephalitis and estimation of the frequency of persisting dementia.. Out of a series of 45 consecutive patients with acute encephalitis prospectively studied in 1990-95, 40 were screened for difficulty in everyday life using the Blessed dementia scale (BDS) 3.7 (1.4), mean (SD), years after onset. Eight patients had had herpes simplex encephalitis (HSVE), 16 some other identified aetiology, and in 21 the aetiology was unknown. All, except two patients with a nonherpetic encephalitis, were treated with acyclovir. All patients with disability in BDS (12/40), were invited to a neuropsychological reassessment, and the results of this assessment were compared with those of a similar assessment done after the acute stage. At follow up one patient could not complete the tests due to intractable epilepsy.. In six of 11 cases the symptoms causing disability were mainly psychiatric. Five patients (two with HSVE) had a pronounced memory impairment together with other cognitive deficits, indicating dementia (frequency of 12.8%). In eight of the 11 testable cases cognitive performance had improved over the years, in two cases a decline was found and one patient with severe deficits showed no change. Intractable epilepsy was found in four of 12 cases.. Cognitive decline had taken place already at the acute stage, and further deterioration was uncommon. Considerable improvement occurred in most patients during follow up. Also in patients with HSVE treated with acyclovir the cognitive recovery was substantial and of a magnitude not expected based on previous literature. Intractable epilepsy contributed to the cognitive deterioration in some cases. Affective disorders also had a surprisingly important role for the long term outcome.

Topics: Acute Disease; Acyclovir; Adult; Aged; Antiviral Agents; Cognition Disorders; Depressive Disorder; Encephalitis, Viral; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neuropsychological Tests; Prospective Studies; Severity of Illness Index

This study sought to produce a cognitive profile of herpes simplex encephalitis (HSE) survivors from a large group of definitively diagnosed, acyclovir-treated participants. Results from 22 adults who underwent a battery of neuropsychological tests indicated anterograde memory dysfunction to be the most severe and common deficit (although the variation was great), with less severe and less frequent impairments in the areas of retrograde memory, executive functions, and language functioning. Overall, neuropsychological outcome was unimpaired in six participants, mildly impaired in thirteen, moderately impaired in one, severely impaired in two. Older participants and those with a lower level of consciousness before the start of treatment produced poorer scores on certain aspects of cognitive outcome (p < 0.05). A significantly better cognitive outcome was found in participants for whom there was a short delay (fewer than 5 days) between symptom onset and acyclovir treatment compared with those participants for whom there was a longer delay. The two children in the study had disparate results on most tests, the exception being those assessing memory functioning on which both children had scores at population norms. On a naming task designed to explore category-specific knowledge deficits, the adults as a group made more errors on pictures of living things than nonliving things (matched pair-wise for word frequency and visual familiarity), although this difference disappeared on a smaller subset of pictures also matched for visual complexity.

Topics: Acyclovir; Adolescent; Adult; Aged; Amnesia; Anomia; Antiviral Agents; Brain Damage, Chronic; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Administration Schedule; Encephalitis, Viral; Female; Follow-Up Studies; Herpes Simplex; Humans; Male; Middle Aged; Neuropsychological Tests; New Zealand; Paired-Associate Learning; Survivors

To identify varicella-zoster virus (VZV) infections of the nervous system in patients infected with human immunodeficiency virus (HIV), polymerase chain reaction (PCR) analysis of cerebrospinal fluid (CSF) samples from 514 consecutive HIV-infected patients with neurological disease was performed to detect VZV DNA. VZV DNA was detected in CSF of 13 (2.5%) of 514 patients. Four of 13 patients had VZV encephalitis or meningoencephalomyelitis. These four patients received intravenous acyclovir therapy; CSF became negative for VZV DNA and clinical conditions improved for two, whereas CSF remained positive for VZV DNA and clinical conditions worsened until death for two. In nine of 13 patients, the neurological symptoms were likely caused by other simultaneous HIV-related complications in the central nervous system. After intravenous therapy with high doses of acyclovir or foscarnet, VZV was cleared from CSF in eight of nine patients. VZV DNA can be detected in CSF of HIV-infected patients in association with either manifestations of neurological VZV disease or subclinical reactivation of VZV infection. Antiviral treatment may be effective in suppressing VZV replication in the nervous system.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Antiviral Agents; Central Nervous System Infections; DNA, Viral; Encephalitis, Viral; Encephalomyelitis; Herpes Zoster; Herpesvirus 3, Human; Humans; Meningoencephalitis; Polymerase Chain Reaction; Recurrence

The frequency and characteristics of the long term sequelae of herpes simplex encephalitis were assessed after treatment with acyclovir.. Patients were included if they were treated with acyclovir and the diagnosis of herpes simplex encephalitis was confirmed by culture of herpes simplex virus (HSV) from the brain, an increase in the CSF HSV antibody titre, or detection of HSV deoxyribonucleic acid in the CSF. Each patient's medical records were reviewed and surviving patients were interviewed and examined.. A diagnosis of herpes simplex encephalitis was confirmed in 42 patients. Five patients (12%) died in the first month. Three patients (7%) had severe neurological sequelae and died after a longer interval. All but one of the 34 surviving patients had neurological symptoms, an abnormal neurological examination, or both. Twenty patients (48%) performed everyday activities as well as before herpes simplex encephalitis; nine patients (21%) were living independently, but were functioning at a lower level than before the illness; and five patients (12%) had a severe neurological deficit. Twenty nine of the 34 survivors were assessed six months to 11 years after herpes simplex encephalitis. The most common long term symptoms were memory impairment (69%), personality and behavioural abnormalities (45%), and epilepsy (24%). Short term memory impairment (70%), anosmia (65%), and dysphasia (41%) were the most common signs.. Although acyclovir has reduced the mortality of herpes simplex encephalitis, 30% of this group of patients either died or had a severe neurological deficit. The other 70% of the patients regained independence in activities of daily living, but most of these people had persistent neurological symptoms, signs, or both.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Child; Child, Preschool; DNA, Viral; Electroencephalography; Encephalitis, Viral; Female; Herpes Simplex; Humans; Infant; Male; Middle Aged; Neurologic Examination; Olfaction Disorders

A sixty-six year old female was admitted to the hospital with an incomplete hemiparesis on the left side combined with a short episode of unconsciousness. According to her husband's account she had a seizure. Relevant laboratory measurements: plasma sodium concentration 113.9 mmol/l, plasma concentration of ADH 10.3 pg/ml, urine sodium concentration 44.4 mmol/l. The plasma concentrations of creatinine and urea were within normal limits. The working hypothesis was SIAD (syndrome of inappropriate antidiuresis) or Schwartz-Bartter-syndrome. The patient was treated immediately with water restriction (500-1000 ml/day), furosemide and i.v. replacement of urinary sodium losses by 3% NaCl. The analysis of cerebrospinal fluid showed pleocytosis and increased concentrations of immunoglobulins G and M. Serological diagnosis was positive for antigen of varicella-zoster virus. These observations were thought to be compatible with a diagnosis of SIAD in the setting of encephalitis. Under water restriction, infusion of 3% saline, treatment with loop diuretics and aciclovir (3 x 750 mg daily) the neurological function returned to normal within 2 days. A standard oral water load on the 14th hospital days showed a return to a normal water metabolism.

Topics: Acyclovir; Aged; Antiviral Agents; Combined Modality Therapy; Diagnosis, Differential; Diuretics; Encephalitis, Viral; Female; Hemiplegia; Herpes Zoster; Herpesvirus 3, Human; Humans; Hyponatremia; Immunoglobulin G; Immunoglobulin M; Inappropriate ADH Syndrome; Unconsciousness

We present a case of subacute focal encephalitis in a 62-year-old man whose clinical manifestations, neuroradiological findings and histopathological features mimicked those of a patient with malignant lymphoma of the central nervous system (CNS). In addition to routine histopathological examination, extensive studies including serological examination for encephalitic viruses, immunohistochemistry and DNA analysis were required to distinguish focal encephalitis from lymphoma of the CNS, clinical entities which differ in treatment.

Topics: Acyclovir; Antiviral Agents; Blotting, Southern; Brain Neoplasms; Diagnosis, Differential; Encephalitis, Viral; Herpes Simplex; Humans; Lymphoma; Magnetic Resonance Imaging; Male; Middle Aged

Primary varicella-zoster virus (VZV) infections in adults generally follow a more severe course than in children and are more often associated with life-threatening complications. In the years 1992 to 1995 we observed 7 immunocompetent adults with a severe course of primary VZV infection. All 7 patients presented initially with a characteristic rash. In 6 patients the diagnosis of VZV was confirmed by ELISA on material taken from the lesions, and in all of them it was confirmed by serology. The following complications were observed: pneumonia (5x), elevated liver enzymes (4x), myocarditis (1x), encephalitis (1x) and myelitis (1x). Pulmonary lesions were characterized by bilateral interstitial infiltrates on chest-x-ray and required mechanical ventilation in 2 patients. The liver enzymes were only slightly elevated and clinically not significant. Myocarditis in one case was postulated in view of elevated creatine kinase levels, ECG-repolarization changes and AV-block III which required the insertion of a transitory pacemaker. Encephalitis presented as abnormal behaviour at work followed by seizures. Myelitis was suspected due to ascending sensory motor tetraparesis and confirmed by MRI. All patients were treated with high doses of parenteral acyclovir (3 x 10 mg/kg body weight i.v. per day) for 5-12 days. 6 patients recovered completely and only the patient with myelitis has residual neurological deficits 3 months after discharge. Although we cannot exclude the possibility that supportive therapy without acyclovir would have had the same outcome, we recommend high-dose parenteral acyclovir for treatment of visceral and neurological complications in primary VZV infections in adults.

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Encephalitis, Viral; Female; Herpesvirus 3, Human; Humans; Male; Middle Aged; Myelitis; Myocarditis; Pneumonia, Viral

Topics: Acyclovir; Adolescent; Encephalitis, Viral; Herpes Simplex; Humans; Male

The presence of PLED or localized or lateralized periodic activity in encephalitis strongly suggests that the encephalitis is due to the herpes simplex virus. Nevertheless, there has been controversy over its clinical significance. In addition, since the introduction of antiviral drugs in the treatment of herpes encephalitis in its initial stages, the prognosis of the disease has improved. We studied nine patients all diagnosed as having herpes encephalitis and treated with acyclovir. The presence or absence of periodic activity and its characteristics were analyzed. It was seen that either there was no such activity, or if there was, it was not exactly as classically described.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Brain; Electroencephalography; Encephalitis, Viral; Female; Humans; Male; Middle Aged; Simplexvirus

Herpes simplex encephalitis is an important disease characterized by focal haemorrhagic necrosis of the temporal and frontal lobes of the brain. The mortality rate may be as high as 70% of untreated cases. Isolation of the virus from brain tissue is the most reliable means of diagnosis. Although some non-invasive diagnostic modalities have been investigated, none is as reliable as brain tissue sampling. Despite acceptance that acyclovir sodium is the most effective drug for treatment, there is not a consensus on the dosage and duration of the antiviral therapy because some patients fail to respond and sometimes there is recurrence following therapy. We report a case of encephalitis in a previously normal host who died after a 13-day course of acyclovir therapy with isolation of HSV-type 1 from the brain post mortem.

Topics: Acyclovir; Antiviral Agents; Brain; Ceftriaxone; Child; Drug Resistance; Encephalitis, Viral; Fatal Outcome; Female; Herpes Simplex; Herpesvirus 1, Human; Humans

Topics: Acyclovir; Adult; Antiviral Agents; Diabetes Insipidus; Encephalitis, Viral; Female; Frontal Lobe; Glasgow Coma Scale; Herpes Simplex; Humans; Magnetic Resonance Imaging; Temporal Lobe; Tomography, X-Ray Computed

Topics: Acyclovir; Antiviral Agents; Encephalitis, Viral; Herpes Simplex; Humans; Infant; Male; Prognosis

The long-term neuropsychological and psychiatric sequelae of herpes simplex virus encephalitis (HSVE) and their relationship to the volume of temporal lesions and to amygdala and hippocampus damage remain undefined. We have conducted a prospective study of long-term sequelae in 11 patients with clinically presumed HSVE and detection of HSV DNA in the cerebrospinal fluid by polymerase chain reaction. Six months after encephalitis, patients underwent neuropsychological and language assessment. At the same stage, single photon emission computed tomography (SPECT) evaluated the occurrence of hypoperfusion with an index of asymmetry. MRI was used for the measurement of amygdala, hippocampus and cerebral lesions by two blind neurologists. The volume of the amygdala and hippocampus was compared with those of five controls, matched for age and level of education. Long-term memory disorders were seen in 6 patients, associated with the larger lesions and damage of at least two structures. Long-term behavioural changes with emotionalism, irritability, anxiety or depression were prominent in 7. Left prefrontal hypoperfusion appeared in 8 patients, associated with psychiatric disorders in 7 and left amygdala damage in 6. The reduction of amygdala and hippocampus volume was correlated with the overall volume of lesions. Different patterns of mesial temporal lobe damage occurred, involving either amygdala alone, or amygdala and hippocampus, but never hippocampus alone. MRI volumetric measurements in HSVE could be a good indicator of long-term prognosis. Persistant behavioural changes could be related to an amygdala and frontal dysfunction.

Topics: Acyclovir; Adult; Aged; Amygdala; Case-Control Studies; Cerebrovascular Circulation; Cognition Disorders; Encephalitis, Viral; Evaluation Studies as Topic; Female; Herpes Simplex; Hippocampus; Humans; Magnetic Resonance Imaging; Male; Mental Disorders; Middle Aged; Neuropsychological Tests; Prospective Studies; Tomography, Emission-Computed, Single-Photon

To describe a case of acute retinal necrosis with concurrent encephalitis and determine the causative virus. The patient had a history of presumed acute retinal necrosis in the left eye at the age of 8 years and recurrent genital herpes.. Diagnostic anterior chamber puncture of the eye and lumbar puncture for laboratory analysis.. Polymerase chain reaction identified herpes simplex virus type 2 in the eye, and local antibody production to herpes simplex virus was demonstrated in the aqueous of this eye and in the cerebrospinal fluid.. Herpes simplex virus type 2 may cause bilateral acute retinal necrosis with long delay of fellow eye involvement and concurrent encephalitis.

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Aqueous Humor; Cerebrospinal Fluid; Combined Modality Therapy; DNA, Viral; Encephalitis, Viral; Eye Infections, Viral; Female; Fluorescein Angiography; Fundus Oculi; Herpes Genitalis; Herpes Simplex; Herpesvirus 2, Human; Humans; Laser Therapy; Polymerase Chain Reaction; Recurrence; Retinal Necrosis Syndrome, Acute

A patient with AIDS who developed the clinical picture of bilateral progressive outer retinal necrosis (PORN) in combination with varicella zoster encephalitis is described. The picture developed more than 2 years after an episode of ophthalmic zoster infection, and following intermittent exposure to oral acyclovir because of recurrent episodes of cutaneous herpes simplex infection.. Aqueous humour, obtained by paracentesis of the anterior chamber, was analysed using immunofluorescence and polymerase chain reaction (PCR). Postmortem analysis of eye and brain tissue was performed by using conventional techniques and in situ hybridisation.. While conventional techniques all failed to detect a causative agent, analysis of the aqueous humour using PCR, and histological examination of necropsy specimens from eyes and brain using in situ hybridisation were conclusive for the diagnosis varicella zoster virus (VZV) infection.. This case documents the presumed association of PORN and VZV encephalitis in a severely immunocompromised AIDS patient.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Encephalitis, Viral; Herpes Simplex; Herpes Zoster; Humans; In Situ Hybridization; Male; Necrosis; Polymerase Chain Reaction; Retinal Diseases

We report five children who had recurrent central nervous system signs after conventional acyclovir therapy for herpes simplex encephalitis. Secondary exacerbation was characterized clinically by severe ballismic movement disorder in all five children, associated with fever, impairment of consciousness, and seizures. Biologic analysis in all children and magnetic resonance imaging and neuropathology studies of the brain in three cases were compatible with inflammatory reaction. In contrast, all viral cultures remained negative, herpes simplex virus antigen in one child and DNA tested by polymerase chain reaction in four children were undetectable in the first samples of cerebrospinal fluid during the relapse, suggesting a postinfectious, immune-mediated mechanism of relapse in these patients.

Topics: Acyclovir; Antigens, Viral; Biopsy; Brain; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Administration Schedule; Encephalitis, Viral; Female; Herpes Simplex; Humans; Infant; Magnetic Resonance Imaging; Male; Neurologic Examination; Recurrence; Simplexvirus

A newborn infant whose condition was diagnosed as herpes simplex encephalitis and who had subsequent recurrences of skin disease had repeated episodes of neutropenia while receiving therapy with intravenous (30 mg/[kg.d]) or oral (30 mg/]kg.d]) acyclovir. The neutropenia did not recur when the dosage of oral acyclovir was reduced to 10 mg/(kg.d). This case represents the first well-documented report of acyclovir-induced neutropenia.

Topics: Acyclovir; Encephalitis, Viral; Female; Follow-Up Studies; Herpesvirus 2, Human; Humans; Infant, Newborn; Magnetic Resonance Imaging; Neutropenia

We report a case of alexia without either agraphia or hemianopia following herpes simplex encephalitis. The patient had a temporal lobe lesion with involvement of the occipitotemporal gyrus. This is an unusual cause of alexia without agraphia. The location of the lesion supports the view that transcallosal fibers from the right hemisphere to the left angular gyrus course inferior to the posterior horn of the left lateral ventricle and pass close to the left occipitotemporal gyrus.

Topics: Acyclovir; Adult; Agraphia; Antiviral Agents; Dyslexia, Acquired; Encephalitis, Viral; Hemianopsia; Herpes Simplex; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Temporal Lobe

A Caucasian homosexual man with AIDS and cytomegalovirus retinitis presented with facial pain and episodic confusion, had several seizures and became obtunded. An electroencephalogram was suggestive of herpes simplex encephalitis. The diagnosis was confirmed by detection of herpes simplex virus type 2 (HSV 2), but not type 1, DNA in cell-free cerebrospinal fluid (CSF) after amplification by nested polymerase chain reaction. The patient also had evidence of concomitant cytomegalovirus (CMV) infection with detectable CMV DNA in CSF. With high-dose acyclovir the patient recovered. Analysis of a follow up CSF sample taken four months later showed no detectable HSV-2 DNA.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Cytomegalovirus Infections; DNA, Viral; Encephalitis, Viral; Herpes Simplex; Humans; Male; Middle Aged; Polymerase Chain Reaction

Herpes simplex encephalitis in adults and young patients carries a high mortality and morbidity. Its presentation may be nonspecific, sometimes hampering early diagnosis. Two young children are reported with herpes simplex encephalitis in whom the operculum syndrome was an outstanding feature. This syndrome is caused by focal, bilateral cortical damage to the anterior opercular regions resulting in anarthria and impairment of mastication and swallowing. After initiation of treatment with acyclovir in the early stage of the disease, the outcomes in both patients were characterized by good general recovery with persistence of deficits of speech, mastication, and swallowing, more pronounced in the patient who was comatose during the illness. Early recognition of the operculum syndrome as a presenting feature of herpes simplex encephalitis may expedite the diagnosis and thereby improve the prognosis.

Topics: Acyclovir; Cerebral Cortex; Child, Preschool; Deglutition Disorders; Dysarthria; Encephalitis, Viral; Female; Follow-Up Studies; Herpes Simplex; Humans; Infant; Magnetic Resonance Imaging; Male; Neurologic Examination; Syndrome; Tomography, X-Ray Computed

A 9-year-old boy developed acute renal failure following intravenous acyclovir (30 mg/kg per day) administered for 6 days to treat herpetic encephalitis. Physical findings and urine output were normal, except for increasing blood urea nitrogen (BUN), serum creatinine and mild proteinuria. Acyclovir was discontinued. However BUN and serum creatinine continued to increase and peaked on the following day at 8.6 mmol/l of urea (24 mg/dl) and 194 mumol/l (2.2 mg/ml), respectively. Conservative treatment and hydration were carried out. The kidney function returned to normal within 1 week. The use of acyclovir when necessary in renal failure patients is discussed.

Topics: Acute Kidney Injury; Acyclovir; Child; Encephalitis, Viral; Humans; Infusions, Intravenous; Male

Positive diagnosis of Herpes simplex virus (HSV) encephalitis was rarely obtained in the past, when brain biopsy had been performed. Other tests (HSV antigen and HSV antibodies detection and interferon alpha measurement, in cerebrospinal fluid) failed to prove HSV infection. Polymerase chain reaction has been proposed for accurate and rapid diagnosis of HSV encephalitis. With 35 cycles of a DNA polymerase sequence duplication, sensitivity reaches 95% and specificity 100%. HSV PCR is a useful tool for the diagnosis of acute encephalitis. This should be available in many neurologic clinics. Therapeutic consequences include rapid disruption of aciclovir when clinical features, MRI study and negative PCR suggest non herpetic encephalitis.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Child; Child, Preschool; Encephalitis, Viral; Herpes Simplex; Humans; Infant; Middle Aged; Polymerase Chain Reaction; Prognosis; Recurrence; Sensitivity and Specificity; Simplexvirus

Topics: Acyclovir; Aged; Diagnosis, Differential; Encephalitis, Viral; Female; Herpes Simplex; Humans; Prognosis; Respiration, Artificial; Tomography, X-Ray Computed

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Child, Preschool; Diagnosis, Differential; Encephalitis, Viral; Female; Herpes Simplex; Humans

The effect of para-amino benzoic acid (PABA) on the virus of Herpes simplex (VHS-1, strain L2) was studied and it was shown to be active in vitro and in vivo. The action of PABA was virucidal in the culture of the cell-free virus-containing material. It lowered the death rate of the laboratory mice with experimental herpetic encephalitis (intraperitoneal contamination) at the average by 40 per cent and increased the mean life-span of the animals significantly decreasing the virus titre in the mouse brain. PABA was not toxic with respect to the Vero cells thus not preventing the virus-induced cytopathic effect in the cultures. However, PABA showed high ability to potentiate the antiherpetic action of acyclovir (Zovirax, acycloguanosine) in the infected cultures when acyclovir was used in inactive concentrations.

Topics: 4-Aminobenzoic Acid; Acyclovir; Animals; Antiviral Agents; Cell-Free System; Chlorocebus aethiops; Drug Synergism; Drug Therapy, Combination; Encephalitis, Viral; Herpes Simplex; Mice; Vero Cells

Twelve children with type 1 herpes simplex encephalitis (3 with relapse, 9 without) have been monitored during the past 7 years. Ten of the children received intravenous infusion of acyclovir (30 mg/kg/day) for 10 days, 1 child who experienced relapse received 15 mg/kg/day, and another relapsed child received no antiviral agents until relapse. Relapse occurred 20-36 days after initial onset. All relapsed patients underwent another 10 days of acyclovir treatment (30 mg/kg/day). Choreoathetosis appeared as the initial sign of relapse followed by rapidly progressive unresponsiveness in all 3 relapsed patients: in 1 nonrelapsed patient choreoathetosis occurred during the recovery period. In these 4 patients involuntary movement was remitted within 3 months to 2 years. One patient with choreoathetosis died of measles pneumonia 4 months after onset of herpes simplex encephalitis and the surviving 3 were severely retarded. Although neuroimaging sparing of basal ganglia does not indicate structural and functional abnormalities, the disturbance of the neural connection among the basal ganglia and the cerebral cortex, which manifested severe damage over frontal, temporal, and parietal mantles on CT, may be the source of movement disorders in these patients. We conclude that choreoathetosis may be the first sign of relapse of herpes simplex encephalitis in children and may be an indicator of poor prognosis. The neuropathogenesis of choreoathetosis requires further investigation.

Topics: Acyclovir; Adolescent; Adult; Aged; Anticonvulsants; Athetosis; Basal Ganglia; Brain Damage, Chronic; Cerebral Cortex; Child; Child, Preschool; Chorea; Dominance, Cerebral; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Encephalitis, Viral; Female; Follow-Up Studies; Herpes Simplex; Herpesvirus 1, Human; Humans; Infant; Infant, Newborn; Infusions, Intravenous; Male; Middle Aged; Neurologic Examination; Recurrence

Herpes simplex virus lesions recur in 8-30% of infants who receive a course of parenteral antiviral therapy for an initial infection. Long-term acyclovir is used by some clinicians to prevent recurrent Herpes simplex disease. We describe nine infants who were treated with doses of oral acyclovir which were chosen to achieve 2-h post-plasma concentrations of > or = 2 micrograms/ml. Eight infants had Herpes simplex encephalitis and one had multiple recurrences of dermal and ocular disease. The target plasma concentration was chosen in order to attain acyclovir cerebrospinal fluid distribution (< or = 50% plasma) for an estimated ID30 of Herpes simplex II strains of 0.1-0.5 microgram/ml. One of nine patients failed to achieve the target plasma acyclovir concentration. One of nine patients developed symptomatic recurrence of the central nervous system disease and none of the remaining eight patients experienced recognized dermal or neurologic recurrence of Herpes simplex disease. Renal and neurologic status were routinely monitored and no signs of acyclovir toxicity were observed. Plasma concentration of acyclovir > or = 2 micrograms/ml may be achieved with average oral doses of 1340 mg/m2/dose (1000-1740 mg/m2/dose) given at 12-h intervals.

Topics: Acyclovir; Administration, Oral; Dose-Response Relationship, Drug; Drug Administration Schedule; Encephalitis, Viral; Female; Follow-Up Studies; Herpes Simplex; Humans; Infant; Infant, Newborn; Keratitis, Herpetic; Long-Term Care; Male; Recurrence

Topics: Acyclovir; AIDS Dementia Complex; AIDS-Related Opportunistic Infections; Cytomegalovirus Infections; Encephalitis, Viral; Ganciclovir; Herpes Simplex; HIV-1; Humans

Using a magnetic resonance imaging-based volumetry, we quantified the volumes of the hippocampal formation (HF), parahippocampal gyrus (PHG), amygdaloid body (AMB), and anterior temporal neocortex (ATN) in 5 post-herpes simplex encephalitic (post-HSE) patients with temporal lobe damage and memory impairment at 12-52 months after the onset, and in 10 age-matched control subjects. In the post-HSE patients, the HF (p < 0.001) and PHG (p < 0.005) were significantly atrophic, while the AMB (p = 0.155) and ATN (p = 0.102) were smaller but not significantly. Performances on the verbal learning memory tests correlated highly with the HF volume, and length of dense retrograde amnesia with the PHG atrophy. Two patients with severe lasting amnesia had a marked atrophy of the HF and PHG, while 3 patients with good recovery from initial amnesia had temporal lobe structures larger than 50% of the control mean volumes. These results suggest that anterograde and retrograde memory functions involve different neural structures; the former is related to the HF and the latter to the PHG. For producing lasting amnesia, either severe HF damage or a combined damage of the HF and PHG might be necessary.

Topics: Acyclovir; Adult; Amygdala; Brain; Brain Damage, Chronic; Encephalitis, Viral; Female; Follow-Up Studies; Herpes Simplex; Hippocampus; Humans; Magnetic Resonance Imaging; Male; Mental Recall; Middle Aged; Neuropsychological Tests; Reference Values; Temporal Lobe; Verbal Learning