ro13-9904 and Encephalitis--Viral

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

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

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

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