Résumé
La encefalitis por virus herpes simple (VHS) es una causa frecuente de encefalitis grave y potencialmente fatal. La encefalitis autoinmune posherpética (EAPH) afecta a un porcentaje de los pacientes que han presentado encefalitis herpética (EH) y se caracteriza por la aparición de nuevos síntomas neurológico/psiquiátricos, y/o por el empeoramiento de los déficits adquiridos durante la infección viral dentro de un lapso temporal predecible. Se produce por un mecanismo no relacionado con el VHS, sino por fenómenos autoinmunes, y es susceptible de tratamiento con inmunomoduladores. Se presenta el caso de un varón de 5 años de edad con EAPH que requirió tratamiento inmunomodulador, de primera y segunda línea, con buena evolución y remisión de los síntomas.
Herpes simplex virus (HSV) encephalitis is a common cause of severe and potentially fatal encephalitis. Autoimmune post-herpes simplex encephalitis (AIPHSE) affects a percentage of patients who developed herpes simplex encephalitis (HSE) and is characterized by the onset of new neurological/psychiatric symptoms and/or worsening of deficits acquired during the herpes infection within a predictable time frame. It is caused by a mechanism not related to HSV, but by autoimmune conditions, and is susceptible to treatment with immunomodulators. Here we describe the case of a 5-year-old boy with AIPHSE who required first- and second-line immunomodulatory treatment, with an adequate course and remission of symptoms.
Sujets)
Humains , Mâle , Enfant d'âge préscolaire , Maladies auto-immunes , Encéphalite à herpès simplex/complications , Encéphalite à herpès simplex/diagnostic , Encéphalite à herpès simplex/traitement médicamenteux , Troubles mentauxRésumé
Central nervous system infections are a medical emergency, due to their high fatality and sequelae. Timely treatment is essential, and should be initially indicated empirically by clinical guidance, without microbiological certainty. Hence the importance of cerebrospinal fluid (CSF) analysis as an etiological and therapeutic guide in the crucial initial hours of management. We report a 57-year-old woman consulting for fever and altered mental status. A brain CAT scan was normal. A lumbar puncture disclosed a CSF with predominance of neutrophils. Suspecting a bacterial meningitis, antimicrobial treatment was started but 48 hours after, the patient did not improve. A new lumbar puncture disclosed a CSF with predominance of lymphocytes. The lymphocyte shift prompted a PCR that was positive for herpes virus. The patient was treated with acyclovir with a good evolution.
Sujets)
Humains , Encéphalite à herpès simplex/liquide cérébrospinal , Encéphalite à herpès simplex/traitement médicamenteux , Anti-infectieux/usage thérapeutique , Antiviraux/usage thérapeutique , Aciclovir/usage thérapeutique , LymphocytesRésumé
ABSTRACT. Considering the variety of mechanisms of Herpes simplex virus (HSV-1) contamination and its broad invasive potential of the nervous system, a life-long latent infection is established. Infected adult individuals may be susceptible to viral reactivation when under the influence of multiple stressors, especially regarding immunocompromised patients. This guides a series of neuroinflammatory events on the cerebral cortex, culminating, rarely, in encephalitis and cytotoxic / vasogenic brain edema. A sum of studies of such processes provides an explanation, even though not yet completely clarified, on how the clinical evolution to cognitive impairment and dementia might be enabled. In addition, it is of extreme importance to recognize the current dementia and cognitive deficit worldwide panorama. The aim of this literature review is to elucidate the available data upon the pathophysiology of HSV-1 infection as well as to describe the clinical panorama of the referred afflictions.
RESUMO. Considerando a variedade de mecanismos de contaminação pelo vírus Herpes simplex (HSV-1) e seu amplo potencial invasivo do sistema nervoso, uma infecção latente por toda a vida é estabelecida. Indivíduos adultos infectados podem ser suscetíveis à reativação viral quando estão sob a influência de múltiplos estressores, principalmente em pacientes imunocomprometidos. Esse fator orienta uma série de eventos neuroinflamatórios no córtex cerebral, culminando, raramente, em encefalite e edema cerebral citotóxico/vasogênico. Um somatório de estudos desses processos fornece uma explanação, embora ainda não totalmente esclarecida, de como a evolução clínica para déficit cognitivo e demência pode ser possibilitada. Além disso, é de extrema importância reconhecer o panorama mundial atual da demência e do déficit cognitivo. O objetivo da presente revisão de literatura é elucidar os dados disponíveis sobre a fisiopatologia da infecção pelo HSV-1, assim como descrever o panorama clínico das referidas afecções.
Sujets)
Humains , Herpèsvirus humain de type 1 , Maladies virales du système nerveux central , Encéphalite à herpès simplex , Démence , Dysfonctionnement cognitifRésumé
O mieloma múltiplo é a segunda neoplasia onco-hematológica mais comum, correspondendo a 1% das neoplasias malignas. Trata-se de uma condição subdiagnosticada, assim como a encefalite herpética. Entretanto, é comum a relação do mieloma com infecções, em decorrência do acometimento da imunidade humoral. A encefalite viral herpética tem como principal agente o vírus do herpes simples 1. O caso foi descrito baseado em um raciocínio clínico, visando contribuir para uma melhor caracterização do quadro clínico e do diagnóstico de duas entidades clínicas que possuem baixa suspeição diagnóstica e elevada morbimortalidade. Durante o curso da investigação, foram propostas variadas etiologias como responsáveis pelo rebaixamento do nível de consciência, levando a uma pesquisa de um espectro mais amplo de hipóteses diagnósticas, as quais precederam a confirmação do diagnóstico final. O quadro clínico atípico descrito apresentou obstáculos à suspeição diagnóstica correta, pois a ausência dos sinais e sintomas característicos de ambas as doenças levaram à pesquisa de um arsenal mais amplo de diagnósticos diferenciais. Assim, o atraso no diagnóstico e o início tardio do tratamento foram fatores que contribuíram para o prognóstico reservado do paciente. A associação dessas doenças é pouco descrita na literatura, de modo que mais estudos acerca do assunto se fazem necessários. (AU)
Multiple myeloma is the second most common onco-hematologic neoplasm, accounting for 1% of malignant neoplasms. As herpetic encephalitis, it is an underdiagnosed condition. However, the relation of myeloma with infections is common, due to the involvement of humoral immunity. Herpetic encephalitis has as its main etiological agent the herpes simplex virus 1. The case was described based on a clinical reasoning, aiming to contribute to a better characterization of the clinical picture and diagnosis of two entities that have low rates of diagnostic suspicion and high rates of morbidity and mortality. During the course of investigation, several etiologies were proposed as responsible for the decreased level of consciousness, leading to a search for a broader range of diagnostic hypotheses, which preceded confirmation of the final diagnosis. The atypical clinical picture described presented obstacles to the correct diagnostic suspicion, as the absence of symptoms and signs characteristic of both diseases led to the search for a broader arsenal of differential diagnoses. Thus, delayed diagnosis and late treatment were factors that contributed to the patient's reserved prognosis. The association of these diseases is poorly described in the literature, so further studies on that subject are required. (AU)
Sujets)
Humains , Mâle , Adulte d'âge moyen , Encéphalite à herpès simplex/complications , Encéphalite à herpès simplex/diagnostic , Myélome multiple/complications , Myélome multiple/diagnostic , Antiviraux/usage thérapeutique , Aciclovir/usage thérapeutique , Dexaméthasone/usage thérapeutique , Issue fatale , Antinéoplasiques alcoylants/usage thérapeutique , Encéphalite à herpès simplex/traitement médicamenteux , Retard de diagnostic , Glucocorticoïdes/usage thérapeutique , Melphalan/usage thérapeutique , Myélome multiple/traitement médicamenteuxRésumé
El uso cada vez más difundido de la terapia antirretroviral de gran actividad (TARGA) en el tratamiento de los pacientes con infección por el virus de la inmunodeficiencia humana (VIH) puede dar lugar a respuestas paradojales, caracterizadas por un empeoramiento de las manifestaciones clínicas o la reactivación de ciertas infecciones oportunistas, hasta ese momento subclínicas, como el Herpes varicela-zóster (HVZ). Este cuadro clínico se conoce desde hace años como síndrome inflamatorio de reconstitución inmune (SIRI). Puede afectar a más del 30% de los pacientes seropositivos para el VIH con un tiempo de aparición promedio de 8 a 12 semanas luego del inicio o cambio de TARGA. El HZ mucocutáneo representa entre el 7% al 12% de los episodios de SIRI en estos pacientes. En este trabajo, se presenta un paciente VIH seropositivo que desarrolló un episodio de HVZ cutáneo monometamérico asociado a compromiso del sistema nervioso central bajo la forma de un síndrome meningoencefalítico
The use of highly active antiretroviral therapy (HAART) in the management of human immunodeficiency virus (HIV) infection has resulted in a paradoxical response associated with the worsening of clinical symptoms of previously subclinical infections, such as herpes varicella-zoster (HVZ). This clinical picture is named as immune reconstitution inflammatory syndrome (IRIS). It may affect up to 30% of HIV-seropositive subjects within a wide range of time after the initiation or change of HAART, but mainly after 8 to 12 weeks. Mucocutaneous HZ accounts for 7%-12% of the diseases associated with HIV infection in patients with immune reconstitution from the administration of HAART. Here we present an HIV seropositive patient that developed an episode of cutaneous metameric eruption of HVZ associated with central nervous system involvement as meningoencephalitis syndrome.
Sujets)
Humains , Mâle , Adulte , Aciclovir/usage thérapeutique , VIH (Virus de l'Immunodéficience Humaine)/immunologie , Encéphalite à herpès simplex/diagnostic , Encéphalite zostérienne/thérapie , Antirétroviraux/usage thérapeutique , Diagnostic précoce , Syndrome inflammatoire de restauration immunitaire/diagnosticRésumé
Abstract The incidence of herpes simplex virus-1 (HSV-1) infection in kidney transplant patients is 3% in those who have received antiviral prophylaxis versus 9.8% without prophylaxis. Herpes viruses usually cause mucocutaneous lesions and only occasionally cause visceral disease or central nervous system infection in immunosuppressed and immunocompetent patients. The gold standard for diagnosis is DNA detection using polymerase chain reaction (PCR) in the affected organ. According to the literature, it is treated with acyclovir, with which remission is expected in most cases without sequelae. Here we present the clinical case of a kidney transplant patient who had HSV-1 encephalitis (with the virus detected in the cerebrospinal fluid (CSF) through PCR), and received the standard treatment with complete recovery of his neurological state. (Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1387).
Resumen La infección por herpes simple tipo 1 (HSV tipo 1) en los pacientes con trasplante renal tiene una incidencia de 3% en quienes han recibido profilaxis antiviral versus 9.8% sin profilaxis. Los virus herpes habitualmente producen lesiones mucocutáneas y sólo en ocasiones causan patología visceral o infección del sistema nervioso central en pacientes inmunosuprimidos e inmunocompetentes. La prueba de oro estándar para su diagnóstico es la detección del ADN mediante la reacción de cadena polimerasa (PCR) en el órgano afectado. El tratamiento de acuerdo con la literatura es con aciclovir, con el cual se espera una remisión de la enfermedad en la mayoría de los casos sin secuelas. A continuación, presentamos el caso clínico de un paciente con trasplante renal quien cursó con encefalitis por HSV tipo 1 detectado en líquido cefalorraquídeo (LCR) mediante PCR, quien recibió tratamiento estándar con recuperación completa de su estado neurológico.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1387).
Sujets)
Humains , Mâle , Adulte d'âge moyen , Transplantation rénale , Infections du système nerveux central , Antibioprophylaxie , Encéphalite à herpès simplex , InfectionsRésumé
RESUMEN La encefalitis por herpes virus simple es la causa más común de encefalitis esporádica letal en el mundo. Una complicación poco usual es la hemorragia intracerebral. Se describe el caso de un preescolar de tres años que ingresa con cuadro clínico de encefalitis aguda, con hallazgos de hemorragia intracerebral temprana en región occipital y estudio en líquido cefalorraquídeo positivo para herpes virus tipo 1, que recibe tratamiento con aciclovir; sin embargo, cursa con evolución tórpida, incremento de hemorragias intracerebrales y desenlace fatal.
ABSTRACT Herpes simplex encephalitis is the most common cause of sporadic lethal encephalitis in the world. Intracerebral hemorrhage is an uncommon complication. The case of a 3-year-old preschooler who was admitted with acute encephalitis clinical picture is described. The patient presents findings of early in tracerebral hemorrhage in the occipital region and a positive cerebrospinal fluid study for herpes virus type 1, which is treated with acyclovir; however, it presents a torpid evolution, increased intracerebral hemorrhages and fatal outcome.
Sujets)
Enfant d'âge préscolaire , Humains , Hémorragie cérébrale , Encéphalite à herpès simplex , Hémorragie cérébrale/diagnostic , Hémorragie cérébrale/virologie , Issue fatale , Encéphalite à herpès simplex/complicationsRésumé
La encefalitis por herpes simple (EHS) es la causa más frecuente de encefalitis focal esporádica en todo el mundo. El aciclovir es el tratamiento preferido para la EHS desde la década de 1980. Después del uso generalizado del aciclovir, se redujo la tasa de mortalidad relacionada con la EHS pero surgieron cepas resistentes. Se ha informado que la incidencia de virus del herpes simple (VHS) resistente al aciclovir es del 0,5 % y del 3,5 %-10 % aproximadamente en los pacientes inmunocompetentes e inmunocomprometidos, respectivamente. En este artículo, describimos el caso de un paciente inmunocompetente de 12 años de edad con encefalitis por VHS-1 tratado satisfactoriamente con aciclovir y foscarnet. En el caso de una condición clínica que desmejora con el tratamiento con aciclovir, incluso si no se demuestra un aumento de la carga viral del VHS en el líquido cefalorraquídeo, se podría considerar la posibilidad de EHS resistente al aciclovir y el agregado de foscarnet al tratamiento con aciclovir.
Herpes simplex encephalitis (HSE) is the most common cause of sporadic focal encephalitis worldwide. Acyclovir is the treatment of choice of HSE since the 1980s. After the widespread use of acyclovir, HSE related mortality rate had reduced but resistant strains emerged. Acyclovir resistant HSV incidence was reported as about 0.5 % and 3.5 %-10 % in immunocompetent and immunocompromised patients, respectively. Herein, a 12-year-old immunocompetent patient with HSV-1 encephalitis who was successfully treated with combined acyclovir and foscarnet therapy is described. In the case of deteriorating clinical condition under acyclovir treatment even if the absence of demonstration of increased CSF HSV viral load, the possibility of acyclovir resistant HSE and the addition of foscarnet to the acyclovir treatment might be considered.
Sujets)
Humains , Mâle , Enfant , Aciclovir , Enfant , Foscarnet , Encéphalite à herpès simplexRésumé
Foram estudados 26 casos de meningoencefalite por herpesvírus bovino (BoHV) diagnosticados entre 2010-2016, no Estado de Goiás (GO). A doença acometeu principalmente bovinos jovens, entre 60 dias a 18 meses de idade. Não houve associação entre os casos e o sexo dos bovinos e a sazonalidade. A doença foi observada em todas as cinco Mesorregiões do Estado, com uma frequência maior nas Mesorregiões Sul e Centro. Os sinais clínicos mais frequentemente observados incluíram cegueira, incoordenação, sialorreia e ataxia. As principais alterações macroscópicas observadas incluíram congestão com tumefação e achatamento das circunvoluções, amolecimento e amarelamento do córtex telencefálico e focos de hemorragia. Em cinco encéfalos, não foram observadas alterações macroscópicas e em quatro as alterações não foram informadas. As principais alterações histológicas ocorreram no córtex telencefálico, principalmente o córtex frontal e parietal, mas em alguns casos, lesões de menor intensidade foram também observadas no tálamo, núcleos basais, mesencéfalo, ponte, bulbo, cerebelo e hipocampo. Todos os casos apresentaram meningoencefalite linfoplasmocítica e corpúsculos de inclusão intranucleares basofílicos em astrócitos e, eventualmente, em neurônios. Outras lesões frequentes incluíram necrose neuronal laminar segmentar (neurônio vermelho), espongiose, tumefação do núcleo das células endoteliais, gliose focal ou difusa, hipertrofia de astrócitos, infiltração por células gitter, congestão e hemorragia. Lesões menos comuns incluíram astrócitos Alzheimer tipo II, lesão residual e neuronofagia. A necrose neuronal e o edema (espongiose) foram mais acentuados nas camadas granular externa, molecular, de células piramidais e granular interna dos telencéfalos. Tanto os giros quanto os sulcos foram afetados igualmente. Dos 26 casos, o DNA de BoHV-5 foi amplificado em dois (7,69%) casos, enquanto que o de BoHV-1 foi identificado em um caso (3,84%). Nos casos positivos para BoHV-5 foram usadas amostras fixadas em formol a 10% e incluídas em parafina e amostras congeladas foram utilizadas no caso positivo para BoHV-1.(AU)
Twenty six cases of bovine herpetic meningoencephalitis diagnosed from 2010-2016 in Goiás state, Brazil, were studied. Affected cattle were mainly 60-day to 18-month-old. There was no association of the disease with sex and seasonality. The disease was found in all five mesoregions with a higher prevalence in southern and central state of Goiás. Clinical signs more frequently observed included blindness, incoordination, circling, excessive salivation, and ataxia. Main gross findings in the brain were congestion with swelling and flattening of gyri, softening and yellow discoloration of cerebral cortex and hemorrhagic foci. In five cases no gross changes were observed in the brain and in four cases there is no information. The main histopathological changes were in the cortex of telencephalic lobes, especially the frontal and parietal; however less prominent and less frequently found lesions occurred in the thalamus, basal nuclei, midbrain, pons, medulla oblongata, cerebellum, and hippocampus. All cases presented lymphoplasmocytic meningoencephalitis and intranuclear basophilic inclusion bodies in astrocytes, less commonly in neurons. Other frequent lesions included segmental laminar neuronal necrosis (red neurons), spongiosis, swollen vascular endothelial nuclei, gliosis (focal and diffuse), hypertrophy of astrocytes, infiltration of gitter cells, congestion, and hemorrhage. Lesions less frequently observed were Alzheimer type II astrocytes, residual lesion and neuronophagia. The most frequently affected cortical layers by neuronal necrosis and edema were external and internal granular, molecular, and pyramidal cell layers. Gyri and sulci were equally affected. Of the 26 cases, in 2 (7.69%) the DNA of BoHV-5 was amplified with samples fixed in 10% formalin and paraffin-embedded. DNA of BoHV-1 was identified in another case (3.84%) where, positive to BoHV-1, fresh samples were used.(AU)
Sujets)
Animaux , Bovins , Bovins/malformations , Bovins/traumatismes , Encéphalite à herpès simplex/médecine vétérinaire , Encéphalite à herpès simplex/épidémiologie , NoxasRésumé
Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis has clinical features of psychiatric symptoms, loss of memory, seizure, dyskinesia and autonomic dysfunction. While Anti-NMDA receptor encephalitis was initially reported in young women with ovarian teratoma, viral infections can trigger anti-NMDA receptor encephalitis as well. Among them, herpes virus is the most common. We report a patient who developed the anti-NMDA receptor encephalitis 47 days after herpes virus encephalitis, which is, to our knowledge, the first case in Korea.
Sujets)
Femelle , Humains , Encéphalite à anticorps anti-récepteur N-méthyl-D-aspartate , Dyskinésies , Encéphalite , Encéphalite à herpès simplex , Herpès , Corée , Mémoire , Crises épileptiques , Simplexvirus , TératomeRésumé
Resumen: Objetivo: Evaluar el comportamiento epidemiológico de la varicela y el herpes zoster (HZ) para determinar políticas de salud y disminuir prevalencia y complicaciones. Material y métodos: La frecuencia de casos se estimó con datos del Sistema Único de Información para la Vigilancia Epidemiológica (SUIVE), periodo 2000-2013; para los egresos hospitalarios de varicela y HZ, se utilizaron datos del Sistema Nacional de Información en Salud (Sinais). Resultados: El promedio de casos de varicela anual fue 296 733, 57% menores de 9 años, la mayoría de marzo a mayo; de 2004 a 2012 los egresos hospitalarios de varicela fueron 17 398, de ellos 4.6% presentó meningoecefalitis, 2.5% neumonía y 18% otras complicaciones. Por herpes zoster 7 042 egresos, más afectados de 65 años o más, 1.3:1 la relación mujer:hombre. Las complicaciones: neuralgia (11%), afección ocular (7%), meningoencefalitis (5.4%), enfermedad diseminada (2.8%) y otras (5.4%); estancia hospitalaria entre 6.4 a 13.3 días. Conclusiones: Los datos coinciden con los de la literatura de otros países. Se discute el papel de la vacunación en la prevención de la infección en niños y adultos.
Abstract: Objective: To evaluate the epidemiological behavior of varicella and herpes zoster (HZ) to determine the need of health policies to diminish prevalence and avoid complications. Materials and methods: To assess frequency, we analyzed data from the National Information System for Epidemiological Surveillance (SUIVE) from 2000 to 2013; to assess the discharge data of varicella and HZ, we evaluated information from the National System of health information (Sinais). Results: The average annual cases of chickenpox were 296 733, 57% mostly children under 9 years, most of them from March to May. From 2004 to 2012 hospital discharge of varicella were 17 398, of which 4.6% had meningoecephalitis, 2.5% pneumonia and 18% other complications. For herpes zoster 7 042 discharges, mostly affected were patients 65 years or older, 1.3:1 the woman-man relationship. Main complications were: neuralgia (11%), eye involvement (7%), meningoencephalitis (5.4%), disseminated disease (2.8%) and others (5.4%); hospital stay was between 6.4 and 13.3 days. Conclusions: Data is consistent with that of the literature in other countries. The role of vaccination to prevent infection in children and adults is discussed.
Sujets)
Humains , Mâle , Femelle , Adulte d'âge moyen , Sujet âgé , Varicelle/épidémiologie , Zona/épidémiologie , Sortie du patient/statistiques et données numériques , Saisons , Varicelle/complications , Varicelle/prévention et contrôle , Santé publique , Prévalence , Encéphalite à herpès simplex/épidémiologie , Géographie médicale , Politique de santé , Besoins et demandes de services de santé , Zona/complications , Durée du séjour , Névralgie/épidémiologieRésumé
Objective To establish an epidemiological surveillance of viral herpes encephalitis in major hospitals of Monteria, Cordoba. Methods From September 2009 to December 2011, a descriptive study of cases of viral encephalitis was made in three hospitals in the city of Monteria. Cerebrospinal fluid (CSF) samples from 118 patients were included in the study. Clinical aspects, as well as cytochemical and microbiological analysis (Gram stain and culture) of CSF, were used for selecting the patients. Virus detection was performed by using multiplex nested PCR for Herpes simplex virus 1 and 2, Epstein Barr virus, Cytomegalovirus and Varicella zoster virus. Results Viral DNA of herpesvirus was detected in the CSFs of 30 (25.4 %) participants, as follows: 22 (18.6 %) Herpes simplex 1 and 2 viruses, 4 (3.3 %) Cytomegalovirus and 1 (0.8 %) Varicella zoster virus. Co-infections were observed in 3 patients (2.5 %), 1 case by HSV-VZV and 2 cases by CMV/HSV. The clinical manifestations of the patients included: headache (18.6 %), fever (14.4 %), asthenia (10.1 %), seizures (9.3 %), vomiting (8.4 %), and stiff neck (5.9 %). Thirty percent of the patients also had HIV-AIDS. A case fatality rate of 20 % was observed for the patients. Conclusions This paper shows that herpesvirus is a cause of infection of the CNS in patients from Cordoba. This study contributes to the epidemiology of encephalitis, as well as to patient management.(AU)
Objetivo Establecer una vigilancia epidemiológica de la encefalitis viral herpética en los principales hospitales de Montería, Córdoba. Materiales y Métodos Se realizó un estudio descriptivo de los casos de encefalitis viral entre septiembre de 2009 diciembre de 2011 en tres hospitales en la ciudad de Montería. Las muestras líquido cefalorraquídeo (LCR) de 118 pacientes fueron incluidos en el estudio. Los aspectos clínicos como el análisis citoquímico y microbiológico (tinción de Gram y cultivo) de LCR fueron utilizados para la selección de los pacientes. La detección de virus se realizó por PCR anidada multiplex para Herpes simplex virus 1 y 2, virus de Epstein Barr, virus zoster de la varicela y el citomegalovirus. Resultados Se detectó ADN viral del virus del herpes en 30 (25,4 %) muestras de LCR en los pacientes de la siguiente manera: 22 (18,6 %) Herpes simplex virus 1 y 2, 4 (3,3 %) Citomegalovirus y 1 (0,8 %) del virus de la varicela zóster. Se observaron Co-infecciones en 3 pacientes (2,5 %), 1 caso por el VHS-VZV y 2 casos por CMV / HSV. Las manifestaciones clínicas de los pacientes fueron: cefalea (18,6 %), fiebre (14,4 %), astenia (10,1 %), convulsiones (9,3 %), vómitos (8,4 %), y rigidez de nuca (5,9 %). El treinta por ciento de los pacientes también tenía VIH-SIDA. Se observó una tasa de letalidad del 20 % de los pacientes. Conclusiones Se demuestra que el herpesvirus es causa de infección del SNC en pacientes en Córdoba. Este estudio contribuye a la caracterización serológica viral epidemiológica de la encefalitis viral, así como en el manejo del paciente ya que se describen hallazgos clínicos importante en la población adulta estudiada.(AU)
Sujets)
Humains , Liquide cérébrospinal/virologie , Encéphalite à herpès simplex/épidémiologie , Surveillance épidémiologique , Herpesviridae/isolement et purification , Épidémiologie Descriptive , Études longitudinales , Colombie/épidémiologieRésumé
Neurosyphilis is an infectious disease of the central nervous system caused by Treponema pallidum spirochete. There are several case reports on atypical manifestations of neurosyphilis, involving progressive cognitive dysfunction and seizures similar to those in herpes encephalitis. Seizures are common in patients with neurosyphilis, but they are usually associated with a positive Jarisch-Herxheimer reaction and status epilepticus is atypical as an initial manifestation of neurosyphilis. Here, we report on neurosyphilis patient whose initial symptom was nonconversive status epilepticus.
Sujets)
Humains , Système nerveux central , Maladies transmissibles , Encéphalite à herpès simplex , Neurosyphilis , Crises épileptiques , Spirochaetales , État de mal épileptique , Treponema pallidumRésumé
BACKGROUND AND PURPOSE: Herpes simplex encephalitis (HSE) is the most common type of sporadic encephalitis worldwide, and it remains fatal even when optimal antiviral therapy is applied. There is only a weak consensus on the clinical outcomes and prognostic factors in patients with HSE. This study examined whether the radiological and electrophysiological findings have a prognostic value in patients with HSE. METHODS: We retrospectively analyzed patients who were diagnosed with HSE by applying the polymerase chain reaction to cerebrospinal fluid and who received intravenous acyclovir at our hospital from 2000 to 2014. We evaluated the clinical outcomes at 6 months after onset and their correlations with initial and clinical findings, including the volume of lesions on MRI, the severity of EEG findings, and the presence of epileptic seizures at the initial presentation. RESULTS: Twenty-nine patients were enrolled (18 men and 11 women). Univariate analysis revealed that the presence of severe EEG abnormality and epileptic seizures at the initial presentation were significant correlated with a poor clinical outcome at 6 months (p=0.005 and p=0.009, respectively). In multivariate analysis, the presence of severe EEG abnormality was the only independent predictor of a poor outcome at 6 months (p=0.006). CONCLUSIONS: In cases of HSE, the initial EEG severity and seizure presentation may be useful predictive factors for the outcome at 6 months after acyclovir treatment.
Sujets)
Humains , Mâle , Aciclovir , Liquide cérébrospinal , Consensus , Électroencéphalographie , Encéphalite , Encéphalite à herpès simplex , Épilepsie , Herpès , Imagerie par résonance magnétique , Analyse multifactorielle , Réaction de polymérisation en chaîne , Études rétrospectives , Crises épileptiques , SimplexvirusRésumé
La encefalitis herpética (EH) secundaria a la infección por el virus de herpes simple 1 (VHS1) es la causa conocida más frecuente a nivel mundial de infección viral fatal del sistema nervioso central (SNC). La agresividad de su curso clínico y la morbilidad asociada a su desarrollo obligan a todo médico generalista a mantener una alta sospecha clínica para lograr su diagnóstico. Ciertas manifestaciones clínicas como la fiebre asociada a alteraciones en el sensorio o a alteraciones en el comportamiento de un paciente o a ambas posibilidades se presentan en un porcentaje superior al 90% de los casos confirmados. La solicitud en el líquido cefalorraquídeo (LCR) de la reacción en cadena de la polimerasa (PCR) para el VHS1 es el estudio complementario de laboratorio que posee la mayor sensibilidad y especificidad para confirmar el diagnóstico de EH. A su vez, la resonancia nuclear magnética (RNM) es el estudio de imagen que posee mayor sensibilidad y especificidad para el diagnóstico de la enfermedad. La EH secundaria al VHS1 es, de las infecciones virales que afectan el SNC, la única que posee tratamiento específico. La instauración temprana de tratamiento con aciclovir disminuye la mortalidad asociada al desarrollo de la enfermedad de un 70% y sin tratamiento, hasta un 10-20%. El objetivo principal de esta revisión es señalar las diversas situaciones clínicas en las cuales se debe sospechar la EH así como guiar la correcta utilización de los estudios complementarios e instaurar de manera temprana el tratamiento para reducir al máximo la morbimortalidad. (AU)
The herpes simplex virus type 1 (HSV1) encephalitis (EH) is the most common known cause of sporadic fatal encephalitis worldwide. The fatal consequences in the development of this disease and the morbidity related to it, should alert general practitioner to be always aware of its possible diagnosis. Clinical features such as fever associated with altered mental status or disturbances in the level of consciousness are present in more than 90% of confirmed cases. The analysis of the polymerase chain reaction (PCR) for HSV1 in central nervous system (CNS) fluid is the laboratory study of choice for establishing the diagnosis with the best sensitivity and specificity. Moreover, magnetic resonance image (MRI) is the most sensitive and specific imaging study for the detection of this entity. The VHS1 EH is one of the few treatable viral infection of the central nervous system to date. Hence, early administration of adequate antiviral therapy with Acyclovir remains paramount. The early administration of empiric therapy can decrease the mortality rate from 70% without treatment to 10-20% in confirmed cases. We sought to describe the disease's clinical features, and to further discuss the accurate use of diagnostic tools and treatment strategies in order to reduce the high related morbi-mortality. (AU)
Sujets)
Humains , Aciclovir/administration et posologie , Herpèsvirus humain de type 1 , Encéphalite à herpès simplex/traitement médicamenteux , Encéphalite à herpès simplex/imagerie diagnostique , Aphasie , Ataxie , Crises épileptiques , Spectroscopie par résonance magnétique , Réaction de polymérisation en chaîne , Confusion , Encéphalite à herpès simplex/mortalité , Encéphalite à herpès simplex/sang , FièvreRésumé
O objetivo deste trabalho foi determinar a prevalência das infecções latentes por BoHV-1 e por BoHV-5 em bovinos de corte criados no Estado do Paraná. Os gânglios do nervo trigêmeo foram coletados de 400 bovinos hígidos, entre 18 e 36 meses de idade, provenientes de 90 propriedades rurais localizadas em diferentes mesorregiões geográficas do Estado e abatidos em frigorífico com Serviço de Inspeção Federal. A reação em cadeia da polimerase com amplificação do gene que codifica a glicoproteína C foi empregada para a detecção do DNA viral. Cento e nove bovinos eram herpéticos (27,25%), sendo 14,25% (57/400) infectados com BoHV-1, 9,75% (39/400) infectados com BoHV-5 e 3,25% (13/400) portadores de infecção mista. A distribuição geográfica foi heterogênea e as infecções foram mais prevalentes nas mesorregiões localizadas ao norte do Estado. A vigilância para a encefalite por BoHV-5 deve ser intensificada na mesorregião Noroeste.
The prevalence of latent infection with BoHV-1 or BoHV-5 in beef cattle raised in the state of Paraná, Brazil, was studied. The trigeminal ganglia were collected in a slaughterhouse from 400 healthy cattle, 18 to 36 months old, raised in 90 farms located in distinct geographical regions of the state. Polymerase chain reaction for amplification of the gene encoding C glycoprotein was performed to detect virus DNA. One hundred and nine (27.25%) animals were herpetic; 14.25% (57/400) were infected with BoHV-1, 9.75% (39/400) were infected with BoHV-5 and 3.25% (13/400) had mixed infection. The geographical distribution was heterogeneous and the infections were more prevalent in the north of the state. The surveillance for BoHV-5 encephalitis should be intensive in the Northwest region.
Sujets)
Animaux , Bovins , Épidémiologie , Herpèsvirus bovin de type 1 , Encéphalite à herpès simplex/médecine vétérinaire , Encéphalite/médecine vétérinaire , Techniques et procédures diagnostiques/médecine vétérinaireRésumé
Introduction: Herpes simplex virus (HSV) is the most common etiology of sporadic encephalitis and presents with an estimated mortality of 50-70%. Objective: To describe baseline characteristics of patients with herpetic encephalitis admitted to a tertiary teaching hospital and their difference with patients with non herpetic encephalitis. Materials and Methods: Nested case control study using a retrospective cohort of patients with suspected encephalitis admitted to the Hospital Italiano de Buenos Aires (2006-2013). Adult patients included had a lumbar puncture with a positive or negative polimerase reaction for HSV. A case of herpetic encephalitis was defined as a positive polimerase reaction in spinal fluid. For each case, 5 controls were randomly selected. Results: There were no baseline differences present between cases and controls. The only covariate associated with herpetic encephalitis was an abnormal brain magnetic resonance imaging (MRI) (OR: 5.37, IC 95% 1.42-20.38, p < 0.01). The most frecuent alterations in the MRI were extratemporal lesions or temporal ones with or without haemorrhage. Discussion: There are no apparent baseline clinical differences between patients with or without herpetic encephalitis. A positive finding in a brain MRI should be taken into account during clinical workup.
Introducción: El virus herpes simplex (VHS) es la causa reportada más común de encefalitis esporádica con una mortalidad estimada de 50 a 70%. Objetivo: Describir las características de los pacientes con encefalitis herpética (EH) en nuestro medio y sus variables clínicas asociadas. Materiales y Métodos: Estudio anidado de casos y controles sobre una cohorte retrospectiva en el Hospital Italiano de Buenos Aires (2006-2013). Se incluyeron pacientes adultos con sospecha de encefalitis a quienes se les realizó una punción lumbar con posterior reacción de polimerasa en cadena para VHS en líquido cefalorraquídeo. Por cada caso (reacción positiva para VHS) se tomaron cinco controles aleatoriamente seleccionados. Resultados: No se observaron diferencias significativas en las características demográficas y clínicas entre los casos de EH y los controles. La única variable clínica asociada al diagnóstico de EH fue la alteración en la resonancia magnética (RM) de cerebro (OR: 5,37, IC 95% 1,4220,38; p < 0,01). Los patrones más comunes de alteración en la RM fueron las lesiones extra-temporales o lesiones temporales con o sin hemorragia. Discusión: Este hallazgo nos hace jerarquizar el hallazgo de un resultado positivo en la RM durante la valoración inicial de un paciente con clínica compatible de EH.
Sujets)
Femelle , Humains , Mâle , Adulte d'âge moyen , Encéphalite à herpès simplex/diagnostic , Études cas-témoins , Encéphalite à herpès simplex/liquide cérébrospinal , Hôpitaux d'enseignement , Imagerie par résonance magnétique , Études rétrospectivesRésumé
Herpes simplex encephalitis is the most common form of encephalitis, but herpes simplex virus type 2 (HSV-2) encephalitis is very rare during pregnancy. In immunocompetent patients, HSV-2 encephalitis is usually mild. With early diagnosis and prompt initiation of antiviral treatment, as well as enhanced neurocritical care, a favorable outcome can be expected in both mother and neonate. We report a rare case of maternal HSV-2 encephalitis diagnosed by polymerase chain reaction following appendectomy. The woman had no symptomatic genital lesion, and the infant was not infected.
Sujets)
Femelle , Humains , Nourrisson , Nouveau-né , Grossesse , Appendicectomie , Diagnostic précoce , Encéphalite , Encéphalite à herpès simplex , Herpèsvirus humain de type 2 , Mères , Réaction de polymérisation en chaîne , Simplexvirus , PeauRésumé
A 59-year old man was admitted for drowsiness and stiff neck. CSF examination showed lymphocytic pleocytosis and PCR for herpes simplex virus (HSV)-1 was positive in CSF. Brain MRI revealed enhanced lesions in left temporal lobe. His symptom improved with acyclovir. Follow-up studies showed red blood cells in CSF and a hematoma in the left temporal lobe. There was no additional symptom related to the hematoma. He was discharged after conservative care. Although rare, hematoma can develop in HSV-1 meningoencephalitis.