Epstein–Barr virus and the nervous system
Avindra Nath, Joseph R. Berger in Clinical Neurovirology, 2020
Characteristic symptoms of EBV-associated encephalitis are fever, headache, confusion, seizures, and paresis, as in any other form of viral encephalitis. The encephalitis often occurs in the context of clinical infectious mononucleosis, with fever, sore throat, malaise, and lymphadenopathy, but it can occur without systemic signs [13,17,18,20,21]. Focal features are often seen, and occasionally EBV encephalitis resembles herpes encephalitis [22]. Three cases of brainstem encephalitis have been reported, with one patient recovering completely, one left with mild residual gait ataxia and nystagmus, and one expiring. All three cases were diagnosed by serology [23–25]. Occasionally, the onset of EBV encephalitis is slow and insidious and can consist of behavioral and focal neurological deficits [26]. A few rare cases of the relapsing-remitting disease, satisfying the criteria of multiple sclerosis, following acute EBV infection with neurological manifestations have been described [27]. The relationship between the acute EBV disease and the subsequent MS-like illness is not clear, but recent serological studies have suggested a contributory role of EBV in MS [28]. Acute rapidly fatal encephalitis has been reported in a patent with HIV infection with low CD4 counts and high HIV viral load. The most common presence of EBV infection in the setting of HIV infection is associated with primary CNS lymphoma [29].
Case 9: Arthritis, Miscarriage and Drowsiness
Layne Kerry, Janice Rymer in 100 Diagnostic Dilemmas in Clinical Medicine, 2017
The patient is confused and, given the prodrome of fever, delirium and encephalitis are likely diagnoses. The multiple causes of encephalitis are classically categorised into viral, bacterial, protozoal and autoimmune. Common causes of viral encephalitis include herpes simplex virus (HSV), varicella-zoster virus (VZV) and HIV. Cytomegalovirus (CMV) and Epstein–Barr virus (EBV) can also cause acute encephalitis. Tick-borne encephalitis (perhaps as a feature of Lyme disease) is a possibility, particularly given the recent history of trekking in Austria. Bacterial encephalitis can develop in patients with exposure to tuberculosis (TB), mycoplasma, syphilis and chlamydia. Toxoplasmosis and amoebiasis are associated with the development of encephalitis, but this is uncommon.
Neurology and Non-Traumatic Spinal Imaging
Gareth Lewis, Hiten Patel, Sachin Modi, Shahid Hussain in On Call Radiology, 2015
Symptoms and signs of adult viral encephalitis include headache, fever, seizures, focal neurological deficits and altered or decreased level of consciousness. Because of the non-specific nature of these symptoms and signs, cases cannot reliably be differentiated clinically from other intracranial pathologies. The mortality rate is high, although the exact prognosis depends on how quickly treatment is initiated. Although the ultimate diagnosis is made from polymerase chain reaction analysis of CSF obtained from LP, typical imaging findings can suggest the diagnosis. Treatment with IV antiviral agents can be started prophylactically prior to diagnosis, therefore imaging does not necessarily have to be performed out of hours. HSV encephalitis should be distinguished from HSV meningitis; the latter is usually caused by HSV-2 infection and generally follows a benign cause.
Pathogenesis and Management of Acute Necrotizing Encephalopathy
Published in Expert Review of Neurotherapeutics, 2023
Ningxiang Qin, Jing Wang, Xi Peng, Liang Wang
Although many diseases that result from pathogenic infections, such as viral meningitis, are associated with direct pathogen invasion, the notion that viruses directly invade the nervous system and cause ANE is still a topic of debate. Viral encephalitis can be easily confused with acute necrotizing encephalopathy. It is worth mentioning that according to the definition of ANE, there should not be CSF pleocytosis or the presence of a CSF pathogen. These characteristics are typically present in viral encephalitis, which is an important differential diagnosis for ANE. For instance, in the case of COVID−19, this theory suggests that the virus penetrates the brain through the trigeminal nerve and olfactory nerve, causing a series of neurological symptoms. However, Frontera JA et al. [50,51] warned that the PCR tests used to amplify the contaminant could yield a false positive, particularly when the initial CSF test was negative. Stein, SR et al. detected SARS-CoV−2 in brain autopsies, but it is possible that the rough endoplasmic reticulum was misidentified as virions [52]. Despite the fact that ANE can be secondary to various pathogens, the theory that viruses directly invade the nervous system and cause ANE remains controversial. ANE is not regarded as a contagious brain disease, and viral RNA has not been found in the CSF of many ANE patients [5,10,53,54]. Therefore, ANE is unlikely to be caused by direct infection but rather by immune-mediated processes involving proinflammatory cytokines [10,39]. The cases above may represent atypical cases of ANE or viral encephalitis.
Mechanical filtration of the cerebrospinal fluid: procedures, systems, and applications
Published in Expert Review of Medical Devices, 2023
Viral encephalitis (VE) and viral myelitis (VM) are inflammations of the brain and spinal cord respectively, caused by viruses. The virus most commonly involved in CNS infections is herpes simplex virus, but other viruses of the herpesviridae family (e.g. varicella-zoster or Epstein–Barr), along with enterovirus, mumps, measles, and viruses associated with respiratory tract infections (adenovirus and influenza B), varicella-zoster virus, rubella, measles, VIH, JC, and SARS-CoV-2 may also cause VE or VM. VM and VE may present with a variety of syndromes depending on the precise location of the inflammatory focus including rapidly progressive encephalopathy. Some cases develop an increase in ICP, seizures, and depression of the level of consciousness, which requires tracheal intubation for airway protection and ventilatory support, control of raised ICP, and the effective treatment of seizures [16]. Treatment options include medication to relieve the symptoms and antiviral medications for some particular types of viruses (few antivirals are indicated and just some types of viruses, i.e. herpesvirus). More antivirals and adjunctive therapies are needed for better outcomes of VE and VM. To our knowledge, the only case with VE/VM treated with CSF filtration to date is a patient with psychotic symptoms related to Borna disease VE with rapid clinical improvement after CSF filtration [17].
Acute Retinal Necrosis Associated with Pseudorabies Virus Infection: A Case Report and Literature Review
Published in Ocular Immunology and Inflammation, 2023
Guangcan Xu, Baoke Hou, Cuiping Xue, Quangang Xu, Linghui Qu, Xiaolu Hao, Ying Liu, Dajiang Wang, Zhaohui Li, Xin Jin
A 52-year-old Chinese female patient presented to our outpatient clinic with a complaint of bilateral acute visual loss of two months duration. The patient had experienced a low-grade fever of 38.5°C accompanied by weakness, drowsiness, cognitive decline, and disturbance of consciousness for 5 days, which occurred two months prior to her presentation. The patient had been previously diagnosed with “viral encephalitis” in a local hospital and had received intravenous administration of an unknown drug or dose. Following improvement in her level of consciousness, the patient reported blurred vision in both eyes, with the left eye being affected more severely. The patient’s neurological symptoms showed significant improvement following the systemic administration of acyclovir and steroid therapy and both neurotrophic treatment and neuroprotective medication were adopted to restore neurofunction and improve microcirculation. Despite these interventions, the patient’s visual impairment gradually worsened over the following months; therefore, leading to her admission to the Senior Department of Ophthalmology at PLA General Hospital. The patient denied that she had any history of ocular trauma or surgery, immune diseases, animal contact, or hereditary diseases. However, she had a history of hypertension, which had been well-controlled for 5 years. The patient’s occupation was the sale of pig offal, which she had been engaged in for over 20 years.
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