Viral Encephalitis In Adults: A Narrative Review

2021 ◽  
Vol 16 ◽  
Author(s):  
Siciliano Valentina ◽  
Rosà Tommaso ◽  
Del Vecchio Pierluigi ◽  
D'Angelillo Anna ◽  
Brigida Mattia ◽  
...  
Keyword(s):  
Viral Encephalitis ◽  
Viral Infections ◽  
Direct Action ◽  
Ventilatory Support ◽  
Signs And Symptoms ◽  
Altered Mental Status ◽  
Poor Quality ◽  
Electrolyte Disorders ◽  
The Central Nervous System

: Viral infections of the central nervous system cause frequent hospitalization. The pathogenesis of viral encephalitis involves both the direct action of invading pathogens and the damage generated by the inflammatory reaction they trigger. The type of signs and symptoms presented by the patient depends on the severity and location of the ongoing inflammatory process. Most of the viral encephalitides are characterized by an acute development, fever, variable alterations in consciousness (confusion, lethargy, even coma), seizures (focal and generalized) and focal neurologic signs. The specific diagnosis of encephalitis is usually based on lumbar puncture. Cerebrospinal fluid examination should be performed in all patients unless absolutely contraindicated. Also, electroencephalogram and neuroimaging play a prominent role in diagnosis. Airway protection, ventilatory support, the management of raised intracranial pressure and correction of electrolyte disorders must be immediately considered in a patient with altered mental status. The only therapy strictly recommended is acyclovir in HSV encephalitis. The use of adjunctive glucocorticoids has poor-quality evidence in HSV, EBV, or VZV encephalitis. The role of antiviral therapy in other types of viral encephalitis is not well defined.

scholarly journals Autonomous requirements of the Menkes disease protein in the nervous system

2015 ◽  
Vol 309 (10) ◽  
pp. C660-C668 ◽  
Author(s):  
Victoria L. Hodgkinson ◽  
Sha Zhu ◽  
Yanfang Wang ◽  
Erik Ladomersky ◽  
Karen Nickelson ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Copper Deficiency ◽  
Copper Homeostasis ◽  
Signs And Symptoms ◽  
Menkes Disease ◽  
Copper Transporter ◽  
Sensorimotor Deficits ◽  
The Central Nervous System

Menkes disease is a fatal neurodegenerative disorder arising from a systemic copper deficiency caused by loss-of-function mutations in a ubiquitously expressed copper transporter, ATP7A. Although this disorder reveals an essential role for copper in the developing human nervous system, the role of ATP7A in the pathogenesis of signs and symptoms in affected patients, including severe mental retardation, ataxia, and excitotoxic seizures, remains unknown. To directly examine the role of ATP7A within the central nervous system, we generated Atp7a Nes mice, in which the Atp7a gene was specifically deleted within neural and glial cell precursors without impairing systemic copper homeostasis, and compared these mice with the mottled brindle ( mo-br) mutant, a murine model of Menkes disease in which Atp7a is defective in all cells. Whereas mo-br mice displayed neurodegeneration, demyelination, and 100% mortality prior to weaning, the Atp7a Nes mice showed none of these phenotypes, exhibiting only mild sensorimotor deficits, increased anxiety, and susceptibility to NMDA-induced seizure. Our results indicate that the pathophysiology of severe neurological signs and symptoms in Menkes disease is the result of copper deficiency within the central nervous system secondary to impaired systemic copper homeostasis and does not arise from an intrinsic lack of ATP7A within the developing brain. Furthermore, the sensorimotor deficits, hypophagia, anxiety, and sensitivity to NMDA-induced seizure in the Atp7a Nes mice reveal unique autonomous requirements for ATP7A in the nervous system. Taken together, these data reveal essential roles for copper acquisition in the central nervous system in early development and suggest novel therapeutic approaches in affected patients.

scholarly journals Intranasal Borna Disease Virus (BoDV-1) Infection: Insights into Initial Steps and Potential Contagiosity

2019 ◽  
Vol 20 (6) ◽  
pp. 1318 ◽  
Author(s):  
Alexandra Kupke ◽  
Sabrina Becker ◽  
Konstantin Wewetzer ◽  
Barbara Ahlemeyer ◽  
Markus Eickmann ◽  
...  
Keyword(s):  
Viral Infections ◽  
Cell Types ◽  
Nerve Fibers ◽  
Olfactory Pathway ◽  
Adult Rats ◽  
The Central Nervous System ◽  
Receptor Neurons

Mammalian Bornavirus (BoDV-1) typically causes a fatal neurologic disorder in horses and sheep, and was recently shown to cause fatal encephalitis in humans with and without transplant reception. It has been suggested that BoDV-1 enters the central nervous system (CNS) via the olfactory pathway. However, (I) susceptible cell types that replicate the virus for successful spread, and (II) the role of olfactory ensheathing cells (OECs), remained unclear. To address this, we studied the intranasal infection of adult rats with BoDV-1 in vivo and in vitro, using olfactory mucosal (OM) cell cultures and the cultures of purified OECs. Strikingly, in vitro and in vivo, viral antigen and mRNA were present from four days post infection (dpi) onwards in the olfactory receptor neurons (ORNs), but also in all other cell types of the OM, and constantly in the OECs. In contrast, in vivo, BoDV-1 genomic RNA was only detectable in adult and juvenile ORNs, nerve fibers, and in OECs from 7 dpi on. In vitro, the rate of infection of OECs was significantly higher than that of the OM cells, pointing to a crucial role of OECs for infection via the olfactory pathway. Thus, this study provides important insights into the transmission of neurotropic viral infections with a zoonotic potential.

scholarly journals Viral Encephalitis: A Hard Nut to Crack

2019 ◽  
Vol 55 (02) ◽  
pp. 098-109
Author(s):  
Alka Shukla ◽  
Mayank Gangwar ◽  
Sonam Rastogi ◽  
Gopal Nath
Keyword(s):  
Viral Encephalitis ◽  
Viral Infections ◽  
Neurological Complication ◽  
Clinical Signs ◽  
Geographical Location ◽  
Signs And Symptoms ◽  
Climatic Conditions ◽  
Altered Level ◽  
Level Of Consciousness ◽  
Clinical Signs And Symptoms

AbstractViral encephalitis is inflammation of brain that manifests as neurological complication of viral infections. There are quite a good number of viruses, for example, human herpes virus, Japanese encephalitis, and enteroviruses that can result in such a dreadful condition. Geographical location, age, gender, immune status, and climatic conditions also contribute to the establishment of this disease in an individual. Clinical signs and symptoms include fever, headache, altered level of consciousness, changed mental status, body ache, seizures, nausea, and vomiting. Effective management of this disease relies on timely diagnosis that in turn depends on apt and suitable investigation techniques. Traditional investigations have thinned out these days owing to the fact that advanced molecular technologies have been introduced to the diagnostic field. Treatment of viral encephalitis mainly involves symptomatic relieve from fever, malaise, myalgia along with measures to reduce viral load in the patient. This review mentions about all the possible aspects of viral encephalitis starting from etiology to the management and preventive measures that include immunization and vector control.

scholarly journals The Role of Extracellular Vesicles in Demyelination of the Central Nervous System

2020 ◽  
Vol 21 (23) ◽  
pp. 9111
Author(s):  
José Antonio López-Guerrero ◽  
Inés Ripa ◽  
Sabina Andreu ◽  
Raquel Bello-Morales
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Extracellular Vesicles ◽  
Viral Infections ◽  
Membrane Vesicles ◽  
Synaptic Activity ◽  
Demyelinating Diseases ◽  
Parkinson’S Diseases ◽  
The Central Nervous System

It is being increasingly demonstrated that extracellular vesicles (EVs) are deeply involved in the physiology of the central nervous system (CNS). Processes such as synaptic activity, neuron-glia communication, myelination and immune response are modulated by EVs. Likewise, these vesicles may participate in many pathological processes, both as triggers of disease or, on the contrary, as mechanisms of repair. EVs play relevant roles in neurodegenerative disorders such as Alzheimer’s or Parkinson’s diseases, in viral infections of the CNS and in demyelinating pathologies such as multiple sclerosis (MS). This review describes the involvement of these membrane vesicles in major demyelinating diseases, including MS, neuromyelitis optica, progressive multifocal leukoencephalopathy and demyelination associated to herpesviruses.

Evaluating the Use of Phenobarbital for the Management of Alcohol Withdrawal Syndrome in Psychiatric Inpatients

2019 ◽  
Vol 33 (4) ◽  
pp. 477-480
Author(s):  
Erin Waldee ◽  
Stephanie V. Phan
Keyword(s):  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Vital Signs ◽  
Alcohol Withdrawal Syndrome ◽  
Psychiatric Inpatients ◽  
Signs And Symptoms ◽  
Altered Mental Status ◽  
Treatment And Prevention ◽  
Appropriate Therapy

Objectives To describe the potential role of phenobarbital as appropriate therapy in the treatment and prevention of alcohol withdrawal syndrome (AWS) among medically cleared psychiatric inpatients. Methods This was a single-center, retrospective, observational study of adult patients admitted to the psychiatric unit and administered phenobarbital for the treatment or prevention of AWS. Changes in vital signs and signs and symptoms of AWS were observed to assess the safety and efficacy of phenobarbital. The primary outcome was safety of phenobarbital for AWS as measured by change in the respiratory rate (RR). Results A total of 122 patients were included in the study. There were no significant changes in RR among patients who received phenobarbital for AWS. Significant reductions in blood pressure and heart rate were observed. Of patients with documented signs and symptoms of AWS upon admission, 94% had improvement in the signs and symptoms during phenobarbital therapy. Approximately 12% of patients had documented sedation or altered mental status during phenobarbital therapy. No patients required transfer to a medical or critical care unit. Conclusions Phenobarbital was safe, not leading to severe adverse effects or requiring a higher level of care, and efficacious for the prevention and treatment of AWS in this cohort of psychiatric inpatients.

scholarly journals Epidemiological study on hospitalizations for viral encephalitis in Brazil between january 2010 to december 2020

2021 ◽  
Author(s):  
Ruan Teixeira Lessa ◽  
Daniel Pedrosa Cassiano ◽  
Yasmin Jawhari da Silva ◽  
Sebastião José de Almeida Júnior ◽  
Adrianny Freitas Teixeira ◽  
...  
Keyword(s):  
Viral Encephalitis ◽  
Signs And Symptoms ◽  
Brain Parenchyma ◽  
Neurological Dysfunction ◽  
Infectious Origin ◽  
Level Of Consciousness ◽  
The Central Nervous System ◽  
Epidemiological Pattern ◽  
Epstein Barr ◽  
Vaccination Campaigns

Introduction: Viral encephalitis (VE) is an inflammation of the brain parenchyma that progresses to neurological dysfunction of infectious origin. It occurs after hematogenous dissemination into the Central Nervous System and the most common agents are herpes virus, influenza, enterovirus, arbovirus, cytomegalovirus and Epstein-Barr. The signs and symptoms are headache, fever, decreased level of consciousness, seizures, focal deficits and behavioral changes. Objective: Recognize the epidemiological pattern of hospitalizations for VE in Brazil, between 2010 and 2020. Methods: A search for original articles and statistical information was performed in the databases Scielo, PUBMED, Medline and DATASUS, the latter related hospitalizations for VE with region, age, gender and year. Results: Hospitalizations are greater between 0 and 14 Y.O. (59.6%) in both genders, being 1.38M: 1F. The data indicate: <1 Y.O. (15%), 1-4 Y.O. (18.1%), 5-9 Y.O. (16.2%), 10-14 Y.O. (10.2%), totalizing 59.5% (21,004) of hospitalizations (35,188) in these groups, also intensified, between 20-29 Y.O., with 3,956 cases (11.2%). Comparing 2010 and 2020 there was a 63.4% reduction in hospitalizations for VE and the Southeast had the highest rate of the disease (42.1%). Conclusion: The epidemiological pattern of VE in the last decade represented higher prevalence in the interval between 0 and 14 Y.O.; mainly from 1 to 4. The decrease in the last 11 years may be due to adherence to vaccination campaigns and increased vector control, while the hypothesis for the higher incidence in the Southeast is because it is the most populous region, with favorable geographical areas for viral dissemination.

Advances in Pediatrics, Vol. XII

PEDIATRICS ◽  
1962 ◽  
Vol 30 (5) ◽  
pp. 748-748
Keyword(s):  
Viral Encephalitis ◽  
Viral Infections ◽  
Usual Sense ◽  
Neoplastic Disease ◽  
Phosphate Metabolism ◽  
Quality Of Information ◽  
Bilirubin Metabolism ◽  
Calcium And Phosphate Metabolism

Such volumes, in themselves reviews, cannot be reviewed in any usual sense of the term. Their contents can be listed, if not too inclusive. Thus, the new volume of Advances in Pediatrics reviews Viral Encephalitis (Russell Blattner and Florence Heys), Bilirubin Metabolism and Neonatal Jaundice (Audrey Brown), Chemotherapy in Neoplastic Disease (Joseph Burchenal, Lois Murphy, Charlotte Tan, and Harold Dargeon), the Teaching of Pediatrics and the Role of the Pediatrician in Developing Countries (Robert Debré), Viral Infections of the Premature and Newborn Infant (Heiz Eichenwald and Henry Shinefield), and Calcium and Phosphate Metabolism (G. Fanconi)—a list which assures high quality of information and opinion.

scholarly journals The role of viral encephalitis in the development of epileptic attacks and epilepsy

2021 ◽  
Vol 17 (2) ◽  
pp. 64-71
Author(s):  
T.A. Litovchenko ◽  
A.V. Litovchenko
Keyword(s):  
Hiv Infection ◽  
Viral Encephalitis ◽  
Viral Infections ◽  
Acute Infection ◽  
Epileptic Seizures ◽  
Epidemiological Data ◽  
Increased Risk ◽  
First Choice ◽  
Early Seizures

The role of non-epidemic viral encephalitis and HIV-infection in the development of acute epileptic seizures and epilepsy, analysis of recent epidemiological data and risk factors are discussed. Infections of the central nervous system produce up to 15 % of all types of new-onset symptomatic epileptic seizures. The risk depends on the ethology of infection, localization of lesion and severity. A high risk of development of epilepsy is seen in case of herpetic encephalitis and HIV-infection. The viral infections have been shown to be often accelerated by epileptic seizures in the acute phase of encephalitis and lead to an increased risk of developing epilepsy later. The mechanisms of development of early and late seizures are different. There are many forms of viral encephalitis, and all are associated to varying degrees with subsequent epilepsy. The risk of developing epilepsy following viral encephalitis is increased seven- to tenfold over premorbid levels. This risk increases the premorbid risk by 22 times if a patient experiences early seizures during the acute infection. Timely treatment of viral infections and early seizures reduces the risk of developing epilepsy later. The treatment of epileptic seizures due to viral infection is similar to those of symptomatic epilepsy. It is necessary to take into account possible drug-drug interactions between antiepileptic and antiviral drugs. Levetiracetam is used as an antiepileptic drug of the first choice in the treatment of epilepsy and epileptic seizures in the case of viral encephalitis.

scholarly journals Vitamin D and acute respiratory infections: prevention or treatment?

2019 ◽  
pp. 116-124
Author(s):  
N. B. Lazareva ◽  
E. V. Rebrova ◽  
L. R. Panteleeva ◽  
A. Yu. Ryazanova ◽  
D. A. Bondarenko
Keyword(s):  
Vitamin D ◽  
Viral Infections ◽  
Respiratory Infections ◽  
Direct Action ◽  
Biological Effects ◽  
Protective Role ◽  
The Body ◽  
Microbial Pathogens ◽  
Acute Respiratory Infections

Vitamin D has a large number of biological effects due to the effect on the vitamin D receptor, which is present in most tissues in  the body. The possible role of vitamin D in infections is explained by its effect on the mechanisms of the innate and acquired immune  response. Suppression of the inflammatory response is also an important effect of vitamin D.  Many scientists strongly believe that vitamin D deficiency is among the so-called «seasonal stimulators» of acute respiratory viral  infections (ARVI), the potential for the prophylactic and therapeutic use of vitamin D in the season of ARVI and influenza is of particular interest.  25-hydroxycalciferol-stimulated production of antimicrobial peptides, such as defensin and cathelicidin is the most important fact  proving the possible protective role of vitamin D in influenza and other acute respiratory infections. These endogenous peptides  have a direct action, destroying not only microbial pathogens, but also viruses, including the influenza virus. 

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