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ISSN (Print): 1574-8871
ISSN (Online): 1876-1038

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Review Article

Viral Encephalitis in Adults: A Narrative Review

Author(s): Valentina Siciliano, Tommaso Rosà, Pierluigi Del Vecchio, Anna D'Angelillo, Mattia Brigida, Yaroslava Longhitano, Christian Zanza, Michele Cosimo Santoro, Marcello Candelli, Francesco Franceschi and Andrea Piccioni*

Volume 17, Issue 4, 2022

Published on: 29 April, 2022

Page: [259 - 267] Pages: 9

DOI: 10.2174/1574887116666211118141117

Price: $65

Abstract

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.

Keywords: Viral infection, central nervous system viral infection, encephalitis, haemophilus influenzae, herpesviridae infections, cerebrospinal fluid.

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[1]
Whitley RJ, Kimberlin DW. Viral encephalitis. Pediatr Rev 1999; 20(6): 192-8.
[http://dx.doi.org/10.1542/pir.20-6-192] [PMID: 10352040]
[2]
Tyler KL. Acute Viral Encephalitis. N Engl J Med 2018; 379(6): 557-66.
[http://dx.doi.org/10.1056/NEJMra1708714] [PMID: 30089069]
[3]
Vora NM, Holman RC, Mehal JM, Steiner CA, Blanton J, Sejvar J. Burden of encephalitis-associated hospitalizations in the United States, 1998-2010. Neurology 2014; 82(5): 443-51.
[http://dx.doi.org/10.1212/WNL.0000000000000086] [PMID: 24384647]
[4]
Stahl JP, Mailles A, Dacheux L, Morand P. Epidemiology of viral encephalitis in 2011. Med Mal Infect 2011; 41(9): 453-64.
[http://dx.doi.org/10.1016/j.medmal.2011.05.015] [PMID: 21802875]
[5]
Shukla ND, Tiwari V, Valyi-Nagy T. Nectin-1-specific entry of herpes simplex virus 1 is sufficient for infection of the cornea and viral spread to the trigeminal ganglia. Mol Visionfile///C/Users/itatr/Desktop/ICU Stud viral Enceph 2012; 18(November): 2711-6.
[6]
Mori I, Nishiyama Y, Yokochi T, Kimura Y. Olfactory transmission of neurotropic viruses. J Neurovirol 2005; 11(2): 129-37.
[http://dx.doi.org/10.1080/13550280590922793] [PMID: 16036791]
[7]
Steiner I, Spivack JG, O’Boyle DR II, Lavi E, Fraser NW. Latent herpes simplex virus type 1 transcription in human trigeminal ganglia. J Virol 1988; 62(9): 3493-6.
[http://dx.doi.org/10.1128/jvi.62.9.3493-3496.1988] [PMID: 2841498]
[8]
Guo Y, Audry M, Ciancanelli M, et al. Herpes simplex virus encephalitis in a patient with complete TLR3 deficiency: TLR3 is otherwise redundant in protective immunity. J Exp Med 2011; 208(10): 2083-98.
[http://dx.doi.org/10.1084/jem.20101568] [PMID: 21911422]
[9]
Lundberg P, Ramakrishna C, Brown J, et al. The immune response to herpes simplex virus type 1 infection in susceptible mice is a major cause of central nervous system pathology resulting in fatal encephalitis. J Virol 2008; 82(14): 7078-88.
[http://dx.doi.org/10.1128/JVI.00619-08] [PMID: 18480436]
[10]
Shives KD, Tyler KL, Beckham JD. Molecular mechanisms of neuroinflammation and injury during acute viral encephalitis. J Neuroimmunol 2017; 308: 102-11.
[http://dx.doi.org/10.1016/j.jneuroim.2017.03.006] [PMID: 28291542]
[11]
Silva MTT. Encefalites virais. Arq Neuropsiquiatr 2013; 71(9B): 703-9.
[12]
Solomon T, Michael BD, Smith PE, et al. Management of suspected viral encephalitis in adults- Association of British Neurologists and British Infection Association National Guidelines. J Infect 2012; 64(4): 347-73.
[http://dx.doi.org/10.1016/j.jinf.2011.11.014] [PMID: 22120595]
[13]
Tuppeny M. Viral meningitis and encephalitis. Crit Care Nurs Clin North Am 2013; 25(3): 363-80.
[http://dx.doi.org/10.1016/j.ccell.2013.04.003] [PMID: 23981453]
[14]
Bradshaw MJ, Venkatesan A. Herpes simplex virus-1 encephalitis in adults: pathophysiology, diagnosis, and management. Neurotherapeutics 2016; 13(3): 493-508.
[http://dx.doi.org/10.1007/s13311-016-0433-7] [PMID: 27106239]
[15]
Rabinstein AA. Herpes virus encephalitis in adults: current knowledge and old myths. Neurol Clin 2017; 35(4): 695-705.
[http://dx.doi.org/10.1016/j.ncl.2017.06.006] [PMID: 28962808]
[16]
Costa BKD, Sato DK. Viral encephalitis: A practical review on diagnostic approach and treatment. J Pediatr (Rio J) 2020; 96 (Suppl. 1): 12-9.
[http://dx.doi.org/10.1016/j.jped.2019.07.006] [PMID: 31513761]
[17]
Rozenberg F. Acute viral encephalitis. Handbook of Clinical Neurology. 2013.
[http://dx.doi.org/10.1016/B978-0-444-52910-7.00038-6]
[18]
Epidemic encephalitis and American neurology, 1919-1940. Bull Hist Med 78(1): 108-47.
[http://dx.doi.org/10.1353/bhm.2004.0029]
[19]
Rust RS. Human arboviral encephalitis. Semin Pediatr Neurol 2012; 19(3): 130-51.
[http://dx.doi.org/10.1016/j.spen.2012.03.002] [PMID: 22889543]
[20]
Solomon T, Hart IJ, Beeching NJ. Viral encephalitis: A clinician’s guide. Pract Neurol 2007; 7(5): 288-305.
[http://dx.doi.org/10.1136/jnnp.2007.129098] [PMID: 17885268]
[21]
Takasaki T. Flavivirus encephalitis. Brain Nerve 2009; 61(2): 145-51.
[PMID: 19235464]
[22]
Solomon T. Flavivirus encephalitis and other neurological syndromes (Japanese encephalitis, WNV, Tick borne encephalits, Dengue, Zika virus). Int J Infect Dis 2016; 45(Suppl 1): 24.
[http://dx.doi.org/10.1016/j.ijid.2016.02.086]
[23]
Tunkel AR, Glaser CA, Bloch KC. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2008; 47(3): 303-27.
[http://dx.doi.org/10.1086/589747] [PMID: 18582201]
[24]
Kneen R, Solomon T, Appleton R. The role of lumbar puncture in suspected CNS infection- a disappearing skill? Arch Dis Child 2002; 87(3): 181-3.
[http://dx.doi.org/10.1136/adc.87.3.181] [PMID: 12193421]
[25]
Glaser CA, Honarmand S, Anderson LJ. Beyond viruses: clinical profiles and etiologies associated with encephalitis. Clin Infect Dis 2006; 43(12): 1565-77.
[http://dx.doi.org/10.1086/509330] [PMID: 17109290]
[26]
Tyler KL. Update on herpes simplex encephalitis. Rev Neurol Dis 2004; 1(4): 169-78.
[PMID: 16400278]
[27]
Weil AA, Glaser CA, Amad Z, Forghani B. Patients with suspected herpes simplex encephalitis: rethinking an initial negative polymerase chain reaction result. Clin Infect Dis 2002; 34(8): 1154-7.
[http://dx.doi.org/10.1086/339550] [PMID: 11915008]
[28]
Sener RN. Herpes simplex encephalitis: diffusion MR imaging findings. Comput Med Imaging Graph 2001; 25(5): 391-7.
[http://dx.doi.org/10.1016/S0895-6111(01)00005-2] [PMID: 11390193]
[29]
McCabe K. Diffusion-weighted MRI abnormalities as a clue to the diagnosis of herpes simplex encephalitis. Neurology 61(7)
[http://dx.doi.org/10.1212/01.WNL.0000082387.97051.F5]
[30]
Richard J, Whitley M. Herpes simplex virus infections of the central nervous system. Neuroinfectious Dis 21(6): 1704-3.
[http://dx.doi.org/10.1212/CON.0000000000000243]
[31]
Poissy J, Wolff M, Dewilde A. Factors associated with delay to acyclovir administration in 184 patients with herpes simplex virus encephalitis. Clin Microbiol Infect 2009; 15(6): 560-4.
[http://dx.doi.org/10.1111/j.1469-0691.2009.02735.x] [PMID: 19392906]
[32]
Chaudhuri A, Kennedy PGE. Diagnosis and treatment of viral encephalitis. Postgrad Med J 2002; 78(924): 575-83.
[http://dx.doi.org/10.1136/pmj.78.924.575] [PMID: 12415078]
[33]
Tien RD, Felsberg GJ, Osumi AK. Herpesvirus infections of the CNS: MR findings. AJR Am J Roentgenol 1993; 161(1): 167-76.
[http://dx.doi.org/10.2214/ajr.161.1.8390790] [PMID: 8390790]
[34]
Peter Höllinger LM. Normal MRI findings in herpes simplex virus encephalitis. J Neurol 247: 799-801.
[35]
Halperin JJ. Diagnosis and management of acute encephalitis. Handb Clin Neurol 2017; 140: 337-47.
[http://dx.doi.org/10.1016/B978-0-444-63600-3.00018-0] [PMID: 28187808]
[36]
Küker W, Nägele T, Schmidt F, Heckl S, Herrlinger U. Diffusion-weighted MRI in herpes simplex encephalitis: A report of three cases. Neuroradiology 2004; 46(2): 122-5.
[http://dx.doi.org/10.1007/s00234-003-1145-3] [PMID: 14747879]
[37]
Gilden D. Varicella zoster virus and central nervous system syndromes. Herpes 2004; 11 (Suppl. 2): 89A-94A.
[PMID: 15319095]
[38]
Reuter JD, Gomez DL, Wilson JH, Van Den Pol AN. Systemic immune deficiency necessary for cytomegalovirus invasion of the mature brain. J Virol 2004; 78(3): 1473-87.
[http://dx.doi.org/10.1128/JVI.78.3.1473-1487.2004] [PMID: 14722303]
[39]
Chow FC, Glaser CA, Sheriff H. Use of clinical and neuroimaging characteristics to distinguish temporal lobe herpes simplex encephalitis from its mimics. Clin Infect Dis 2015; 60(9): 1377-83.
[http://dx.doi.org/10.1093/cid/civ051] [PMID: 25637586]
[40]
Whitley RJ. Diseases that mimic herpes simplex encephalitis Diagnosis, presentation, and outcomeNIAD Collaborative Antiviral Study Group JAMA J Am Med Assoc. 1989.
[41]
Cinque P, Cleator GM, Weber T, Monteyne P, Sindic CJ, van Loon AM. The role of laboratory investigation in the diagnosis and management of patients with suspected herpes simplex encephalitis: A consensus report. The EU Concerted Action on Virus Meningitis and Encephalitis. J Neurol Neurosurg Psychiatry 1996; 61(4): 339-45.
[http://dx.doi.org/10.1136/jnnp.61.4.339] [PMID: 8890768]

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