Advertisement

Viral Encephalitides

  • Heng Thay Chong
  • Chong Tin Tan
Chapter

Abstract

Viral encephalitis is defined as an inflammation of the brain parenchyma caused by a viral infection. There is often concomitant involvement of the surrounding meninges, a condition generally referred to as meningoencephalitis. This chapter focuses on viral encephalitis as viral meningitis is dealt with in Chap.  14. Other non-infective causes include autoimmune encephalitis and Rasmussen syndrome. The pathological findings in most encephalitides are non-specific and include neuronal death, perivascular cuffing, mononuclear cell infiltration and, later, gliosis. In herpes encephalitis, homogeneous, eosinophilic intranuclear inclusion bodies (Cowdry type A) are seen in about half of the patients in the first week of infection. After about 2 weeks, gliosis, glial nodule and satellitosis–neuronophagia with necrosis and haemorrhage are seen. In rabies infection, intracytoplasmic inclusion or Negri bodies are seen in 80% of patients. In less common infections, the pathological process may differ. In acute Venezuelan equine, Eastern equine and Nipah and Hendra encephalitides, there is widespread vasculitis, thrombosis and infarction, while demyelinating encephalitis is seen in herpes simplex encephalitis in the immunocompromised and in human herpesvirus 6 (HHV6) infections [1–5].

References

  1. 1.
    Dudgeon JA. Herpes encephalitis–II. Pathology of herpes encephalitis. Postgrad Med J. 1969;45:386–91.CrossRefGoogle Scholar
  2. 2.
    Wong KT, Shieh WJ, Kumar S, et al. Nipah virus infection: pathology and pathogenesis of an emerging paramyxoviral zoonosis. Am J Pathol. 2002;161:2153–67.CrossRefGoogle Scholar
  3. 3.
    Calisher CH. Medically important arboviruses of the United States and Canada. Clin Microbiol Rev. 1994;7:89–116.CrossRefGoogle Scholar
  4. 4.
    Novoa LJ, Nagra RM, Nakawatase T, et al. Fulminant demyelinating encephalomyelitis associated with productive HHV-6 infection in an immunocompetent adult. J Med Virol. 1997;52:301–8.CrossRefGoogle Scholar
  5. 5.
    Johnson M, Valyi-Nagy T. Expanding the clinicopathologic spectrum of herpes simplex encephalitis [editorial]. Hum Pathol. 1998;29:207–10.CrossRefGoogle Scholar
  6. 6.
    Solomon T, Dung NM, Kneen R, et al. Japanese encephalitis. J Neurol Neurosurg Psychiatry. 2000;68:405–15.CrossRefGoogle Scholar
  7. 7.
    Chokephaibulkit K, Kankirawatana P, Apintanapong S, et al. Viral etiologies of encephalitis in Thai children. Pediatr Infect Dis J. 2001;20:216–8.CrossRefGoogle Scholar
  8. 8.
    Srey VH, Sadones H, Ong S, et al. Etiology of encephalitis syndrome among hospitalized children and adults in Takeo, Cambodia, 1999–2000. Am J Trop Med Hyg. 2002;66:200–7.CrossRefGoogle Scholar
  9. 9.
    Glaser CA, Honarmand S, Anderson LJ, et al. Beyond viruses: clinical profiles and etiologies associated with encephalitis. Clin Infect Dis. 2006;43:1565–77.CrossRefGoogle Scholar
  10. 10.
    Khetsuriani N, Holman RC, Anderson LJ. Burden of encephalitis-associated hospitalizations in the United States, 1988–1997. Clin Infect Dis. 2002;35:175–82.CrossRefGoogle Scholar
  11. 11.
    Kupila L, Vuorinen T, Vainionpaa R, et al. Etiology of aseptic meningitis and encephalitis in an adult population. Neurology. 2006;66:75–80.CrossRefGoogle Scholar
  12. 12.
    Chaudhuri A, Kennedy PG. Diagnosis and treatment of viral encephalitis. Postgrad Med J. 2002;78:575–83.CrossRefGoogle Scholar
  13. 13.
    Geisbert TW, Jahrling PB. Exotic emerging viral diseases: progress and challenges. Nat Med. 2004;10(12 Suppl):S110–21.CrossRefGoogle Scholar
  14. 14.
    Tunkel AR, Glaser CA, Bloch KC, et al. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2008;47:303–27.CrossRefGoogle Scholar
  15. 15.
    Domingues RB, Fink MC, Tsanaclis AM, et al. Diagnosis of herpes simplex encephalitis by magnetic resonance imaging and polymerase chain reaction assay of cerebrospinal fluid. J Neurol Sci. 1998;157:148–53.CrossRefGoogle Scholar
  16. 16.
    Singh N, Paterson DL. Encephalitis caused by human herpesvirus-6 in transplant recipients: relevance of a novel neurotropic virus. Transplantation. 2000;69:2474–9.CrossRefGoogle Scholar
  17. 17.
    Suzuki Y, Toribe Y, Mogami Y, et al. Epilepsy in patients with congenital cytomegalovirus infection. Brain and Development. 2008;30:420–4.CrossRefGoogle Scholar
  18. 18.
    Maschke M, Kastrup O, Diener HC. CNS manifestations of cytomegalovirus infections: diagnosis and treatment. CNS Drugs. 2002;16:303–15.CrossRefGoogle Scholar
  19. 19.
    Weaver S, Rosenblum MK, DeAngelis LM. Herpes varicella zoster encephalitis in immuno-compromised patients. Neurology. 1999;52:193–5.CrossRefGoogle Scholar
  20. 20.
    Huang CC, Liu CC, Chang YC, et al. Neurologic complications in children with enterovirus 71 infection. N Engl J Med. 1999;341:936–42.CrossRefGoogle Scholar
  21. 21.
    Wang SM, Liu CC, Tseng HW, et al. Clinical spectrum of enterovirus 71 infection in children in southern Taiwan, with an emphasis on neurological complications. Clin Infect Dis. 1999;29:184–90.CrossRefGoogle Scholar
  22. 22.
    Li CC, Yang MY, Chen RF, et al. Clinical manifestations and laboratory assessment in an enterovirus 71 outbreak in Southern Taiwan. Scand J Infect Dis. 2002;34:104–9.CrossRefGoogle Scholar
  23. 23.
    Cree BC, Bernardini GL, Hays AP, et al. A fatal case of coxsackievirus B4 meningoencephalitis. Arch Neurol. 2003;60:107–12.CrossRefGoogle Scholar
  24. 24.
    Ooi MH, Wong SC, Clear D, et al. Adenovirus type 21-associated acute flaccid paralysis during an outbreak of hand-foot-and-mouth disease in Sarawak, Malaysia. Clin Infect Dis. 2003;36:550–9.CrossRefGoogle Scholar
  25. 25.
    Studahl M. Influenza virus and CNS manifestations. J Clin Virol. 2003;28:225–32.CrossRefGoogle Scholar
  26. 26.
    Goh KJ, Tan CT, Chew NK, et al. Clinical features of Nipah virus encephalitis among pig farmers in Malaysia. N Engl J Med. 2000;342:1229–35.CrossRefGoogle Scholar
  27. 27.
    Tan CT, Goh KJ, Wong KT, et al. Relapsed and late-onset Nipah encephalitis. Ann Neurol. 2002;51:703–8.CrossRefGoogle Scholar
  28. 28.
    Sarji SA, Abdullah BJ, Goh KJ, et al. MR imaging features of Nipah encephalitis. AJR Am J Roentgenol. 2000;175:437–42.CrossRefGoogle Scholar
  29. 29.
    Chong HT, Ramli N, Wong KT, et al. Subacute measles encephalitis: a case of long term survival with follow-up MR brain scans. Neurology Asia. 2007;12:121–5.Google Scholar
  30. 30.
    Mawrin C, Lins H, Koenig B, et al. Spatial and temporal disease progression of adult-onset subacute sclerosing panencephalitis. Neurology. 2002;58:1568–71.CrossRefGoogle Scholar
  31. 31.
    Solomon T. Exotic and emerging viral encephalitides. Curr Opin Neurol. 2003;16:411–8.CrossRefGoogle Scholar
  32. 32.
    Kalita J, Misra UK. EEG in dengue virus infection with neurological manifestations: a clinical and CT/MRI correlation. Clin Neurophysiol. 2006;11:2252–6.CrossRefGoogle Scholar
  33. 33.
    Lindquist L, Vapalathi O. Tick-borne encephalitis. Lancet. 2008;371:1861–71.CrossRefGoogle Scholar
  34. 34.
    Wong SH, Smith DW, Fallon MJ, et al. Murray valley encephalitis mimicking herpes simplex encephalitis. J Clin Neurosci. 2005;12:822–4.CrossRefGoogle Scholar
  35. 35.
    Einsiedel L, Kat E, Ravindran J, et al. MRI findings in Murray Valley encephalitis. Am J Neuroradiol. 2003;24:1379–82.PubMedGoogle Scholar
  36. 36.
    Huang C, Campbell LG, Kirouac I, et al. Diagnosis of Jamestown Canyon encephalitis by polymerase chain reaction. Clin Infect Dis. 1999;28:1294–7.CrossRefGoogle Scholar
  37. 37.
    Kennedy PG. Viral encephalitis: causes, differential diagnosis, and management. J Neurol Neurosurg Psychiatry. 2004;75(Suppl 1):i10–5.CrossRefGoogle Scholar
  38. 38.
    Cinque P, Cleator GM, Weber T, et al. 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;61:339–45.CrossRefGoogle Scholar
  39. 39.
    Chew MH, Arguin PM, Shay DK, et al. Risk factors for Nipah virus infection among abattoir workers in Singapore. J Infect Dis. 2000;181:1760–3.CrossRefGoogle Scholar
  40. 40.
    Roos KL. What I have learned about infectious diseases with my sleeves rolled up. Semin Neurol. 2002;22:9–15.CrossRefGoogle Scholar
  41. 41.
    Wasay M, Diaz-Arrastia R, Suss RA, et al. St. Louis encephalitis: a review of 11 cases in a 1995 Dallas, Tex, epidemic. Arch Neurol. 2000;57:114–8.CrossRefGoogle Scholar
  42. 42.
    Kennedy PG, Chaudhuri A. Herpes simplex encephalitis. J Neurol Neurosurg Psychiatry. 2002;73:237–8.CrossRefGoogle Scholar
  43. 43.
    Whitley RJ. Herpes simplex encephalitis: adolescents and adults. Antivir Res. 2006;71:141–8.CrossRefGoogle Scholar
  44. 44.
    Domingues RB, Lakeman FD, Mayo MS, et al. Application of competitive PCR to cerebrospinal fluid samples from patients with herpes simplex encephalitis. J Clin Microbiol. 1998;36:2229–34.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Larghi OP, Gonzalez E, Held R. Evaluation of the corneal test as a laboratory method for rabies diagnosis. Appl Microbiol. 1973;25:187–9.PubMedPubMedCentralGoogle Scholar
  46. 46.
    Warrell MJ, Warrell DA. Rabies and other lyssavirus diseases (seminar). Lancet. 2004;363:959–69.CrossRefGoogle Scholar
  47. 47.
    Feyssaguet M, Dacheux L, Audry L, et al. Multicenter comparative study of a new ELISA, PLATELIA RABIES II, for the detection and titration of anti-rabies glycoprotein antibodies and comparison with the rapid fluorescent focus inhibition test (RFFIT) on human samples from vaccinated and non-vaccinated people. Vaccine. 2007;25:2244–51.CrossRefGoogle Scholar
  48. 48.
    Hemachudha T, Wacharapluesadee S. Antemortem diagnosis of human rabies. Clin Infect Dis. 2004;39:1085–6.CrossRefGoogle Scholar
  49. 49.
    Wilde H, Khawplod P, Khamoltham T, et al. Rabies control in South and Southeast Asia. Vaccine. 2005;23:2284–9.CrossRefGoogle Scholar
  50. 50.
    Cohen JI, Davenport DS, Stewart JA, et al. Recommendations for prevention of and therapy for exposure to B virus (cercopithecine herpesvirus 1). Clin Infect Dis. 2002;35:1191–203.CrossRefGoogle Scholar
  51. 51.
    Rotbart HA, Webster AD. Treatment of potentially life-threatening enterovirus infections with pleconaril. Clin Infect Dis. 2001;32:228–35.CrossRefGoogle Scholar
  52. 52.
    Chong HT, Kamarulzaman A, Tan CT, et al. Treatment of acute Nipah encephalitis with ribavirin. Ann Neurol. 2001;49:810–3.CrossRefGoogle Scholar
  53. 53.
    Haley M, Retter AS, Fowler D, et al. The role for intravenous immunoglobulin in the treatment of West Nile virus encephalitis. Clin Infect Dis. 2003;37:e88–90.CrossRefGoogle Scholar
  54. 54.
    Rahal JJ, Anderson J, Rosenberg C, et al. Effect of interferon-a2b therapy on St Louis viral meningoencephalitis: clinical and laboratory results of a pilot study. J Infect Dis. 2004;190:1084–7.CrossRefGoogle Scholar
  55. 55.
    Huggins JW, Hsiang CM, Cosgriff TM, et al. Prospective, double-blind, concurrent, placebo-controlled of intravenous ribavirin therapy of hemorrhagic fever with renal syndrome. J Infect Dis. 1991;164(6):1119–27.CrossRefGoogle Scholar
  56. 56.
    Smith JS. New aspects of rabies with emphasis on epidemiology, diagnosis, and prevention of the disease in the United States. Clin Microbiol. 1996;9:166–76.CrossRefGoogle Scholar
  57. 57.
    Arif H, Hirsch LJ. Treatment of status epilepticus. Semin Neurol. 2008;28:342–54.CrossRefGoogle Scholar
  58. 58.
    Al-Hazmi M, Ayoola EA, Abdurahman M, et al. Epidemic Rift Valley fever in Saudi Arabia: a clinical study of severe illness in humans. Clin Infect Dis. 2003;36:245–52.CrossRefGoogle Scholar
  59. 59.
    Sivertsen B, Christensen PB. Acute encephalitis. Acta Neurol Scand. 1996;93:156–9.CrossRefGoogle Scholar
  60. 60.
    Wang IJ, Lee PI, Huang LM, et al. The correlation between neurological evaluations and neurological outcome in acute encephalitis: a hospital-based study. Eur J Paediatr Neurol. 2007;11:63–9.CrossRefGoogle Scholar
  61. 61.
    Bausch DG, Sprecher AG, Jeffs B, et al. Treatment of Marburg and Ebola hemorrhagic fevers: a strategy for testing new drugs and vaccines under outbreak conditions. Antivir Res. 2008;78:150–61.CrossRefGoogle Scholar
  62. 62.
    Hoenen T, Groseth A, Falzarano D, et al. Ebola virus: unravelling pathogenesis to combat a deadly disease. Trends Mol Med. 2006;12:206–15.CrossRefGoogle Scholar
  63. 63.
    Lowry PW. Arbovirus encephalitis in the United States and Asia. J Lab Clin Med. 1997;129:405–11.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2019

Authors and Affiliations

  • Heng Thay Chong
    • 1
  • Chong Tin Tan
    • 2
  1. 1.Western HealthMelbourneAustralia
  2. 2.University of MalayaKuala LumpurMalaysia

Personalised recommendations