RESUMEN
RESUMEN La meningoencefalitis por el VZV es una patología poco frecuente que se presenta con la reactivación del virus dentro del organismo. OBJETIVO: Describir la presentación clínica de dos pacientes con neuroinfección por VZV posteriormente a infección por SARS-CoV-2. REPORTE DEL CASO: El primer caso corresponde a un hombre de 59 años con antecedente de neumonía moderada por SARS-CoV-2 que después cursó con meningoencefalitis por VZV y, además, desarrolló un síndrome de Ramsay Hunt. El segundo caso es el de una mujer de 37 años con antecedente de infección leve por SARS CoV-2 con un cuadro de cefalea con signos de alarma, en quien se documentó neuroinfección por VZV
ABSTRACT Meningoencephalitis caused by varicella zoster virus is a rare pathology that presents due to the reactivation of the virus in the organism OBJECTIVE: To describe the clinical presentation of two patients with VZV neuroinfection presented after a SARS CoV-2 infection. CASE REPORT: The first case is a 59 year old male with previous moderate SARS CoV-2 infection who presented meningoencephalitis and was diagnosed with Ramsay Hunt's Syndrome. The second case is a 37 year old female with previous SARS CoV-2 infection who presented with an acute onset headache and was documented with VZV neuroinfection.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Encefalitis por Varicela Zóster/virología , COVID-19/complicaciones , Antivirales/uso terapéutico , Aciclovir/uso terapéutico , Encefalitis por Varicela Zóster/diagnóstico , Encefalitis por Varicela Zóster/tratamiento farmacológicoRESUMEN
The frequency of central nervous system infections due to herpesvirus have been studied in various populations; however, studies in Mexican mestizo patients are scant. This paper documents the frequency of herpesvirus encephalitis in Mexican mestizo patients from the National Institute of Neurology and Neurosurgery (NINN) of Mexico. To study the frequency of herpetic viral encephalitis at the NINN in the period from 2004 to 2009. We reviewed clinical records from patients with clinically suspected encephalitis; polymerase chain reaction assays were done for detection of herpesviruses in cerebrospinal fluid (CSF) samples. The total number of patients studied was 502; in 59 (12%), the diagnosis of herpetic encephalitis was confirmed by PCR-based testing of CSF. Of them, 21 (36%) were positive for herpes simplex virus type 1, 15 (25%) for Epstein-Barr virus, 10 (17%) for varicella zoster virus, 8 (14%) for cytomegalovirus, 3 (5%) for human herpesvirus 6, and 2 (3%) for herpes simplex virus 2. Our results show a varied frequency of viral encephalitis in mestizo patients due to herpesviruses in a tertiary neurological center and point out the importance of modern molecular technology to reach the etiological diagnosis in cases of encephalitis.
Asunto(s)
Infecciones por Citomegalovirus/diagnóstico , Encefalitis por Varicela Zóster/diagnóstico , Encefalitis Viral/diagnóstico , Infecciones por Virus de Epstein-Barr/diagnóstico , Herpes Genital/diagnóstico , Herpes Simple/diagnóstico , Infecciones por Roseolovirus/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Citomegalovirus/genética , Citomegalovirus/patogenicidad , Infecciones por Citomegalovirus/epidemiología , Infecciones por Citomegalovirus/etnología , Infecciones por Citomegalovirus/virología , Encefalitis por Varicela Zóster/epidemiología , Encefalitis por Varicela Zóster/etnología , Encefalitis por Varicela Zóster/virología , Encefalitis Viral/epidemiología , Encefalitis Viral/etnología , Encefalitis Viral/virología , Infecciones por Virus de Epstein-Barr/epidemiología , Infecciones por Virus de Epstein-Barr/etnología , Infecciones por Virus de Epstein-Barr/virología , Etnicidad , Femenino , Herpes Genital/epidemiología , Herpes Genital/etnología , Herpes Genital/virología , Herpes Simple/epidemiología , Herpes Simple/etnología , Herpes Simple/virología , Herpesvirus Humano 1/genética , Herpesvirus Humano 1/patogenicidad , Herpesvirus Humano 2/genética , Herpesvirus Humano 2/patogenicidad , Herpesvirus Humano 3/genética , Herpesvirus Humano 3/patogenicidad , Herpesvirus Humano 4/genética , Herpesvirus Humano 4/patogenicidad , Herpesvirus Humano 6/genética , Herpesvirus Humano 6/patogenicidad , Humanos , Incidencia , Masculino , México/epidemiología , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa/métodos , Estudios Retrospectivos , Infecciones por Roseolovirus/epidemiología , Infecciones por Roseolovirus/etnología , Infecciones por Roseolovirus/virologíaRESUMEN
BACKGROUND: The herpes simplex virus (HSV) is the most common cause of sporadic encephalitis worldwide. Even with proper treatment, this infection is associated with a mortality rate of 19%-30% and with potential neurologic sequelae. Recurrences of encephalitis are rare and limited to a few cases in the literature. Although the mechanism of reactivation has not yet been clarified, in our patient, the surgery might have acted as a precipitating factor. CASE DESCRIPTION: The case involved a female 10-year-old patient with a history of type 1 HSV encephalitis since 24 months of age. Secondarily, the patient developed postherpetic epilepsy in the following years. At 10 years old, she was referred to the epilepsy surgery service, and an elective right temporal lobectomy was performed. After surgery, the patient experienced severe clinical deterioration characterized by fever, severe headache, and altered state of consciousness. Encephalitis was diagnosed based on a positive polymerase chain reaction for HSV in the cerebrospinal fluid. The symptoms remitted after 8 weeks of treatment with acyclovir. The histopathologic diagnosis was a chronic encephalitic process with late secondary parenchymal changes without specific viral cytopathic findings. The only limitation that persisted was related to fine movements of the left hand. One year after surgery, the patient rejoined her school activities and is currently free of seizures. CONCLUSIONS: HSV encephalitis is a rare but serious complication that should be suspected in cases of unexplained postoperative fever with altered consciousness, especially in patients with histories of encephalitic states.
Asunto(s)
Encefalitis por Varicela Zóster/etiología , Encefalitis por Varicela Zóster/cirugía , Herpes Simple/complicaciones , Procedimientos Neuroquirúrgicos/efectos adversos , Simplexvirus/patogenicidad , Niño , Encefalitis por Varicela Zóster/virología , Femenino , Humanos , RecurrenciaRESUMEN
Neurological complications of varicella-zoster virus (VZV) are infrequent and include various clinical pictures. The reactivation of VZV in patients with AIDS is generally associated with an acute and severe meningoencephalitis. We report the epidemiological, clinical and virological data from 11 consecutive patients with diagnosis of HIV/AIDS and central nervous system (CNS) involvement due to VZV. All patients were male and seropositive for HIV. The primary risk factor for HIV infection was unprotected sexual contact. The median of CD4 T cell count was 142 cells/µL. All of them presented signs and symptoms of meningoencephalitis. Six patients (54.5%) presented pleocytosis; they all showed high CSF protein concentrations with a median of 2.1 g/dL. Polymerase chain reaction of cerebrospinal fluid specimen was positive for VZV in all of them and they were treated with intravenous acyclovir at doses of 30/mg/kg/day for 21 days. Overall survival was 63% (7 of 11 patients). The four dead patients had low cellular counts in CSF, below the median of this parameter. VZV should be included among the opportunistic pathogens that can involve CNS with a diffuse and severe meningoencephalitis in patients with advanced HIV/AIDS disease.
As complicações neurológicas do vírus varicela-zoster (VVZ) são pouco frequentes e incluem vários quadros clínicos. A reativação do VVZ em pacientes com AIDS é geralmente associada com meningoencefalite aguda e grave. Nós relatamos os dados epidemiológicos, clínicos e virológicos de onze pacientes consecutivos com diagnóstico de HIV/AIDS e comprometimento do sistema nervoso central (SNC) devido ao VVZ. Todos os pacientes eram do sexo masculino e soropositivos para HIV. O principal fator de risco para a infecção pelo HIV foi o contato sexual sem proteção. A mediana da contagem de células CD4 T foi de 142 cel/µL. Todos apresentavam sinais e sintomas devido à meningoencefalite. Seis pacientes (54,5%) apresentaram pleiocitose; todos apresentaram hiperproteinorraquia com mediana de 2,1 g/dL. A reação em cadeia da polimerase de amostra do líquido cefalorraquidiano foi positiva para VVZ em todos eles. Todos os pacientes foram tratados com aciclovir por via intravenosa em doses de 30 mg/kg/dia durante 21 dias. A sobrevida global foi de 63% (sete de 11 pacientes). Os quatro pacientes mortos tiveram uma escassa resposta celular no LCR abaixo da mediana para este parâmetro. O VVZ deve ser incluído entre os patógenos oportunistas que podem comprometer o SNC com meningoencefalite difusa e grave em pacientes com doença avançada por HIV/SIDA.
Asunto(s)
Adulto , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Antivirales/uso terapéutico , Encefalitis por Varicela Zóster/virología , /aislamiento & purificación , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/virología , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Aciclovir/uso terapéutico , Encefalitis por Varicela Zóster/complicaciones , Encefalitis por Varicela Zóster/líquido cefalorraquídeo , Resultado Fatal , Seropositividad para VIH/complicaciones , Seropositividad para VIH/virología , Leucocitosis/líquido cefalorraquídeo , Reacción en Cadena de la Polimerasa , Factores de Riesgo , Sexo InseguroRESUMEN
Neurological complications of varicella-zoster virus (VZV) are infrequent and include various clinical pictures. The reactivation of VZV in patients with AIDS is generally associated with an acute and severe meningoencephalitis. We report the epidemiological, clinical and virological data from 11 consecutive patients with diagnosis of HIV/AIDS and central nervous system (CNS) involvement due to VZV. All patients were male and seropositive for HIV. The primary risk factor for HIV infection was unprotected sexual contact. The median of CD4 T cell count was 142 cells/µL. All of them presented signs and symptoms of meningoencephalitis. Six patients (54.5%) presented pleocytosis; they all showed high CSF protein concentrations with a median of 2.1 g/dL. Polymerase chain reaction of cerebrospinal fluid specimen was positive for VZV in all of them and they were treated with intravenous acyclovir at doses of 30/mg/kg/day for 21 days. Overall survival was 63% (7 of 11 patients). The four dead patients had low cellular counts in CSF, below the median of this parameter. VZV should be included among the opportunistic pathogens that can involve CNS with a diffuse and severe meningoencephalitis in patients with advanced HIV/AIDS disease.