Other Types of Viral Encephalitis

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Herpes zoster encephalitis is accompanied by a segmental vesicular rash in the territory of a peripheral nerve (cranial nerve). CSF examination reveals lympho-cytic pleocytosis up to 200 cells/mm3. The disease may appear in particularly severe form after a generalized herpes zoster infection.

Rarer types. Other, rarer viruses causing meningoen-cephalitis, some of which are specific to particular regions, are listed in Table 6.16 in addition to those already discussed. Fig. 6.29 concerns one such virus (papova-virus encephalitis in an HIV-positive man).

Table 6.16 Viruses that cause meningoencephalitis

Virus

Route of infection

Season of peak incidence

Persons at risk

Clinical features

Special aspects of diagnostic evaluation

Echovirus

fecal-oral

summer/fall

children and family members living with them

M, rash, gastrointestinal symptoms

virology

Coxsackie virus A

fecal-oral

summer/fall

children and family members living with them

M, rash, gastrointestinal symptoms

virology

Coxsackie virus B

fecal-oral

summer/fall

children and family members living with them

M, rash, pleuritis, pericarditis, myocarditis, or-chitis, gastrointestinal symptoms

virology

Mumps virus

inhalation

late winter/ spring

children, mainly boys

M, parotitis, orchitis, oophoritis, pancreatitis

elevated amylase, CSF cell count, and CSF glucose

Adenovirus

inhalation

infants and children

M, pharyngitis, pneumonia

Lymphocytic chorio-meningitis virus

mice

late winter/ spring

laboratory personnel

M, pharyngitis, pneumonia

Hepatitis viruses

fecal-oral, sexual intercourse, blood transfusion

mainly intravenous drug abusers, homo-and bisexuals, recipients of blood transfusions

M, jaundice, arthritis

hepatic dysfunction

Epstein-Barr virus

(infectious mononucleosis)

oral

teenagers and young adults

M, lymphadenopathy, pharyngitis, rash, splenomegaly

atypical lymphocytes, Paul-Bunnell reaction, hepatic dysfunction

Echovirus

M, enanthem and exan-them

ESME virus (early summer meningoencephalitis)

tick bite, cutaneous

early summer, fall

persons who go into a forest in an endemic area

M, E, myelitis, menin-goradiculitis

serology

Varicella-zoster virus

inhalation

children and persons who come in contact with them

M, radiculitis; M, E, and myelitis: pain, vesicular eruption

demonstration of in-trathecal antibodies, PCR

Cytomegalovirus

(CMV)

HlV-positive persons

E, epileptic seizures, radiculitis

detection of HIV in the CSF or urine, PCR of CSF or EDTA blood, CMV-specific intrathecal IgG synthase, CMV retinitis

*M = predominantly meningitic manifestations, E = predominantly encephalitic manifestations

Continued

*M = predominantly meningitic manifestations, E = predominantly encephalitic manifestations

Table 6.16 Viruses that cause meningoencephalitis (Continued)

Virus

Route of infection

Season of peak incidence

Persons at risk

Clinical features

Special aspects of diagnostic evaluation

Herpes simplex

person-to-

all year

all persons

E, focal neurological

MRI, virus detection,

virus type I

person

deficits, epileptic seizures, impairment of consciousness

PCR of the CSF, EEG with periodic steep waves, intrathecal HSV-specific IgG synthesis

Herpes simplex

person-to-

all year

neonates and child-

E (in neonates);

virus type II

person

ren, rarely adults

M in others

Arboviruses

mosquitoes

children and adults in

E, rash

virology

(Eastern equine,

the Americas

Western equine,

Venezuelan equine)

Human im

sexual inter

all year

sexual partners of

E, AIDS dementia, my

serology

munodeficiency

course, blood

HIV-positive persons,

elopathy, poly-

virus (HIV)

transfusion

mother-child, intravenous drug abusers, homosexuals

neuropathy, myopathy, opportunistic infections

Papovaviruses

all year

immunocom-promised persons (AIDS, lymphoma)

E, myelitis, clinical picture of progressive multifocal leuko-encephalopathy

MRI with subcortical T2-hyperintensities, virology

*M = predominantly meningitic manifestations, E = predominantly encephalitic manifestations

*M = predominantly meningitic manifestations, E = predominantly encephalitic manifestations

Mri Equine Encephalitis
Fig. 6.29 Asymmetrical encephalitis, probably due to papova-virus, in a 42-year-old, HIV-positive man. MRI reveals involvement of the occipital lobes bilaterally.

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