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Update on HSV and VZV Encephalitis in Adults

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Neurological Complications of Infectious Diseases

Part of the book series: Current Clinical Neurology ((CCNEU))

Abstract

HSV and VZV are the most frequent viruses responsible for encephalitis in western countries. In a French study HSV accounted for 42% of identified causes of encephalitis and a US study reported HSV being accountable for 37% of cases with an etiological diagnosis.

Both viruses carry an important genome (152-kbp), with linear double-stranded DNA, coding for 100–200 different genes. The viral persistence in the human cell, during a long asymptomatic period, is a characteristic feature of these viruses. In case of some independent aggressions toward the host (other infection, immunodeficiency, chemical or physical stimulation), the virus reassembles and comes back to its initial pathogenicity.

Deficiency in interferon regulatory factors is correlated to easier and more severe infection in animal models. HSV encephalitis involves most frequently temporal and frontal cerebral lobes and typical clinical presentation is linked to this localization: inappropriate behavior, dysexecutive syndrome, hallucinations of any type are typical symptoms, as well as language and memory disorders, at the very beginning. VZV encephalitis presents most frequently disorientation and confusion, meningeal signs, focal neurological signs (cranial nerve palsy in 40% of cases) and apathy. Gold standard for biological diagnosis is PCR in CSF, and MRI is the standard for imaging. Intravenous acyclovir is the standard treatment of HSV and VZV encephalitis. HSVE is now demonstrated as a trigger for auto-immune encephalitis, meaning testing auto-antibodies in CSF in case of persisting or recurring neurological symptoms. Sequels are a key point for encephalitis. They are as frequent as more than 50% and should be evaluated 6 months and 1 year after discharge from the hospital.

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Author information

Authors and Affiliations

  1. Department of Infectious Diseases, University and Hospital of Grenoble Alpes, Grenoble, France

    J. P. Stahl

  2. European Study Group for the Infections of the Brain (ESGIB), Basel, Switzerland

    J. P. Stahl & A. Mailles

  3. Infectious Diseases Department, Santé Publique France, Saint Maurice, France

    A. Mailles

Authors
  1. J. P. Stahl
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  2. A. Mailles
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Correspondence to J. P. Stahl .

Editor information

Editors and Affiliations

  1. UT Health McGovern Medical School, Houston, TX, USA

    Rodrigo Hasbun, MD MPH

  2. Div of Infectious Dis, MCN A-2200, Vanderbilt University, Nashville, TN, USA

    Karen C. Bloch, MD MPH

  3. Dept of Infectious Diseases, Apt 635, Cleveland Clinic Foundation, Cleveland, OH, USA

    Adarsh Bhimraj, MD

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Stahl, J.P., Mailles, A. (2021). Update on HSV and VZV Encephalitis in Adults. In: Hasbun, MD MPH, R., Bloch, MD MPH, K.C., Bhimraj, MD, A. (eds) Neurological Complications of Infectious Diseases. Current Clinical Neurology. Humana, Cham. https://doi.org/10.1007/978-3-030-56084-3_8

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  • DOI: https://doi.org/10.1007/978-3-030-56084-3_8

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  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-56083-6

  • Online ISBN: 978-3-030-56084-3

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