HSV Encephalitis: Difference between revisions

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(Created page with "*Prevalence: 500,000 individuals per year, 2-4 cases per 1 million population. *90% caused by HSV-1,10% due to HSV-2. * *Fever and may have seizures esp in temporal lobe *Common symptoms of HSE include **Headaches, Drowsiness, Hyperactivity, General weakness **Mostly have Impaired level of consciousness+ Altered mental state presenting as confusion.,. **Symptoms similar with meningitis such as a Stiff neck, Altered reflexes, Confusion, Speech abnormalities. **Skin...")
 
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=== Clinic ===
*Prevalence: 500,000 individuals per year, 2-4 cases per 1 million population.
*Prevalence: 500,000 individuals per year, 2-4 cases per 1 million population.
*90% caused by HSV-1,10% due to HSV-2.
*90% caused by HSV-1,10% due to HSV-2
*
*Fever and may have seizures esp in temporal lobe
*Fever and may have seizures esp in temporal lobe
*Common symptoms of HSE  include
*Common symptoms of HSE  include
**Headaches,  Drowsiness, Hyperactivity, General weakness
**Headaches,  Drowsiness, Hyperactivity, General weakness
**Mostly have Impaired level of consciousness+ Altered mental state presenting as confusion.,.
**Mostly have Impaired level of consciousness+ Altered mental state presenting as confusion.,.
**Symptoms similar with [[meningitis]] such as a Stiff neck, Altered reflexes, Confusion, Speech abnormalities.
**Symptoms similar with [[meningitis]] such as a Stiff neck, [[Tendon reflexes|Altered reflexes]], Confusion, Speech abnormalities.
**Skin lesions usually are not found in association with herpes simplex encephalitis. <ref>NORD</ref>
**Skin lesions usually are not found in association with herpes simplex encephalitis. <ref>NORD</ref>


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*O'''lfactory nerve''' may be involved, which explain its predilection for the temporal lobes.
*O'''lfactory nerve''' may be involved, which explain its predilection for the temporal lobes.


*Recently included 420 adult patients with schizophrenia or bipolar spectrum and 481 healthy controls. The results of this cross-sectional study indicate that HSV1 may be an environmental factor associated with brain structural abnormalities and cognitive impairment in severe mental illnesses such as Schizophrenia and bipolar disorder. <ref>Andreou, D., Jørgensen, K.N., Nerland, S. ''et al.'' Herpes simplex virus 1 infection on grey matter and general intelligence in severe mental illness. ''Transl Psychiatry'' '''12''', 276 (2022). <nowiki>https://doi.org/10.1038/s41398-022-02044-3</nowiki></ref>
*Recently included 420 adult patients with schizophrenia or bipolar spectrum and 481 healthy controls. The results of this cross-sectional study indicate that [[HSV-1, Herpes Simplex Virus|HSV-1]] may be an environmental factor associated with brain structural abnormalities and cognitive impairment in severe mental illnesses such as Schizophrenia and bipolar disorder. <ref>Andreou, D., Jørgensen, K.N., Nerland, S. ''et al.'' Herpes simplex virus 1 infection on grey matter and general intelligence in severe mental illness. ''Transl Psychiatry'' '''12''', 276 (2022). <nowiki>https://doi.org/10.1038/s41398-022-02044-3</nowiki></ref>


*HSV-1 is the most common cause of [[sporadic necrotizing encephalitis]] in US, with a mortality rate of 30 -70%, and leaves various neurologic sequelae in the survivors. HSV-2 has been recognized as an etiologic agent in fatal infections in neonates and a mild meningitis in adults, but its role in encephalitis in adults is less well known. We suggest that some cases of acute psychosis may, like in our case, represent HSV-2 encephalitis.<ref>[https://wikihomeopathy.com/index.php/Herpes%20simplex%20type%202%20virus%20encephalitis%20presenting%20as%20psychosis,%20VOLUME%2073,%20ISSUE%203,%20P445-448,%20SEPTEMBER%2001,%201982 Herpes simplex type 2 virus encephalitis presenting as psychosis, VOLUME 73, ISSUE 3, P445-448, SEPTEMBER 01, 1982]</ref>
*HSV-1 is the most common cause of [[sporadic necrotizing encephalitis]] in US, with a mortality rate of 30 -70%, and leaves various neurologic sequelae in the survivors. [[HSV-2, Herpes Simplex Virus|HSV-2]] has been recognized as an etiologic agent in fatal infections in neonates and a mild meningitis in adults, but its role in encephalitis in adults is less well known. We suggest that some cases of acute psychosis may, like in our case, represent HSV-2 encephalitis.<ref>[https://wikihomeopathy.com/index.php/Herpes%20simplex%20type%202%20virus%20encephalitis%20presenting%20as%20psychosis,%20VOLUME%2073,%20ISSUE%203,%20P445-448,%20SEPTEMBER%2001,%201982 Herpes simplex type 2 virus encephalitis presenting as psychosis, VOLUME 73, ISSUE 3, P445-448, SEPTEMBER 01, 1982]</ref>
*HSE as a cause of '''[[psychosis]]''' is rare. It is suggested that herpes infection like other environmental stressors causes psychosis through inhibition of NMDA receptor and subsequent microglia activation in the hippocampus. <ref>Klein H. C., Doorduin J., de Witte L., de Vries E. F. ''Immunology and Psychiatry''. Vol. 8. Switzerland: Springer; 2015. Microglia activation, herpes infection, and NMDA receptor inhibition: common pathways to psychosis? pp. 243–254. (Current Topics in Neurotoxicity).</ref>
*HSE as a cause of '''[[psychosis]]''' is rare. It is suggested that herpes infection like other environmental stressors causes psychosis through inhibition of NMDA receptor and subsequent microglia activation in the hippocampus. <ref>Klein H. C., Doorduin J., de Witte L., de Vries E. F. ''Immunology and Psychiatry''. Vol. 8. Switzerland: Springer; 2015. Microglia activation, herpes infection, and NMDA receptor inhibition: common pathways to psychosis? pp. 243–254. (Current Topics in Neurotoxicity).</ref>
*Seizures during the acute phase of HSE are the main risk for the development of postencephalitic epilepsy <ref>Sellner J, Trinka E. Seizures and epilepsy in herpes simplex virus encephalitis: current concepts and future directions of pathogenesis and management. J Neurol. 2012 Oct;259(10):2019-30. doi: 10.1007/s00415-012-6494-6. Epub 2012 Apr 18. PMID: 22527234.</ref>
*Seizures during the acute phase of HSE are the main risk for the development of postencephalitic epilepsy <ref>Sellner J, Trinka E. Seizures and epilepsy in herpes simplex virus encephalitis: current concepts and future directions of pathogenesis and management. J Neurol. 2012 Oct;259(10):2019-30. doi: 10.1007/s00415-012-6494-6. Epub 2012 Apr 18. PMID: 22527234.</ref>
*Persistent infection with HSV and other brain infections is consistently associated with cognitive impairment. These infections can also affect sleep. Thus, sleep abnormalities could explain the cognitive dysfunction.<ref>Meshreky KM, Wood J, Chowdari KV, Hall MH, Wilckens KA, Yolken R, Buysse DJ, Nimgaonkar VL. Infection with Herpes Simplex virus type 1 (HSV-1) and sleep: The dog that did not bark. Psychiatry Res. 2019 Oct;280:112502. doi: 10.1016/j.psychres.2019.112502. Epub 2019 Jul 31. PMID: 31382180; PMCID: PMC7265549.</ref>
*Persistent infection with HSV and other brain infections is consistently associated with cognitive impairment. These infections can also affect sleep. Thus, sleep abnormalities could explain the cognitive dysfunction.<ref>Meshreky KM, Wood J, Chowdari KV, Hall MH, Wilckens KA, Yolken R, Buysse DJ, Nimgaonkar VL. Infection with Herpes Simplex virus type 1 (HSV-1) and sleep: The dog that did not bark. Psychiatry Res. 2019 Oct;280:112502. doi: 10.1016/j.psychres.2019.112502. Epub 2019 Jul 31. PMID: 31382180; PMCID: PMC7265549.</ref>

Latest revision as of 06:21, 13 April 2023

Clinic

  • Prevalence: 500,000 individuals per year, 2-4 cases per 1 million population.
  • 90% caused by HSV-1,10% due to HSV-2
  • Fever and may have seizures esp in temporal lobe
  • Common symptoms of HSE include
    • Headaches, Drowsiness, Hyperactivity, General weakness
    • Mostly have Impaired level of consciousness+ Altered mental state presenting as confusion.,.
    • Symptoms similar with meningitis such as a Stiff neck, Altered reflexes, Confusion, Speech abnormalities.
    • Skin lesions usually are not found in association with herpes simplex encephalitis. [1]
  • HSE can trigger of NMDR encephalitis.
  • The virus lies dormant in the ganglion of the trigeminal cranial nerve.
  • Olfactory nerve may be involved, which explain its predilection for the temporal lobes.
  • Recently included 420 adult patients with schizophrenia or bipolar spectrum and 481 healthy controls. The results of this cross-sectional study indicate that HSV-1 may be an environmental factor associated with brain structural abnormalities and cognitive impairment in severe mental illnesses such as Schizophrenia and bipolar disorder. [2]
  • HSV-1 is the most common cause of sporadic necrotizing encephalitis in US, with a mortality rate of 30 -70%, and leaves various neurologic sequelae in the survivors. HSV-2 has been recognized as an etiologic agent in fatal infections in neonates and a mild meningitis in adults, but its role in encephalitis in adults is less well known. We suggest that some cases of acute psychosis may, like in our case, represent HSV-2 encephalitis.[3]
  • HSE as a cause of psychosis is rare. It is suggested that herpes infection like other environmental stressors causes psychosis through inhibition of NMDA receptor and subsequent microglia activation in the hippocampus. [4]
  • Seizures during the acute phase of HSE are the main risk for the development of postencephalitic epilepsy [5]
  • Persistent infection with HSV and other brain infections is consistently associated with cognitive impairment. These infections can also affect sleep. Thus, sleep abnormalities could explain the cognitive dysfunction.[6]
  1. ↑ NORD
  2. ↑ Andreou, D., Jørgensen, K.N., Nerland, S. et al. Herpes simplex virus 1 infection on grey matter and general intelligence in severe mental illness. Transl Psychiatry 12, 276 (2022). https://doi.org/10.1038/s41398-022-02044-3
  3. ↑ Herpes simplex type 2 virus encephalitis presenting as psychosis, VOLUME 73, ISSUE 3, P445-448, SEPTEMBER 01, 1982
  4. ↑ Klein H. C., Doorduin J., de Witte L., de Vries E. F. Immunology and Psychiatry. Vol. 8. Switzerland: Springer; 2015. Microglia activation, herpes infection, and NMDA receptor inhibition: common pathways to psychosis? pp. 243–254. (Current Topics in Neurotoxicity).
  5. ↑ Sellner J, Trinka E. Seizures and epilepsy in herpes simplex virus encephalitis: current concepts and future directions of pathogenesis and management. J Neurol. 2012 Oct;259(10):2019-30. doi: 10.1007/s00415-012-6494-6. Epub 2012 Apr 18. PMID: 22527234.
  6. ↑ Meshreky KM, Wood J, Chowdari KV, Hall MH, Wilckens KA, Yolken R, Buysse DJ, Nimgaonkar VL. Infection with Herpes Simplex virus type 1 (HSV-1) and sleep: The dog that did not bark. Psychiatry Res. 2019 Oct;280:112502. doi: 10.1016/j.psychres.2019.112502. Epub 2019 Jul 31. PMID: 31382180; PMCID: PMC7265549.
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