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病毒性脑炎的治疗。

Treatment of viral encephalitis.

作者信息

Domingues Renan Barros

机构信息

Department of Pathology, Santa Casa School of Health Sciences, EMESCAM, Vitória, ES, Brazil.

出版信息

Cent Nerv Syst Agents Med Chem. 2009 Mar;9(1):56-62. doi: 10.2174/187152409787601905.

Abstract

Several viruses may cause central nervous system diseases with a broad range of clinical manifestations. The time course of the viral encephalitis can be acute, subacute, or chronic. Pathologically there are encephalitis with direct viral entry into the CNS in which brain parenchyma exhibits neuronal damaging and viral antigens and there are postinfectious autoimmune encephalitis associated with systemic viral infections with brain tissue presenting perivascular aggregation of immune cells and myelin damaging. Some virus affect previously healthy individuals while others produce encephalitis among imunocompromised ones. Factors such evolving lifestyles and ecological changes have had a considerable impact on the epidemiology of some viral encephalitis [e.g. West-Nile virus, and Japanese B virus]. Citomegalovirus and JC virus are examples of infections of the brain that have been seen more frequently because they occur in immunocompromised patients. In the other hand many scientific achievements in neuroimaging, molecular diagnosis, antiviral therapy, immunomodulatory treatments, and neurointensive care have allowed more precise and earlier diagnoses and more efficient treatments, resulting in improved outcomes. In this article, we will present the current drug options in the management of the main acute and chronic viral infection of the central nervous system of immunocompetent and immunocompromised adults, focusing on drugs mechanisms of action, efficacy, and side effects. The early diagnosis and correct management of such diseases can reduce mortality and neurological sequelae; however, even with recent treatment advances, potentially devastating outcomes are still possible.

摘要

几种病毒可导致具有广泛临床表现的中枢神经系统疾病。病毒性脑炎的病程可以是急性、亚急性或慢性的。病理上,有病毒直接进入中枢神经系统的脑炎,其中脑实质表现出神经元损伤和病毒抗原,还有与全身性病毒感染相关的感染后自身免疫性脑炎,脑组织呈现血管周围免疫细胞聚集和髓鞘损伤。一些病毒感染以前健康的个体,而另一些则在免疫功能低下的个体中引发脑炎。生活方式演变和生态变化等因素对某些病毒性脑炎(如西尼罗河病毒和日本乙型脑炎病毒)的流行病学产生了相当大的影响。巨细胞病毒和JC病毒是在免疫功能低下患者中更常见的脑部感染例子。另一方面,神经影像学、分子诊断、抗病毒治疗、免疫调节治疗和神经重症监护等许多科学成就使得诊断更加精确和早期,治疗更加有效,从而改善了预后。在本文中,我们将介绍免疫功能正常和免疫功能低下的成年患者中枢神经系统主要急性和慢性病毒感染管理中的当前药物选择,重点关注药物的作用机制、疗效和副作用。这些疾病的早期诊断和正确管理可以降低死亡率和神经后遗症;然而,即使有最近的治疗进展,仍可能出现潜在的毁灭性后果。

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