Bookstaver P Brandon, Mohorn Phillip L, Shah Ansal, Tesh Lauren D, Quidley April M, Kothari Ravish, Bland Christopher M, Weissman Sharon
Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA.
Department of Pharmacy, Spartanburg Medical Center, Spartanburg Regional Healthcare System, Spartanburg, SC, USA.
J Cent Nerv Syst Dis. 2017 May 1;9:1179573517703342. doi: 10.1177/1179573517703342. eCollection 2017.
Viruses are a common cause of central nervous system (CNS) infections with many host, agent, and environmental factors influencing the expression of viral diseases. Viruses can be responsible for CNS disease through a variety of mechanisms including direct infection and replication within the CNS resulting in encephalitis, infection limited to the meninges, or immune-related processes such as acute disseminated encephalomyelitis. Common pathogens including herpes simplex virus, varicella zoster, and enterovirus are responsible for the greatest number of cases in immunocompetent hosts. Other herpes viruses (eg, cytomegalovirus, John Cunningham virus) are more common in immunocompromised hosts. Arboviruses such as Japanese encephalitis virus and Zika virus are important pathogens globally, but the prevalence varies significantly by geographic region and often season. Early diagnosis from radiographic evidence and molecular (eg, rapid) diagnostics is important for targeted therapy. Antivirals may be used effectively against some pathogens, although several viruses have no effective treatment. This article provides a review of epidemiology, diagnostics, and management of common viral pathogens in CNS disease.
病毒是中枢神经系统（CNS）感染的常见病因，有许多宿主、病原体和环境因素影响病毒性疾病的表现。病毒可通过多种机制导致中枢神经系统疾病，包括在中枢神经系统内直接感染和复制，从而引发脑炎，感染局限于脑膜，或引发免疫相关过程，如急性播散性脑脊髓炎。常见病原体包括单纯疱疹病毒、水痘带状疱疹病毒和肠道病毒，在免疫功能正常的宿主中导致的病例最多。其他疱疹病毒（如巨细胞病毒、约翰·坎宁安病毒）在免疫功能低下的宿主中更为常见。诸如日本脑炎病毒和寨卡病毒等虫媒病毒是全球重要的病原体，但发病率因地理区域而异，且往往具有季节性。根据影像学证据和分子（如快速）诊断进行早期诊断对于靶向治疗很重要。抗病毒药物可能对某些病原体有效，尽管几种病毒尚无有效治疗方法。本文综述了中枢神经系统疾病中常见病毒病原体的流行病学、诊断和管理。
