Baldwin Kelly J, Cummings Christopher L
Continuum (Minneap Minn). 2018 Oct;24(5, Neuroinfectious Disease):1349-1369. doi: 10.1212/CON.0000000000000661.
This article reviews the spectrum of neurologic disease associated with human herpesvirus infections.
As more patients are becoming therapeutically immunosuppressed, human herpesvirus infections are increasingly common. Historically, infections with human herpesviruses were described as temporal lobe encephalitis caused by herpes simplex virus type 1 or type 2. More recently, however, additional pathogens, such as varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, and human herpesvirus 6 have been identified to cause serious neurologic infections. As literature emerges, clinical presentations of herpesvirus infections have taken on many new forms, becoming heterogeneous and involving nearly every location along the neuraxis. Advanced diagnostic methods are now available for each specific pathogen in the herpesvirus family. As data emerge on viral resistance to conventional therapies, newer antiviral medications must be considered.
Infections from the herpesvirus family can have devastating neurologic outcomes without prompt and appropriate treatment. Clinical recognition of symptoms and appropriate advanced testing are necessary to correctly identify the infectious etiology. Knowledge of secondary neurologic complications of disease is equally important to prevent additional morbidity and mortality. This article discusses infections of the central and peripheral nervous systems caused by herpes simplex virus type 1 and type 2, varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, and human herpesvirus 6. The pathophysiology, epidemiology, clinical presentations of disease, diagnostic investigations, imaging characteristics, and treatment for each infectious etiology are discussed in detail.
本文综述了与人类疱疹病毒感染相关的神经系统疾病谱。
随着越来越多的患者接受治疗性免疫抑制，人类疱疹病毒感染越来越常见。历史上，人类疱疹病毒感染被描述为由1型或2型单纯疱疹病毒引起的颞叶脑炎。然而，最近已确定其他病原体，如水痘-带状疱疹病毒、爱泼斯坦-巴尔病毒、巨细胞病毒和人类疱疹病毒6可引起严重的神经系统感染。随着文献的出现，疱疹病毒感染的临床表现呈现出许多新形式，变得异质性且几乎累及神经轴的每个部位。现在针对疱疹病毒家族中的每种特定病原体都有先进的诊断方法。随着关于病毒对传统疗法耐药性的数据出现，必须考虑使用更新的抗病毒药物。
如果不及时进行适当治疗，疱疹病毒家族感染可导致毁灭性的神经系统后果。临床症状识别和适当的先进检测对于正确识别感染病因至关重要。了解疾病的继发性神经并发症对于预防额外的发病率和死亡率同样重要。本文讨论了由1型和2型单纯疱疹病毒、水痘-带状疱疹病毒、爱泼斯坦-巴尔病毒、巨细胞病毒和人类疱疹病毒6引起的中枢和外周神经系统感染。详细讨论了每种感染病因的病理生理学、流行病学、疾病临床表现、诊断检查、影像学特征和治疗方法。
