Kennedy P G, Adams J H, Graham D I, Clements G B
Glasgow University, Department of Neurology.
Neuropathol Appl Neurobiol. 1988 Sep-Oct;14(5):395-415. doi: 10.1111/j.1365-2990.1988.tb01141.x.
A retrospective clinical and pathological analysis has been performed of 24 cases of herpes simplex virus encephalitis (HSE) seen at the Institute of Neurological Sciences, Glasgow, between 1972 and 1985. All patients had been diagnosed on the basis of isolation of herpes simplex virus (HSV) from, and/or the demonstration of characteristic histological changes of acute necrotizing encephalitis (ANE) in brain biopsy and/or autopsy tissue. Clinical presentation on admission included a prodromal influenza-like illness (46%), sudden onset of headache and confusion (54%), meningism (38%), deep coma (42%), aphasia (54%) and focal neurological signs (79%). Seizures occurred in 46% of cases during the course of the illness. Of the 24 cases, 14 (58%) died and 10 (42%) survived. Intravenous acyclovir treatment was associated with the best prognosis. Cerebral biopsy of one temporal lobe was performed in 22 cases and in 19 of these a positive histological diagnosis of HSE could be made. HSV was isolated from 15 of the 19 (79%) biopsied cases in whom virus isolation was attempted. Only seven out of the 15 cases (47%) in which immunofluorescence assays for HSV antigens were performed were unequivocally positive. Herpes simplex virus was isolated in culture from all cases which were negative by immunofluorescence. Immunocytochemical analysis on tissue sections of five representative brain biopsies demonstrated the presence of HSV antigens in some astrocytes, neurons and macrophages especially within areas of inflammatory infiltration. In situ hybridization experiments with a cloned HSV DNA probe demonstrated viral RNA in astrocytes, neurons and macrophages in two human biopsies and mouse brains in areas broadly corresponding to the distribution of viral antigen labelling. The combined immunocytochemical and in situ hybridization procedure showed that many but not all of the cells containing viral RNA also contained HSV antigens, indicating a productive infection in these double-labelled cells.
对1972年至1985年间在格拉斯哥神经科学研究所就诊的24例单纯疱疹病毒性脑炎（HSE）患者进行了回顾性临床和病理分析。所有患者均根据从脑活检和/或尸检组织中分离出单纯疱疹病毒（HSV）和/或显示急性坏死性脑炎（ANE）的特征性组织学变化而确诊。入院时的临床表现包括前驱性流感样疾病（46%）、头痛和意识模糊突然发作（54%）、脑膜刺激征（38%）、深度昏迷（42%）、失语（54%）和局灶性神经体征（79%）。46%的病例在病程中发生癫痫发作。24例患者中，14例（58%）死亡，10例（42%）存活。静脉注射阿昔洛韦治疗预后最佳。22例患者进行了一侧颞叶脑活检，其中19例可做出HSE的阳性组织学诊断。在19例尝试进行病毒分离的活检病例中，15例（79%）分离出HSV。在进行HSV抗原免疫荧光检测的15例病例中，只有7例（47%）明确为阳性。所有免疫荧光检测为阴性的病例在培养中均分离出单纯疱疹病毒。对5例代表性脑活检组织切片进行免疫细胞化学分析，结果显示在一些星形胶质细胞、神经元和巨噬细胞中存在HSV抗原，尤其是在炎症浸润区域。用克隆的HSV DNA探针进行原位杂交实验，在两份人类活检组织和小鼠脑中的星形胶质细胞、神经元和巨噬细胞中检测到病毒RNA，其分布大致与病毒抗原标记的分布相对应。免疫细胞化学和原位杂交联合检测显示，许多但并非所有含有病毒RNA的细胞也含有HSV抗原，表明这些双标记细胞发生了增殖性感染。
