Ramírez-Colombres M, Maenza C E, Rocchetti N S, Gattino S P, Diodati S, Luchitta C A, Ré M D, Settecase C J, Bagilet D H
Hospital Escuela Eva Perón, Granadero Baigorria, Argentina.
Universidad Nacional de Rosario, Rosario, Argentina.
Rev Neurol. 2022 Apr 16;74(8):280-283. doi: 10.33588/rn.7408.2021121.
The SARS-CoV-2 virus, which causes COVID-19, could give rise to damage the nervous system. Many studies have been conducted on this topic, but few have focused specifically on encephalitis. The effect of SARS-CoV-2 on the clinical expression of other neurotropic viruses, such as Herpesviridae, is unknown.
We describe the cases of two young men (39 and 18 years old) in whom SARS-CoV-2 had been detected -reverse transcription polymerase chain reaction (RT-PCR)-, and with a clinical diagnosis and cerebrospinal fluid (CSF) analysis consistent with encephalitis. The first patient had a positive PCR for varicella zoster virus in CSF, while the second had a positive PCR for herpes simplex virus types 1 and 2. The first patient, who was recently diagnosed with human immunodeficiency virus, presented with fever, headache, vomiting, cough, inappropriate behaviour and epileptic seizures; the second was seen to have fever, headache, myalgia and exanthema. Both offered the same laboratory findings (lymphopenia and high interleukin 6). CSF showed pleocytosis with a predominance of monomorphonuclear cells, hyperproteinorrachia and normal glycorrhachia. A cranial CT scan showed only mild diffuse cerebral oedema in the first case. Both cases were treated with corticosteroids, antibiotics and acyclovir. The second progressed favourably, while the first did not.
Little is known about co-infection of SARS-CoV-2 with neurotropic viruses, such as Herpesviridae, and we have only limited evidence of direct neurological involvement of SARS-CoV-2, due to the technical difficulty of detecting it in the nervous system, thus making it important to take co-infection into account in order to be able to establish an early diagnosis and treatment to improve prognosis.
导致新冠肺炎的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）可能会对神经系统造成损害。关于这一主题已经开展了许多研究，但专门针对脑炎的研究较少。SARS-CoV-2对其他嗜神经病毒（如疱疹病毒科）临床表型的影响尚不清楚。
我们描述了两名年轻男性（39岁和18岁）的病例，他们经逆转录聚合酶链反应（RT-PCR）检测出SARS-CoV-2，临床诊断和脑脊液（CSF）分析结果均符合脑炎。第一名患者脑脊液中水痘带状疱疹病毒PCR检测呈阳性，而第二名患者单纯疱疹病毒1型和2型PCR检测呈阳性。第一名患者最近被诊断出感染人类免疫缺陷病毒，表现为发热、头痛、呕吐、咳嗽、行为异常和癫痫发作；第二名患者表现为发热、头痛、肌痛和皮疹。两人的实验室检查结果相同（淋巴细胞减少和白细胞介素6升高）。脑脊液显示细胞增多，以单核细胞为主，蛋白含量升高而糖含量正常。首例患者的头颅CT扫描仅显示轻度弥漫性脑水肿。两例患者均接受了皮质类固醇、抗生素和阿昔洛韦治疗。第二例患者病情好转，而第一例患者则不然。
关于SARS-CoV-2与嗜神经病毒（如疱疹病毒科）的合并感染知之甚少，而且由于在神经系统中检测SARS-CoV-2存在技术困难，我们仅有有限的证据证明其直接累及神经，因此，考虑合并感染对于早期诊断和治疗以改善预后非常重要。
