Chrétien F, Bélec L, Hilton D A, Flament-Saillour M, Guillon F, Wingertsmann L, Baudrimont M, de Truchis P, Keohane C, Vital C, Love S, Gray F
Laboratoire d'Anatomie Pathologique (Neuropathologie), Hôpital Raymond Poincaré-Faculté de Médecine Paris-Ouest, Garches, France.
Neuropathol Appl Neurobiol. 1996 Oct;22(5):394-404. doi: 10.1111/j.1365-2990.1996.tb00909.x.
Herpes simplex (HSV) infection of the central nervous system is uncommon in AIDS and usually has an atypical topography. This review is centred around the case of a 49-year-old homosexual patient with AIDS who died from diffuse encephalopathy. Neuropathological examination revealed necrotic and haemorrhagic changes involving both temporal lobes, insulae and cingulate gyri. Cowdry type A intranuclear inclusion bodies were abundant but inflammation was minimal. Electron microscopy confirmed characteristic herpes virus particles. Immunocyto-chemistry was positive for HSV type 1 and 2. In situ hybridization and PCR, however, were positive for HSV type 1 but excluded HSV type 2. There was associated cytomegalovirus ventriculitis but clearly separated from HSV encephalitis. There were no histological features of HIV encephalitis and HIV could not be demonstrated by immunocytochemistry or by PCR to demonstrate proviral DNA. Apoptotic neurons were numerous in areas with a severe macrophage reaction. Only two pathological cases with characteristic limbic distribution and necrotic haemorrhagic histologic have been reported previously. The rarity of these reports suggests that in advanced AIDS, the immune reaction causing a typical necrotizing encephalitis cannot be mounted. Distinction between HSV type 1 and 2 infection may be difficult by immunocytochemistry and usually requires in situ hybridization, tissue culture or PCR. In AIDS patients, HSV-1 has been identified as responsible for encephalitis whereas HSV-2 has been more responsible for myelitis. Associated productive HIV infection of the CNS was found in none of the cases. In contrast, cytomegalovirus encephalitis was found in nine of 11 cases of AIDS-associated HSV encephalitis.
单纯疱疹病毒（HSV）感染中枢神经系统在艾滋病患者中并不常见，且通常具有非典型的病变部位。本综述围绕一名49岁死于弥漫性脑病的艾滋病同性恋患者的病例展开。神经病理学检查显示双侧颞叶、脑岛和扣带回出现坏死和出血性改变。可见大量A型考德里核内包涵体，但炎症轻微。电子显微镜检查证实了特征性的疱疹病毒颗粒。免疫细胞化学检测显示1型和2型单纯疱疹病毒均呈阳性。然而，原位杂交和聚合酶链反应（PCR）检测显示仅1型单纯疱疹病毒呈阳性，排除了2型单纯疱疹病毒感染。同时存在巨细胞病毒性脑室炎，但与单纯疱疹病毒性脑炎明显分开。没有发现HIV脑炎的组织学特征，免疫细胞化学或PCR检测均未发现HIV前病毒DNA。在有严重巨噬细胞反应的区域可见大量凋亡神经元。此前仅报道过两例具有典型边缘系统分布和坏死出血性组织学特征的病理病例。这些报道的罕见性表明，在晚期艾滋病患者中，无法引发典型坏死性脑炎的免疫反应。通过免疫细胞化学区分1型和2型单纯疱疹病毒感染可能较为困难，通常需要进行原位杂交、组织培养或PCR检测。在艾滋病患者中，已确定1型单纯疱疹病毒是脑炎的病因，而2型单纯疱疹病毒更多地与脊髓炎有关。所有病例均未发现中枢神经系统存在相关的有活性HIV感染。相比之下，在11例艾滋病相关单纯疱疹病毒性脑炎病例中，有9例发现了巨细胞病毒性脑炎。
