Neurological Disorders Associated with Human Alphaherpesviruses

Area of Science:

• Neurovirology
• Infectious Diseases
• Immunology

Background:

• Herpes simplex virus (HSV) encephalitis is a leading cause of fatal encephalitis globally, affecting the central nervous system (CNS) in many neonates.
• Innate immunity gene defects increase susceptibility to HSV encephalitis.
• Varicella-zoster virus (VZV) also causes diverse CNS conditions, including encephalitis and vasculopathy leading to stroke.

Purpose of the Study:

• To review the diagnosis and management of HSV and VZV central nervous system infections.
• To highlight diagnostic methods and treatment strategies for these viral encephalitides.

Main Methods:

• Review of diagnostic techniques including magnetic resonance imaging (MRI) and polymerase chain reaction (PCR) for detecting viral DNA in cerebrospinal fluid (CSF).
• Discussion of established and common treatment protocols for HSV and VZV CNS infections.

Main Results:

• Temporal lobe abnormalities on MRI are indicative of HSV encephalitis.
• PCR detection of viral DNA in CSF is the gold standard for diagnosing HSV and VZV encephalitis/vasculopathy.
• Intravenous acyclovir is the standard treatment for HSV encephalitis, with prolonged courses improving neonatal outcomes.
• Acyclovir is also a common treatment for VZV CNS manifestations, despite a lack of controlled trials.

Conclusions:

• Prompt diagnosis and treatment of HSV and VZV CNS infections are critical.
• Standardized treatment protocols, particularly for neonatal HSV encephalitis, significantly improve neurological outcomes.
• Further research into VZV treatment efficacy is warranted.