JC Polyomavirus Infection: A Narrative Review

Area of Science:

• Neurovirology
• Immunology
• Infectious Diseases

Background:

• Progressive multifocal leukoencephalopathy (PML) is a rare, fatal central nervous system infection caused by John Cunningham polyomavirus (JCPyV).
• PML occurs due to JCPyV reactivation in immunocompromised individuals, including those with HIV, organ transplants, autoimmune diseases, and certain cancer treatments.
• Diagnosis relies on clinical presentation, imaging, and JCPyV detection in cerebrospinal fluid (CSF) via PCR.

Purpose of the Study:

• To review risk factors, clinical, laboratory, and radiological features of JCPyV-associated PML.
• To propose a management algorithm for PML.
• To highlight emerging immunotherapeutic strategies for PML.

Main Methods:

• Literature review of JCPyV and PML.
• Analysis of diagnostic criteria for PML.
• Evaluation of current and novel treatment approaches, including immunotherapies.

Main Results:

• JCPyV reactivation is linked to impaired cellular immunity across various conditions.
• Diagnosis is established through a combination of clinical, imaging, and laboratory findings (CSF PCR for JCPyV).
• Current treatment focuses on immune restoration, as no effective antiviral therapies exist.

Conclusions:

• PML is a serious JCPyV infection requiring prompt diagnosis and management.
• Restoring immune function is the cornerstone of PML treatment.
• Novel immunotherapies, like checkpoint inhibitors and T-cell therapies, offer potential but require further investigation.