Related Experiment Videos
[Cytomegalovirus encephalitis in immunologically normal adults]
Insights
Cytomegalovirus (CMV) encephalitis is rare in healthy adults. Adenine arabinoside (ara-A) showed promise in one case, while acyclovir (Acv) was ineffective in another fatal case.
Area of Science:
- Neurology
- Infectious Diseases
- Virology
Background:
- Cytomegalovirus (CMV) encephalitis is a rare condition, particularly in immunocompetent adults.
- This report details two distinct cases to further understand its clinical presentation and treatment outcomes.
Observation:
- Case 1: A 53-year-old male presented with acute headache, fever, and altered consciousness. Cerebrospinal fluid (CSF) analysis showed elevated cells and protein. Treatment with adenine arabinoside (ara-A) led to complete recovery.
- Case 2: A 78-year-old female experienced similar symptoms, with significantly higher CSF abnormalities and evidence of intrathecal CMV antibody production. Despite acyclovir (Acv) treatment, her condition deteriorated, leading to a fatal outcome.
Findings:
- CMV encephalitis in normal adults is uncommon, with limited reported cases.
- Treatment responses varied significantly between the two cases, highlighting potential differences in disease course or therapeutic efficacy.
- Adenine arabinoside (ara-A) may be a viable treatment option for acute encephalitis unresponsive to acyclovir (Acv).
Implications:
- These findings suggest that prompt and appropriate antiviral therapy is crucial for managing CMV encephalitis in immunocompetent individuals.
- Further research is warranted to elucidate the mechanisms underlying CMV encephalitis and to establish optimal treatment guidelines.
- Clinicians should consider CMV encephalitis in the differential diagnosis of acute encephalitis, even in immunocompetent patients, and consider ara-A when Acv is ineffective.
Abstract:
We report two cases of cytomegalovirus (CMV) encephalitis in immunologically normal adults. Patient 1, a 53-year-old man: onset was acute with headache and pyrexia, followed by moderate disturbance of consciousness with meningeal signs. Repeated lumbar puncture revealed 58 CSF cells per microliters and 96 mg protein per dl. On the 11th day after onset, we started treatment with adenine arabinoside (ara-A). He recovered completely. With IgG-ELISA methods, antibody to CMV turned into positive on the third week, and into negative again on the fifth week, and these conversions were concomitant with the symptomatic aggravation and amelioration, respectively. Patient 2, a 78-year-old woman: onset was acute with general fatigue and pyrexia, followed by meningeal signs and mild disturbance of consciousness. Consciousness level was worsened and two courses of acyclovir (Acv) treatment were started on the 59th and on the 93rd day after onset, but consciousness level went down to coma and she died. Repeated lumbar puncture revealed 787 CSF cells per microliters and 229 mg protein per dl. CMV antibody titer (CF) in CSF was 1:32 and antibody index was 58 or more, suggesting antibody production in central nervous system. CMV encephalitis in immunologically normal adults is very rare, only 10 cases having been reported so far. Most patients recover spontaneously, but some may be fatal. In our view ara-A treatment should be taken in consideration in case of acute encephalitis unresponsive to Acv.