Virology 11- Nervous System

Clinical presentation of HSV-1/2 CNS disease

Severe encephalitis (temporal lobe necrosis, seizures, confusion); HSV-2 can cause aseptic meningitis

Diagnostic method for HSV CNS disease

CSF PCR; MRI showing temporal lobe involvement; Tzanck smear (multinucleated giant cells, Cowdry inclusions)

Treatment of HSV CNS disease

IV acyclovir; supportive care

Clinical presentation of JC virus (JC penney hurts my brain)

BRAIN: Causes Progressive Multifocal Leukoencephalopathy (PML) in immunocompromised; progressive dementia, weakness, visual/speech/personality changes

Clinical presentation of BK virus

KIDNEY: Causes nephropathy, hemorrhagic cystitis in renal transplant patients

Diagnostic method for JC/BK virus

PCR; antibody testing; MRI shows non-enhancing multifocal brain lesions in PML

Treatment of JC/BK virus

Supportive; reduce immunosuppression

Prevention strategies for JC/BK virus

No vaccine; prevention by monitoring immunosuppression in transplant/HIV patients

Clinical presentation of Poliovirus

Most asymptomatic; fever of unknown origin; aseptic meningitis; paralytic polio (asymmetric flaccid paralysis, no sensory loss, anterior horn motor neuron involvement)

Diagnostic method for Poliovirus

Antibody testing; PCR; CSF shows viral meningitis pattern (normal glucose, high protein, lymphocytosis)

Treatment of Poliovirus

Supportive only

Prevention strategies for Poliovirus

Salk killed vaccine (IgG response, preferred); Sabin live oral vaccine (IgG + IgA, risk of reversion); herd protection and herd immunity

Clinical presentation of West Nile Virus

West Nile Fever: flu-like illness with rash; Neuroinvasive disease: meningitis, encephalitis, asymmetric flaccid paralysis, seizures, coma

Diagnostic method for West Nile Virus

Antibody testing (blood, CSF); CSF PCR

Treatment of West Nile Virus

Supportive only

Prevention strategies for West Nile Virus

No vaccine; vector control (Culex mosquitoes); climate change awareness for spread

Clinical presentation of St. Louis Encephalitis Virus

Mild illness or aseptic meningitis; severe encephalitis with confusion, tremors, seizures, spastic paralysis

Diagnostic method for St. Louis Encephalitis Virus

Antibody testing (blood, CSF)

Treatment of St. Louis Encephalitis Virus

Supportive only

Prevention strategies for St. Louis Encephalitis Virus

No vaccine; vector control (Culex mosquitoes, bird reservoirs)

Clinical presentation of Japanese Encephalitis Virus

Most asymptomatic; severe encephalitis with fever, seizures, hemiparesis, neurodevelopmental delay, deafness; 30% mortality, high sequelae

(Japan is on another HEMIsphere sis)

Diagnostic method for Japanese Encephalitis Virus

Antibody testing (blood, CSF)

Treatment of Japanese Encephalitis Virus

Supportive only

Prevention strategies for Japanese Encephalitis Virus

Live attenuated and inactivated vaccines in endemic areas; vector control (Culex mosquitoes, pig/bird reservoirs)

Clinical presentation of Equine Encephalitis viruses

EEE(Eastern Equine Encephalitis): severe encephalitis, high mortality; WEE(Western Equine Encephalitis): milder encephalitis; VEE: encephalitis outbreaks

Clinical presentation of Chikungunya virus

Fever, rash, incapacitating joint pain lasting weeks to months; not primarily encephalitic

(Rip the chicken leg from its Joint will ya)

Diagnostic method for Alphaviruses

Antibody testing

Treatment of Alphaviruses

Supportive only

Prevention strategies for Alphaviruses

Chikungunya vaccines under development; vector control (mosquitoes, horses, primates, birds, rodents)

Clinical presentation of LaCrosse/California Encephalitis

Mild illness or severe summer encephalitis with fever, headache, seizures, paralysis

Diagnostic method for LaCrosse/California Encephalitis

PCR; antibody testing

Treatment of LaCrosse/California Encephalitis

Supportive only

Prevention strategies for LaCrosse/California Encephalitis

No vaccine; vector control (mosquitoes); climate change awareness

Clinical presentation of Rabies

Flu-like prodrome → hydrophobia, hallucinations, seizures, coma, death; fatal unless treated early

Diagnostic method for Rabies

Negri bodies (intracytoplasmic inclusions in neurons); DFA of corneal epithelial cells; PCR; Bullet shaped

Treatment of Rabies

Post-exposure prophylaxis: human rabies immunoglobulin + 4-dose killed virus vaccine series; supportive for advanced disease

Prevention strategies for Rabies

Vaccine for high-risk individuals and domestic animals; avoid bat/dog exposure; climate change altering bat habitats

Clinical presentation of LCMV (Lymphocytic Choriomeningitis Virus Disease)

Two-phase illness: flu-like prodrome → aseptic meningitis/encephalitis; congenital infection → abortion, hydrops, brain/optic abnormalities

Diagnostic method for LCMV

Antibody testing; PCR of CSF

Treatment of LCMV

Supportive; ribavirin sometimes used

Prevention strategies for LCMV

No vaccine; rodent control (mice, hamsters); ask social history for rodent exposure