Comparing molecular quantification of herpes simplex virus (HSV) in cerebrospinal fluid (CSF) with quantitative structural and functional disease severity in patients with HSV encephalitis (HSVE): Implications for improved therapeutic approaches
| Autor: | Anami Patel, Kacy A Ramirez, John P. DeVincenzo, Noel Lenny, Rebecca E. Thompson, Nancy Clanton Watson, Asim F. Choudhri, Leslie Berkelhammer Greenberg, Mehmet Kocak |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male 0301 basic medicine medicine.medical_specialty Adolescent Herpesvirus 2 Human Acyclovir Herpesvirus 1 Human HSL and HSV Disease medicine.disease_cause Polymerase Chain Reaction Severity of Illness Index Gastroenterology Young Adult 03 medical and health sciences 0302 clinical medicine Cerebrospinal fluid Virology Internal medicine medicine Humans Child CSF albumin business.industry Infant Newborn Brain Infant Viral Load medicine.disease Magnetic Resonance Imaging 030104 developmental biology Infectious Diseases Herpes simplex virus Child Preschool DNA Viral Cohort Female Encephalitis Herpes Simplex business Viral load 030217 neurology & neurosurgery Encephalitis |
| Zdroj: | Journal of Clinical Virology. 107:29-37 |
| ISSN: | 1386-6532 |
| DOI: | 10.1016/j.jcv.2018.08.005 |
| Popis: | Background Herpes Simplex Virus encephalitis (HSVE) is a devastating disease of all ages. Rigorous studies correlating viral load with neuroradiological and clinical severity have not been performed, particularly in neonates. Understanding these relationships may improve therapies. Objectives To correlate molecularly quantified HSV in cerebrospinal fluid (CSF) and disease severity. Study Design HSV loads (VL) were evaluated by real-time PCR from the CSF of 33 patients (20 neonates, 5 children, 8 adults) with HSVE. We studied relationships between CSF VL and structural and volumetric brain abnormalities (MRI); hospital morbidity; and discharge and long-term (>3 month) clinical outcomes. Results Initial CSF VL did not differ in neonates vs non-neonates (median 4.6 vs 5.1 log10 copies/mL, p = 0.75). Initial CSF VL was higher in neonates with HSV-2 vs HSV-1 (median 4.8 vs 3.2 log10 copies/mL, respectively, p = 0.02). Persistently detectable DNA in CSF despite acyclovir trended towards higher odds of unfavorable outcome at discharge for neonates [0.87 (CI 0.75–1), p = 0.07]. Initial VL correlated with higher CSF protein concentrations for the cohort and for neonates (p = 0.03 and 0.01, respectively), but not with lesion volume or subarachnoid exposure of involved brain (p all >0.05), hospital morbidity (p all >0.05), nor with higher odds of unfavorable discharge or long-term outcomes for the cohort [OR = 0.9(CI 0.5–1.6), p = 0.72; OR = 1.0(CI 0.5–1.8), p = 0.9] or for neonates [OR = 1.3(CI 0.5–3.3), p = 0.57; OR = 2.3(CI 0.7–8), p = 0.2]. Conclusions Initial HSV VL did not predict neuroradiological or clinical outcomes in patients with HSVE, suggesting host inflammatory factors contribute to disease in treated patients with good viral clearance. |
| Databáze: | OpenAIRE |
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