Jpn. J. Infect. Dis., 55, 6-13, 2002

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Review

Herpesvirus Infections of the Central Nervous System

Hiroshi Shoji*, Kyoko Wakasugi, Yumiko Miura, Toshihiro Imaizumi and Yukumasa Kazuyama¹

First　Department (Neurology) of　Internal Medicine, Kurume University School of Medicine, Asahimachi 67, Kurume 830-0011 and ¹Kitasato-Otsuka Virus Laboratory, Tokyo 108-8642, Japan

(Received October 1, 2001. Accepted February 4, 2002)

Contents:
1. Introduction
2. Herpes simplex virus type 1 (HSV-l) encephalitis
2-1. Incidence and pathogenesis
2-2. Pathology
2-3. Clinical features
2-4. Diagnosis
2-5. Differential diagnosis
2-6. Prognosis
3. HSV-2 nervous system infections and other herpesvirus group infections
3-1. HSV-2 acute encephalitis
3-2. HSV myelitis
3-3. Herpes zoster nervous system infections
3-4. Epstein-Barr virus central nervous system (CNS) infections
3-5. Cytomegalovirus CNS infections
3-6. Human herpesviruses 6, 7 CNS infections
4. Conclusion

SUMMARY: In recent years, advances in the diagnosis and treatment of herpes simplex encephalitis (HSE) have been achieved due to the prevalence of antiviral drugs and the introduction of the polymerase chain reaction (PCR) to test the cerebrospinal fluid. The several clinical forms of herpes simplex virus type 1 (HSV-1) infections of the central nervous system (CNS), including acute disseminated encephalomyelitis and brainstem encephalitis, have been clarified. However, fatal, prolonged, or relapsed cases are still observed, and early detection and appropriate treatment is necessary to lead to a good prognosis for these intractable HSE cases. In adult HSV-2 infections, meningitis and myelitis associated with genital herpes are common. In the past, HSV-2 myelitis has been reported as a form of fatal necrotizing myelopathy; however, using PCR and magnetic resonance imaging studies, mild surviving cases are increasingly likely to be identified. Meanwhile, various CNS syndromes resulting from the herpes group viruses, including varicella-zoster virus and Epstein-Barr virus have also been reported. These herpesviruses have several characteristics in common, e.g., they exist in the latent state and they occur in both mucocutaneous and CNS infections. Adult HSV-1 and -2 infections of the CNS are discussed together with other herpes group virus infections of the CNS.

*Corresponding author: Tel: +81 0942 35 3311, Fax: +81 0942 31 7703, E-mail: hshoji@med.kurume-u.ac.jp

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