Herpes : the journal of the IHMF最新文献

{"title":"HHV-8 infection in African children.","authors":"Loredana Sarmati","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Human herpesvirus 8 (HHV-8) is prevalent in Africa and parts of southern Europe, but less common elsewhere. It is analogous to its distant relative, the Epstein-Barr virus, in that it rarely causes disease in the immunocompetent host but is highly oncogenic when associated with immunosuppression or HIV-1 infection. HHV-8 infection is endemic in sub-Saharan Africa, where high seroprevalence rates of up to 58% in young children were found in Ghana, Tanzania, Cameroon, Uganda and Egypt. Paediatric HHV-8 transmission has been studied in various African populations. Frequent detection of the virus from oral secretions suggests the horizontal route is the most common way to acquire the virus during childhood. A clinical presentation characterized by a self-limited maculopapular rash and fever was associated with HHV-8 primary infection in Egyptian children.</p>","PeriodicalId":83725,"journal":{"name":"Herpes : the journal of the IHMF","volume":"11 2","pages":"50-3"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25135931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human herpesvirus type 6 and multiple sclerosis.","authors":"Duncan Clark","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The aetiology of multiple sclerosis (MS) is unknown, but is probably the result of an interaction between predisposing genetic and environmental factors. The potential role of an infectious agent in MS aetiology stems from evidence of a geographical risk component, with disease being more prevalent in temperate regions. Also, several epidemics of MS have been recorded, suggesting a transmittable element to the disease. Although no one particular virus has been implicated as a causative factor, several herpesviruses have been incriminated due to their neurotropism, ubiquitous nature and ability to establish latency. The majority of evidence supporting a link between MS and human herpesvirus-6 (HHV-6) comes from case control studies comparing the presence of HHV-6 in brain tissue, cerebrospinal fluid (CSF) and peripheral blood mononuclear cells (PBMCs) in patients with and without MS. HHV-6 was detected in a high proportion of individuals without MS, indicating that HHV-6 polymerase chain reaction (PCR) positivity in itself is not sufficient for its causality in the development of MS. Studies of the association between HHV-6 and MS have been contradictory and the International Herpes Management Forum (IHMF) recommends that any future studies should use validated, sensitive methods and that masked samples should undergo independent analyses. If therapy trials are indicated, it is recommended that drugs with improved activity against HHV-6 are evaluated.</p>","PeriodicalId":83725,"journal":{"name":"Herpes : the journal of the IHMF","volume":"11 Suppl 2 ","pages":"112A-119A"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24642858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis of herpesvirus infections of the central nervous system.","authors":"Guy Boivin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The International Herpes Management Forum (IHMF) has produced guidelines to promote improved diagnosis of herpesvirus infections of the central nervous system (CNS). Recommendations include using polymerase chain reaction (PCR) analysis of cerebrospinal fluid (CSF) to help diagnose herpes simplex virus (HSV), varicella zoster virus (VZV) and cytomegalovirus (CMV) infections of the CNS. Laboratories routinely using such tests should participate in a proficiency testing programme. For retrospective diagnosis of herpesvirus infections of the CNS, intrathecal antibody detection can be used as an adjunct to PCR, assuming all appropriate controls are utilized. For suspected cases of herpes simplex encephalitis (HSE), a sensitive HSV PCR test of the CSF should be used in preference to other methods. Cultures are not recommended for HSE except as an adjunctive test in suspected neonatal HSV infections. While research continues into the role of PCR with VZV infections of the CNS, studies demonstrate that the technique is useful for diagnosing varicella-associated CNS syndromes but further research is required for its role in zoster-associated syndromes. For CMV CNS infections, PCR represents the most sensitive diagnostic method and can be used in conjunction with virus culture to determine suspected cases of CMV myelitis. For CNS infections with lymphotropic herpesviruses, a positive PCR test is suggestive, but not definitive, evidence of virus encephalitis. PCR analysis of CSF for Epstein-Barr virus can be useful for diagnosing AIDS-associated primary CNS lymphoma. This article presents the current evidence for these and other guidelines for the diagnosis of herpesvirus infections of the CNS.</p>","PeriodicalId":83725,"journal":{"name":"Herpes : the journal of the IHMF","volume":"11 Suppl 2 ","pages":"48A-56A"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24642877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's.","authors":"Kenneth L Tyler","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Herpes simplex encephalitis (HSE) is a life-threatening consequence of herpes simplex virus (HSV) infection of the central nervous system (CNS). Although HSE is rare, mortality rates reach 70% in the absence of therapy and only a minority of individuals return to normal function. Antiviral therapy is most effective when started early, necessitating prompt diagnosis. The International Herpes Management Forum (IHMF) has issued guidelines to aid the diagnosis and treatment of HSE. Polymerase chain reaction (PCR) of the cerebrospinal fluid (CSF) is the diagnostic method of choice for HSE, but negative results need to be interpreted in the context of the patient's clinical presentation and the timing of the CSF sampling. CSF virus culture is of little value in all but patients under the age of 6 months. CSF (intrathecal) antibody measurements are not recommended for acute diagnostic purposes. However, demonstration of an intrathecal HSV antibody response may be helpful in retrospective diagnosis or in cases in which CSF is sampled only late after onset of infection and PCR is negative. Serum HSV antibody measurements are not of utility in the diagnosis of HSV encephalitis in adults. In children and young adults, HSV serology may help define whether HSE is part of a primary or a reactivated HSV infection, although the clinical features, therapy, and prognosis of these two forms of HSV encephalitis are similar. The IHMF recommends that all patients with HSE receive intravenous aciclovir 10 mg/kg every 8 h for 14-21 days. Owing to the life-threatening nature of the disease, if there is a delay in diagnostic test results therapy should not be withheld until they become available. After completion of therapy, PCR of the CSF can confirm the elimination of replicating virus, aiding further management of the patient. Clinical trials of other antiviral agents (i.e. adjunctive oral valaciclovir after intravenous aciclovir) for the treatment of HSE are underway. Herpes infection of the CNS, especially with HSV-2, can also cause both monophasic and recurrent aseptic meningitis, as well as myelitis or radiculitis. Limited evidence suggests that aciclovir may be effective in its treatment. Recurrent aseptic meningitis is predominantly caused by HSV-2 infection, and is characterized by self-limited episodes of fever, meningismus and severe headache. Many cases are indistinguishable from cases previously classified as \"Mollaret's meningitis\", a term that should now be reserved for idiopathic cases of recurrent aseptic meningitis.</p>","PeriodicalId":83725,"journal":{"name":"Herpes : the journal of the IHMF","volume":"11 Suppl 2 ","pages":"57A-64A"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24642878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human herpesvirus type 6 and human herpesvirus type 7 infections of the central nervous system.","authors":"Stephen Dewhurst","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In developing guidelines for the improved management of herpesvirus infections of the central nervous system (CNS), the International Herpes Management Forum (IHMF) has considered human herpesvirus (HHV) type 6 and type 7 disease. Although HHV-6 is generally asymptomatic, it has been associated with exanthema subitum, febrile convulsions and encephalitis in infants and immunocompromised adults and may play a role in multiple sclerosis, Guillain-Barre syndrome and acute disseminated encephalomyelitis. As HHV-6 is present in the brain tissue of healthy individuals, its role as an aetiological agent in CNS disorders is unclear. While polymerase chain reaction (PCR) is a method useful for diagnosis of other viral CNS infections, it has no value for diagnosing HHV-6. HHV-7 has not been shown to cause a specific disease but is associated with febrile convulsions and has been implicated as a cause of encephalitis. Ganciclovir and foscarnet, either alone or in combination, may be used for the management of HHV-6-related neurological disease. Although ganciclovir is unlikely to be effective against HHV-7-related CNS disease, foscarnet may be useful but prospective trials are needed.</p>","PeriodicalId":83725,"journal":{"name":"Herpes : the journal of the IHMF","volume":"11 Suppl 2 ","pages":"105A-111A"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24642857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Viruses and schizophrenia: a focus on herpes simplex virus.","authors":"Robert Yolken","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Various factors have been implicated in the pathogenesis of schizophrenia. Evidence for an infectious cause includes the 5-8% increased risk among those born in the winter-spring months, when infectious diseases are more prevalent and at times when other infections (measles, varicella, poliomyelitis) show increased activity. Herpes simplex virus (HSV) has been implicated in schizophrenia as it has a tropism for the nervous system and is capable of replication in the brain. Although post-mortem studies of brain tissue of schizophrenic patients have failed to detect the virus, these studies have been hampered by the unknown cellular localization of HSV genomes and by attempting to detect the virus years after the symptom onset. A more recent, nested, case-control study evaluated pregnant women between 1959 and 1966 and identified 27 surviving offspring who were later diagnosed with schizophrenia. Analysis of stored blood samples showed an association between high levels of maternal antibody to HSV-2 and subsequent development of adult psychosis. No association was found between HSV-1 infection and psychosis. There is also evidence that human endogenous retroviruses (HERVs) may play a role in schizophrenia, as antibodies to these agents have been found at a greater frequency in the sera of affected individuals compared with controls. This is supported by the presence of reverse transcriptase, a retroviral marker, at levels four times higher in the cerebrospinal fluid (CSF) of people with recent onset schizophrenia compared with controls, and by its elevated presence in long-term schizophrenic patients. Further research to investigate the relationship between virus infection and schizophrenia is warranted.</p>","PeriodicalId":83725,"journal":{"name":"Herpes : the journal of the IHMF","volume":"11 Suppl 2 ","pages":"83A-88A"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24642881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Varicella zoster virus and central nervous system syndromes.","authors":"Donald Gilden","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Varicella zoster virus (VZV) causes chicken pox (varicella) after which it establishes latency and can subsequently reactivate to cause herpes zoster. Central nervous system (CNS) complications can follow both primary infection and reactivation of VZV. The more serious manifestations arise when VZV invades the spinal cord or cerebral arteries after reactivation of the virus, causing diseases such as myelitis and focal vasculopathies. The International Herpes Management Forum (IHMF) has developed guidelines to aid in the diagnosis and management of CNS syndromes associated with VZV and these have focused on VZV vasculopathy. The new guidelines recommend that where VZV vasculopathy is suspected, cerebrospinal fluid (CSF) should be analysed by polymerase chain reaction (PCR) for VZV DNA. As VZV antibodies may be present in the CSF in the presence or absence of detectable VZV DNA, CSF should also be analysed for VZV-specific antibody if there is a high likelihood of CNS disease. Early diagnosis of these serious complications is important, as aggressive antiviral treatment can be effective. Patients with VZV focal vasculopathy should be treated with intravenous aciclovir (10 mg/kg every 8 h for adults, 500 mg/m2 body surface area for children) for 7 days. The immunocompromised patient may require longer treatment. However, treatment should be discontinued if negative results are obtained for both VZV DNA and anti-VZV antibody in CSF. Steroid therapy (prednisone 60-80 mg/day for 3-5 days) should be considered in VZV vasculopathy to reduce inflammation.</p>","PeriodicalId":83725,"journal":{"name":"Herpes : the journal of the IHMF","volume":"11 Suppl 2 ","pages":"89A-94A"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24642855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epstein-Barr virus and human herpesvirus type 8 infections of the central nervous system.","authors":"Antonio Volpi","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In developing guidelines for the improved management of herpesvirus infections of the central nervous system (CNS), the International Herpes Management Forum (IHMF) has studied Epstein-Barr virus (EBV) and human herpesvirus type 8 (HHV-8)- related diseases. EBV has been associated with numerous CNS diseases including meningitis, encephalitis and post transplant lymphoproliferative disorder (PTLD). The pathogenesis of EBV-associated CNS disorders is not completely understood but may be due to direct virus invasion of the CNS. Alternatively, damage may be immunologically mediated by infiltration of cytotoxic CD8+ lymphocytes into neural tissue or deposition of antibody-antigen complexes. The IHMF recommends that diagnosis of EBV infections of the CNS may involve polymerase chain reaction (PCR) of cerebrospinal fluid (CSF) for EBV DNA but the sensitivity and specificity of the technique remains to be determined. Furthermore, the value of PCR in this context may be limited as EBV DNA is often detected in patients without neurological symptoms. Antiviral therapy has not demonstrated clinical efficacy in the treatment of EBV-related CNS disorders. CNS complications of HHV-8 infection are rare, but the virus has been associated with AIDS-dementia complex, amyotrophic lateral sclerosis (ALS) and primary CNS lymphoma; however these links remain to be proven.</p>","PeriodicalId":83725,"journal":{"name":"Herpes : the journal of the IHMF","volume":"11 Suppl 2 ","pages":"120A-127A"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24642859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Herpes simplex virus, meningitis and encephalitis in neonates.","authors":"David Kimberlin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The consequences of neonatal herpes simplex virus (HSV) infection can be severe. Disease can be localized to skin, eye and mouth (SEM disease), involve the central nervous system (CNS) or manifest as disseminated infection involving multiple organs. Most surviving infants in the latter two categories have neurological sequelae, and the mortality rate in the absence of therapy is very high (80%) for babies in the latter category. The International Herpes Management Forum (IHMF) has produced guidelines on the diagnosis, prevention and effective management of neonatal herpes. Neonatal herpes may occur in the absence of skin lesions, so if the infection is suspected, swabs of the oropharynx, conjunctiva, rectum, skin lesions, mucosal lesions and urine should be promptly taken and submitted for virus culture. Cerebrospinal fluid (CSF) should be submitted for polymerase chain reaction (PCR) detection of HSV DNA. Evidence for disseminated or CNS infection should be sought using liver function tests, complete blood cell count, CSF analysis and chest X-ray, if respiratory abnormalities are present. Neonates with suspected HSV infection should be treated with intravenous aciclovir (20 mg/kg) every 8 h for 21 days. If disease is localized to the SEM, treatment should be limited to 14 days. The neutrophil count for children receiving intravenous aciclovir should be monitored. If the absolute neutrophil count falls below 500/mm3, decreasing the aciclovir dose or administering granulocyte colony stimulating factor (GCSF) should be considered. At the end of therapy in CNS and disseminated disease, PCR assessment of CSF should be used and treatment continued if the child remains PCR positive at this site.</p>","PeriodicalId":83725,"journal":{"name":"Herpes : the journal of the IHMF","volume":"11 Suppl 2 ","pages":"65A-76A"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24642879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytomegalovirus infection of the central nervous system.","authors":"Paul Griffiths","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Studies report that 40-100% of the general population are infected with cytomegalovirus (CMV), a virus associated with severe neurological conditions, such as CMV encephalitis, and which may have a role in some cases of Guillain-Barre syndrome. CMV infection is a particular concern among individuals with HIV, as almost all are co-infected with it. The introduction of highly active antiretroviral therapy (HAART) has provided a means of reconstituting the immune system of those with HIV/AIDS in such a way as to allow CMV infection to be controlled. In doing so, HAART has done much to reduce the mortality rate associated with CMV disease in such patients. Despite this, response to treatment in these patients remains suboptimal and many do not have access to such therapy, so, efforts to improve the treatment of CMV have been a priority. The International Herpes Management Forum (IHMF) has developed management guidelines to promote the improved diagnosis and treatment of CMV disease of the central nervous system (CNS). It is recommended that polymerase chain reaction (PCR) for viral DNA should be performed on CSF as a means of diagnosing CMV infection of the CNS. As CMV disease is always preceded by viraemia, treatment should be directed toward the prevention of CMV disease. However, if CMV disease develops, ganciclovir is recommended as therapy and continued in a maintenance fashion, which can be discontinued should CD4 count remain above 100 cells/mm3 for 6 months. In many circumstances, valganciclovir may be preferred, depending on the level of function in the patient, their ability to take oral therapy and the severity of disease. Use of foscarnet should be limited to ganciclovir-resistant cases due to the high level of toxicity associated with the drug and its intravenous mode of administration.</p>","PeriodicalId":83725,"journal":{"name":"Herpes : the journal of the IHMF","volume":"11 Suppl 2 ","pages":"95A-104A"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24642856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}