Cytomegalovirus encephalitis.
OBJECTIVE
To review the pathologic and clinical features of and establish the frequency of cytomegalovirus encephalitis in adults and to review the methods available for diagnosis and treatment.


METHODS
MEDLINE search of all English-language articles from January 1965 to August 1995.


METHODS
Articles dealing with cytomegalovirus infection of the brain in adults. We also reviewed all unselected autopsies of these populations to establish the frequency of cytomegalovirus encephalitis in recipients of organ transplants and in patients infected with the human immunodeficiency virus (HIV).


METHODS
Epidemiologic and pathologic characteristics, clinical manifestations, diagnostic methods, pathogenetic mechanisms, and use of anticytomegalovirus treatments.


RESULTS
Of 676 patients receiving a diagnosis of cytomegalovirus encephalitis, 574 (85%) were infected with HIV, 81 (12%) had other causes of immunosuppression, and 21 (3%) were otherwise healthy. Cytomegalovirus encephalitis was confirmed during autopsy in 12% of HIV-infected patients and 2% of transplant recipients. The most common lesion was microglial nodule encephalitis, but the clinical findings corresponding to this pathologic entity are not well defined. In contrast, the pathologic entity of cytomegalovirus ventriculoencephalitis, found almost exclusively in patients with advanced HIV infection, has distinct clinical features that allow recognition even in patients with HIV encephalopathy. Polymerase chain reaction has been shown to be useful for diagnosis of cytomegalovirus encephalitis.


CONCLUSIONS
Cytomegalovirus encephalitis is an important opportunistic infection in HIV-infected patients but is rarely recognized in other groups. Cytomegalovirus ventriculoencephalitis has emerged as a unique entity in patients with advanced HIV infection. Recent developments in diagnostic techniques allow early recognition and may make more aggressive approaches to therapy possible.
Arribas
J R
JR
Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
Storch
G A
GA
Clifford
D B
DB
Tselis
A C
AC
D000998:Antiviral Agents / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D018792:Encephalitis, Viral / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D011379:Prognosis
D000998:Antiviral Agents