Treatment of viral encephalitis.
Several viruses may cause central nervous system diseases with a broad range of clinical manifestations. The time course of the viral encephalitis can be acute, subacute, or chronic. Pathologically there are encephalitis with direct viral entry into the CNS in which brain parenchyma exhibits neuronal damaging and viral antigens and there are postinfectious autoimmune encephalitis associated with systemic viral infections with brain tissue presenting perivascular aggregation of immune cells and myelin damaging. Some virus affect previously healthy individuals while others produce encephalitis among imunocompromised ones. Factors such evolving lifestyles and ecological changes have had a considerable impact on the epidemiology of some viral encephalitis [e.g. West-Nile virus, and Japanese B virus]. Citomegalovirus and JC virus are examples of infections of the brain that have been seen more frequently because they occur in immunocompromised patients. In the other hand many scientific achievements in neuroimaging, molecular diagnosis, antiviral therapy, immunomodulatory treatments, and neurointensive care have allowed more precise and earlier diagnoses and more efficient treatments, resulting in improved outcomes. In this article, we will present the current drug options in the management of the main acute and chronic viral infection of the central nervous system of immunocompetent and immunocompromised adults, focusing on drugs mechanisms of action, efficacy, and side effects. The early diagnosis and correct management of such diseases can reduce mortality and neurological sequelae; however, even with recent treatment advances, potentially devastating outcomes are still possible.
Domingues
Renan Barros
RB
Department of Pathology, Santa Casa School of Health Sciences, EMESCAM, Vitória, ES, Brazil. renan-domingues@uol.com.br
D000328:Adult; D019380:Anti-HIV Agents; D000998:Antiviral Agents; D001921:Brain / Q000187:drug effects; D002493:Central Nervous System Diseases / Q000188:drug therapy; D003072:Cognition Disorders; D004664:Encephalitis Virus, Japanese / Q000187:drug effects; D018792:Encephalitis, Viral / Q000150:complications / Q000188:drug therapy*; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology; D056747:Immunomodulation / Q000276:immunology*; D017053:Infection Control; D011070:Poly I-C / Q000276:immunology; D014901:West Nile Fever / Q000150:complications / Q000821:virology; D014902:West Nile virus / Q000187:drug effects
D019380:Anti-HIV Agents; D000998:Antiviral Agents; D011070:Poly I-C