CNS Viruses

Question 1

CNS viruses that can be treated w/ antivirals

Answer 1

HSV 1 / 2, CMV, and HIV

Question 2

Vaccines against CNS viruses (5)

Answer 2

Polio, measles, mumps, rabies (post-exposure), VEE vaccines for humans likely to be exposed (vets, field workers, lab techs).

Question 3

Viruses that cause meningitis (6)

Answer 3

• Enteroviruses (coxsackie virus / echovirus) are MOST COMMON viral causes of meningitis in US. Coxsackie virus meningitis is usually self-limiting, w/ improvement in 1-3 days.
• West Nile virus – usually asymptomatic, but may be severe in elderly
• HSV2 (HSV1 is more encephalitis)
• HIV
• Polio – but unlikely due to vaccine

Question 4

Viruses that cause encephalitis (6)

Answer 4

HSV (1 more than 2), EEE, VEE, La Crosse virus, St Louis virus, West Nile virus.

Question 5

HSV Encephalitis
Sxs
Travel in body
Treatment

Answer 5

•HSV often causes damage in the temporal lobe.
Does not travel through blood. Retrograde axonal transport to CNS.
Tx w/ acyclovir and anticonvulsants.

Question 6

West Nile Encephalitis
Sxs by age
Complication
Pathogenesis
Diagnosis

Answer 6

• West Nile is endemic throughout the entire US.
• Kids / young adults usually have mild disease. Adults have more severe disease. Usually only infects the CNS in elderly and immunosuppressed pxs.
• One complication of WNV is acute flaccid paralysis
• Can cause demyelination in basal ganglia → gait / motor disturbances.
• Diagnose w/ PCR, or serology / ELISA (IgM early or IgG late).

Question 7

When are corticosteroids used for meningitis?

Answer 7

Corticosteroids are NOT used for viral encephalitis due to risk of immunosuppression. Are used for bacterial encephalitis / meningitis.