Questions. Herpes in the brain: how to recognize? Symptoms and signs Complications and consequences of the disease

Of the total number of viral encephalitis, herpetic encephalitis accounts for an average of 10-20%. According to WHO materials, mortality from herpes infection ranks second after influenza in the structure of mortality from viral infections. Diagnosis of viral neuroinfections is complex and requires material and technological costs and highly qualified medical personnel. The percentage of deciphering viral neuroinfections in leading clinics in the world rarely exceeds 40-50%. A clinical case of a favorable outcome of herpetic meningoencephalitis in a patient during conservative therapy is described. Key words: viral meningitis, herpetic meningoencephalitis, herpetic neuroinfection, liquor filtration.

Authors: prof. Doctor of Medical Sciences Shmyrev V.I., prof. Doctor of Medical Sciences Devyatkin A.V., Ph.D. Kalenova I.E., Gavrilov D.Yu., Sharinova I.A., Litvinov N.I.

Herpetic encephalitis is a common complication of recurrent HSV-1 viral infection; in neurology, the pathology is classified as severe. In most cases, hospitalization is required to relieve acute symptoms and prevent death.

Signs of pathology

The disease develops with an acute increase in body temperature to 39⁰C, which is difficult to bring down. The day before, the patient develops symptoms of acute respiratory infections and herpetic rashes. The patient complains of convulsions. Signs of damage to the central nervous system are disturbances of consciousness. In some cases, everything is limited to inhibition of reactions, in others, the patient falls into a coma. The individual reaction of the body to the activity of the pathogen superimposes on the main symptoms additional ones in the form of:

confusion;
headache;
epileptic seizure;
the appearance of hallucinations;
paresis;
speech disorders.

The latent period of the disease lasts up to 20 days. In practice, this period is reduced to 7 days. The first symptoms appear as a painful tingling sensation on the skin and the appearance of a rash in these areas within a day. Localization of brain herpes in the organ trunk contributes to disruption of the body’s autonomic functions, which in severe cases results in cardiac or respiratory arrest.

The development of the disease in adults is associated with susceptibility to type 1 virus or carriage. The pathogen can exist for a long time outside the body.

After 12-24, an increase in body temperature to a critical level is observed. Self-administration of medications does not provide the expected results. The patient requires immediate hospitalization. If the patient doubts the need to seek medical help, then symptoms associated with further progression of the pathology should prompt them to dial an ambulance number. Signs of herpes brain appear in the following order:

The appearance of weakness throughout the body.
Convulsive seizures. Either all the muscles of the body contract, or only their individual groups. The administration of medications does not help get rid of frequently recurring unpleasant symptoms.
Impaired consciousness. The patient is stunned, may suffer from hallucinations, and lose consciousness.
Difficulty focusing vision. Patients complain of double vision, limited ability to look in one direction, pain when trying to move the eyeballs, and strabismus.

Afterwards, a lack of coordination develops, which limits the person’s ability to control the limbs. He has an unsteady gait and paresis of half his body. If a person is conscious, then he may experience memory loss, headaches, increased excitability, and loss of clarity of speech.

Classification

Inflammation of the brain occurs in fulminant, acute, subacute and chronic forms. The fulminant course progresses over several hours, often leading to death. Acute and subacute forms are characterized by a standard course for the disease. The chronic version is accompanied by sluggish development, alternating with periods of exacerbation.

Meningoencephalitis is also differentiated by the quality of the spinal fluid: serous, hemorrhagic, purulent. The composition and color of the cerebrospinal fluid indicates the nature of the inflammatory process.

If you vaccinate with a live vaccine when your immune system is weakened, the pathogen can penetrate the brain barrier, resulting in encephalitic meningitis.

Manifestations of the disease vary depending on the type of meningoencephalitis. There are brucellosis, influenza hemorrhagic, chickenpox, amoebic, herpetic, viral and purulent types. Fungal meningoencephalitis is diagnosed less frequently.

Develops as a complication after suffering from the flu. It's leaking hard.

Symptoms include a sharp increase in temperature, epileptic seizures, chills, and confusion. This form is difficult to treat and usually causes serious complications.

The form can manifest itself as a separate disease or occur along with a viral infection. The danger of this species lies in the absence of clinical manifestations at the initial stage of development. Vivid symptoms of intoxication are observed, the brain swells, accompanied by the death of neurons.

This type is often diagnosed in infants. Infection occurs in the prenatal period or during delivery. The disease can manifest itself even in people who have antibodies to viral strains.

Occurs as a result of the bite of an infected tick or after consuming the milk of infected goats and cows. The frequency of diagnosis increases in spring and summer, when insects are most active.

Initially, signs manifest themselves as fever, intense pain in the head, and vomiting. After a week, the symptoms are complemented by damage to the central nervous system, which is expressed in neurological disorders.

A rare type of pathology characterized by high mortality. The infection in the form of tiny amoebas (protozoa) penetrates the upper parts of the respiratory tract. Infection occurs in fresh water reservoirs through drinking tap water.

The pathogen can be found on mushrooms, fruits, or in the soil. The incubation period lasts about 2 weeks.

The soft membrane of the brain is damaged, which affects the appearance of brucellosis-type granules. Paralysis appears and neuropsychiatric disorders are observed. Long-term treatment is required.

The development of purulent meningoencephalitis occurs as a result of the invasion of the body by staphylococci, bacteria, meningococci, and Haemophilus influenzae. Pathogens usually enter the body through the nasopharyngeal mucosa.

Infectious agents damage the cerebral cortex and brain structures. The risk of developing pathology increases with an immunodeficiency state, traumatic brain injury, and head surgery.

This form manifests itself due to secondary inflammation of the meninges. It is diagnosed in people with different types of tuberculosis, as well as in children under one year of age. The disease is accompanied by systematic pain in the head, weakness, irritability, decreased appetite and quality of sleep.

Appears as a complication of chickenpox in young children. It occurs in a severe form. Expressed in the development of convulsive seizures, headaches, fever, dizziness.

Principles of treatment

To combat the pathogen, the patient is placed in an intensive care unit in a hospital. The basis of the treatment course for herpes brain is Herpevir or Acyclovir. Only a doctor can determine the effective dosage and frequency of administration of the drug, taking into account the risk of side effects and the severity of symptoms.

Herpes cerebri can be detected by testing the cerebrospinal fluid. To do this, a spinal cord puncture is performed.

The success of treatment largely depends on the speed of restoration of the body's natural defenses. For this . Drugs of these groups can significantly increase.

To suppress accompanying symptoms, the patient is additionally prescribed medications:

antipyretics;
anti-inflammatory and B vitamins - to eliminate weakness;
nootropics - for memory restoration;
drip solutions - in the presence of dehydration;
diuretics - to get rid of swelling;
anticonvulsants.

The effectiveness of treatment depends on the accuracy of the selection of funds and the creation of comfortable conditions for the patient. With herpes of the brain, whenever possible, all irritating factors are excluded and the patient’s activity is reduced as much as possible.

Treatment methods

Therapy for encephalitic meningitis is carried out in a medical institution, the patient is placed in the infectious diseases department. The choice of therapeutic methods depends on the form of the pathology.

Bacterial forms of purulent meningoencephalitis are treated with antibiotics: carbapenems, penicillins. The amoebic variety requires additional administration of antifungal drugs.

Diseases of viral etiology are eliminated through intramuscular administration of globulin and interferon. Children with the herpetic form of the disease are prescribed corticosteroids.

General therapeutic measures include the use of:

infusions that normalize blood composition;
antihistamines – Suprastin, Diphenhydramine;
nootropics that restore the functioning of the central nervous system;
means that improve blood circulation;
multivitamins;
sedatives;
anticonvulsant medications.

In addition to drug treatment, patients require rehabilitation therapy, which includes massages, physical therapy, and acupuncture.

Complications and consequences of the disease

The consequences of a herpetic infection of the brain are: headache, dizziness, hearing and speech impairment, migraines, memory or mental problems, decreased mental activity and constant weakness. After rehabilitation measures, all these signs disappear.

Restoration of health after suffering from herpes of the brain is carried out in special centers where several doctors work with the patient at once. Typically, a rehabilitation program is developed individually. Its basis is a combination of therapeutic exercises, movement therapy and a course of physiotherapy. Over time, it is possible to restore joint function and get rid of muscle weakness and pain.

Rehabilitation after brain herpes necessarily includes physical therapy (physical therapy).

Changes that are difficult to treat occur rarely and are observed in patients who neglect the doctor’s recommendations during treatment, abuse alcohol, or suffer from constant mental overload.

If you do not seek medical help in a timely manner, there is a risk of developing pathological complications in the form of:

epilepsy;
personality disorders;
decreased mental abilities;
paralysis

These changes are caused by structural changes in the brain, which makes them resistant to treatment. The lack of adequate treatment for herpes brain causes death in 80% of cases.

Herpetic meningitis

Herpes meningitis is a serous inflammation of the soft membranes of the brain.
An isolated form of damage to the membranes is rare, since more often the disease occurs either in the form of encephalitis or in the form of meningoencephalitis - that is, a combined form. Herpetic meningoencephalitis occurs with general cerebral and focal symptoms against the background of clinical signs of membrane damage.

Symptoms of herpetic inflammation of the soft meninges are:

Damage to the muscles of the back of the neck in the form of their rigidity - intractability. The patient in the supine position is unable to reach the edge of the chin to the chest.
Severe photophobia.
Unbearable headache.
Cramps.
Uncontrollable vomiting.
Pain when pressing on the eyeballs.
Increased auditory and tactile sensitivity.
Skin rash and rashes on mucous membranes.
Enlarged lymph nodes.
Fever.

Symptoms of meningitis due to herpes can develop at lightning speed - in less than 24 hours. Death can occur from infectious-toxic shock.

Mechanism of disease development

Scientists identify two ways of developing herpetic encephalitis:

The first is primary infection. The herpevirus enters the mucous membrane of the nose or mouth, and, since it is tropic for nervous tissue, penetrates the axons of the smelling nerves, from where it spreads throughout the nervous system - into the nerve ganglia and the brain.
The second is the activation of the virus. In carriers, due to decreased immunity (stress, trauma, poor nutrition, diseases that cause immunodeficiency - tuberculosis, rheumatism, cancer, AIDS), the virus becomes active and affects the tissue of the cerebral convolutions, namely the lower part of the frontal lobe and the temporal lobe. Cell damage is accompanied by swelling, inflammation, and cell death.

How does brain inflammation manifest?

Signs of the disease depend on the cause of the pathology and the extent of damage to other organs. The latent period of meningitis encephalitis is about 2 weeks; in some forms the incubation period lasts a month. During this phase, the virus in the body actively replicates and penetrates all tissues.

In case of convulsive seizures and loss of consciousness, you should immediately call an ambulance.

Body temperature begins to rise. A painful headache and vomiting indicate the progression of intoxication processes. Damage to the nervous system is expressed in increased sensitivity and restlessness. After a few days, stiffness of the neck muscles appears, in which the patient cannot tilt his head forward due to severe pain. In infants, the fontanelle swells.

As the disease progresses, speech skills are impaired, and it is difficult for a person to swallow and breathe. The heart rate gradually decreases, part of the brain swells, which leads to death.

Symptoms

Common characteristic features are:

acute respiratory infection with herpetic rashes suffered the day before;
acute increase in body temperature to 39 degrees and above, which is difficult to treat;
disturbances of consciousness of varying severity - from general lethargy to coma;
convulsions of the whole body or parts of it.

All other symptoms are purely individual, as they depend on which area is affected.

It can be:

various paresis;
speech disorders;
auditory or visual hallucinations;
confusion;
epileptic seizures;
violation of autonomic functions, up to cardiac arrest;
headache.

Herpetic encephalitis

Herpetic encephalitis in adults occurs in acute and chronic forms.
The disease develops against a background of decreased immunity, when the herpes simplex virus from an inactive state enters the phase of active replication and reaches the brain tissue along nerve fibers. HSV is located in the trigeminal ganglia under the control of immunocompetent cells that contain the infectious process. But against the background of provoking factors, viral particles overcome this barrier. In addition to the classic manifestation of herpes on the lips and herpetic stomatitis, HSV is capable of attacking brain cells, leading to tissue inflammation.

Herpetic encephalitis develops both during carriage and during primary infection, but the latter option is diagnosed more often in children.

In both children and adults, the Varicella-Zoster virus, the causative agent of chickenpox, can lead to complications in the form of encephalitis.

Diagnostics

The diagnosis of herpetic encephalitis can be made on the basis of clinical data in combination with laboratory and instrumental studies.

Spinal puncture and analysis of cerebrospinal fluid for viral DNA is a mandatory research method. Using polymerase chain reaction (PCR), identifying the virus is simple and quick. Computed tomography or nuclear magnetic resonance imaging is also prescribed, which allows identifying foci of tissue necrosis in the brain. The disadvantage of this study is that in the first stages of the disease there are no structural changes in the organ; they appear on the 4-5th day of the disease.

A biopsy and examination of the biopsy sample for the presence of a virus are quite informative, but due to the traumatic nature of the method and the high risk of complications, it is rarely used.

Routes of infection↑

In 95% of cases, the source of herpetic encephalitis is PVG-1, the natural focus of which in the body is the oral cavity, nasopharynx and facial nerves. The infectious agent enters the brain through the hematogenous and neuronal route. In children and young people, encephalitis most often manifests itself as a primary infection with direct infection with HSV-1 through airborne droplets or household contact. In elderly people, damage to the nervous system occurs as a secondary infection against a background of weakened immunity.

Herpes on the back →

The channel for neuronal penetration of an infectious agent into the brain usually becomes the olfactory nerves. Having penetrated through it into the olfactory bulb (bulbus olfactorius) and trigeminal ganglia, the virus then spreads through the frontal and temporal lobes of the brain, primarily affecting the cells of its cortex.

Treatment

Patients should be immediately hospitalized in the intensive care unit.

There is specific therapy for herpetic encephalitis - acyclovir, herpevir. The dose, frequency of administration and dosage form depend on the severity of the disease and are determined by the attending physician.

Immunomodulators and interferons, corticosteroids are also prescribed to significantly increase the effect of antiviral therapy. At the same time, detoxification therapy, dehydration and symptomatic agents are used.

Consequences and prevention

Herpes of the brain can go away without consequences, but sometimes undesirable complications remain:

epilepsy;
personality and intellectual disorders;
paralysis and paresis.

The changes are persistent and cannot be treated, since they appear as a result of structural disorders in the brain. If patients with encephalitis of herpes etiology are not treated, death occurs in more than 80% of cases.

The herpes virus is quite common. About 85% of people living on the planet are infected with it. True, in most cases, the virus is in an inactive state in the human body. Only when certain factors appear that can affect the decrease in the immune defense system does herpes become dangerous.

Consequences in adults and children

Acute herpes meningoencephalitis in an adult causes such consequences as paresis of the limbs, personality disorder, chronic fatigue, memory loss, and attention problems.

Chronic herpes meningoencephalitis causes the following complications:

dementia (dementia);
multiple sclerosis;
Alzheimer's disease;
epilepsy;
parkinsonism;
schizophrenia.

Herpes meningoencephalitis in children causes hydrocephalus, paresis and paralysis, epilepsy, and neuroendocrine disorders in the future.

Causes and symptoms

Basically, the herpes virus manifests itself in the form of wounds on the lips, mucous membranes of the eyes, nose, sometimes the mouth, as well as on the skin and genital area. Its treatment does not cause any particular difficulties, since it does not take much time and effort. It is enough to apply a special ointment or gel to the affected area for 2-3 weeks, and soon there will be no trace of the unpleasant disease.

Sometimes, to achieve the desired effect, it is necessary to take antiviral drugs orally for some time. But herpes cannot be completely cured.

It remains in the human body forever, manifesting itself from time to time (in the presence of favorable circumstances).

Its most dangerous manifestation is herpetic encephalitis of the brain. This infectious disease is caused by a simple herpes virus (type 1 or 2), which provokes an inflammatory process. Most often, herpes brain occurs in people with weak immune systems. The risk group is most often children (under 6 years old) and elderly people (after 55 years old).

It is not known exactly why the brain becomes infected with the herpes virus. For its development, the following factors must be present:

Penetration of the herpes virus into the body, which comes in two types: congenital (when the fetus is infected in the womb) and acquired (enters the body from the external environment through airborne droplets, sexual intercourse and other routes).
Weakening of the immune system due to one reason or another (due to age, due to a previous illness).

The herpes virus, entering cells (including neurons), exists in them in an oppressed latent state. When the immune system is weakened, it begins to actively multiply and penetrates the nerve fibers into the brain, provoking an inflammatory process in it - encephalitis.

Often herpetic encephalitis is localized in the temporal and frontal parts of the brain. This is where the death of brain cells and the inflammatory process occur.

The most characteristic symptoms for this disease are:

The occurrence of such symptoms may also indicate the presence of other diseases of the central nervous system. In any case, you should consult an experienced doctor.

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Causes of meningoencephalitis

The disease has many types, so the causes are also presented in a large list. The development of meningoencephalitis can be triggered by infectious, infectious-allergic and toxic factors. Bacteria, viruses, protozoa and even amoebas from fresh water bodies are often the cause of this disease. The following main types of meningoencephalitis are distinguished:

Viral. Develops as a result of infection by tick-borne encephalitis, chickenpox, influenza, mumps, rabies, herpes, measles, and West Nile fever.
Bacterial. Associated with damage to the body by bacteria, including tuberculosis bacillus, listeria, staphylo-, pneumo-, meningo- and streptococci.
Caused by the action of protozoan microorganisms. These include malarial plasmodium and toxoplasma.
Caused by the penetration into the body of mutant species of amoebas, whose habitat is fresh water bodies.

Meningoencephalitis in children is diagnosed more often due to an incompletely developed immune system. Another predisposing factor is the failure of the blood-brain barrier. The same applies to older people. Risk factors for inflammation of the brain and meninges also include:

acute or chronic pathologies of the ENT organs, including sinusitis, mastoiditis (inflammation of the mastoid process of the temporal bone), sinusitis;
ARVI;
traumatic brain injuries;
ixodid tick bite;
vaccinations;
rubella, measles, chickenpox, tuberculosis.

How does the treatment work?

To carry out adequate treatment, it is necessary to make a correct diagnosis. To do this, the patient must undergo a series of examinations:

If the diagnosis is confirmed, it is necessary to begin therapy immediately, since this disease is very life-threatening.

Treatment is carried out exclusively in a hospital setting. There is a risk of sudden respiratory arrest, as well as a high probability that the patient may fall into a comatose state. In such cases, resuscitation is carried out.

Treatment of herpes brain involves the use of medications that are aimed at eliminating the infectious process and accompanying symptoms. First of all, prescribe:

Additionally, a patient with a similar diagnosis is advised to undergo strict bed rest, proper nutrition, and plenty of fluids. If he cannot consume food and water on his own, he is prescribed internal administration of drugs that can relieve exhaustion and dehydration.

The course of treatment lasts from 5 days to 2 weeks, depending on the complexity of the disease and the general condition of the patient. A comatose state significantly reduces the chances of recovery. Only 20-30% of people recover from a coma, and death is possible. Therefore, it is very important to diagnose the disease in time.

Treatment of meningoencephalitis

Therapy of the disease is carried out in several directions at once: etiotropic, symptomatic and pathogenetic. The first type of treatment involves eliminating the cause of the disease. Depending on it, the following medications are used:

Antifungal. Indicated for the treatment of fungal inflammation of the membranes and substance of the brain. Fluconazole and Amphotericin B are considered effective.
Antibacterial. Used for bacterial diseases. Antibiotics include cephalosporins or their combination with penicillins, more often with Ampicillin. Before receiving the results of an analysis to identify the type of pathogen, the doctor prescribes a broad-spectrum antibacterial agent. After determining the type of infectious agent, therapy is adjusted taking into account the sensitivity of bacteria to specific drugs.
Antiviral. For the herpetic form of the disease, Ganciclovir is used, for the arboviral form, Ribavirin is used. Among antiviral drugs, Acyclovir is most often prescribed. It increases the patient's chances of life, but does not protect against severe meningeal consequences. Antiviral therapy is combined with immunomodulatory drugs such as Interferon.
Antiparasitic. They are prescribed for brain damage by amoebas or toxoplasma. They are often used together with antibiotics and antifungal drugs.

The second direction of treatment of the disease is pathogenetic. It is carried out to eliminate the main meningeal symptoms. The objectives of such therapy:

Relieving cerebral edema. For this purpose, diuretics are used, which increase the amount of fluid excreted in the urine. As a result, brain swelling decreases. Additionally, glucocorticosteroids are used - hormonal agents that have a strong anti-inflammatory effect.
Preservation of the vital activity of brain cells - neurons. To achieve this goal, the patient is prescribed neurometabolic and neuroprotective drugs.

The last direction of treatment is symptomatic. The goal is to eliminate signs of the disease and alleviate the patient’s condition. Taking into account the manifestations of the disease, a person may be prescribed the following drugs:

psychotropic;
anticonvulsants;
antipyretics (antipyretics);
improving the activity of the cardiovascular system;
sedatives;
antioxidants;
improving blood microcirculation;
multivitamins;
anticholinesterase.

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Encephalitic meningitis is a disease that develops as a result of the penetration of a virus into the human body. Another name for the pathology is meningoencephalitis.

The patient simultaneously exhibits 2 inflammatory processes: meningitis, which is expressed in inflammation of the cerebral cortex, and encephalitis, in which the brain becomes inflamed. This is the difference between meningitis and encephalitis. In children, the disease is especially severe, characterized by a number of irreversible consequences and high mortality.

Danger of the disease and possible complications

Herpetic encephalitis of the brain is a very serious and dangerous disease. Full recovery after it occurs quite rarely - only about 25% of people with this diagnosis after undergoing a course of therapy are able to lead a full life.

Most patients die before they even begin treatment, since the disease comes unexpectedly and develops rapidly. But this does not mean that with such a disease the obligatory outcome is death. Early detection and proper specialized treatment can save the patient both life and health.

Brain damage very rarely goes away without complications. Any violation of its operation and functionality leads to irreversible consequences.

Herpes infection causes an inflammatory process that can lead to pathological conditions in humans:

Coma. It significantly complicates the treatment process. Often patients never come out of a coma.
Stopping breathing. If the patient is not resuscitated immediately, he may die.
Mental deviation. Damage to the brain is accompanied by the destruction of its cells, which leads to a deterioration in its functioning.
Mental disorders. This could be a nervous state, sleep disturbances, prolonged hallucinations, or memory loss.
Constant headache that is difficult to relieve.
General deterioration of health, weakness, apathy, loss of performance.
Complete or partial loss of hearing and vision.
Speech dysfunction.
Meningitis.
Deterioration or loss of motor activity, paralysis of the entire body or individual limbs.

Recovery of a person suffering from herpetic encephalitis of the brain occurs depending on the severity of the disease.

In mild forms, the prognosis is often favorable, and the course of therapy lasts no more than a month. Treatment of advanced stages and severe forms lasts for years.

There are factors that can affect the course of the disease and also provoke relapses:

incorrect or untimely treatment;
pregnancy;
stress, mental exhaustion;
persistent overwork of the body due to physical activity;
consumption of alcoholic beverages and junk food.

In any case, herpetic encephalitis of the brain is not a death sentence. Timely diagnosis and proper treatment under the supervision of an experienced specialist give positive results. The main thing is not to panic and not to self-medicate.

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Do you still think that it is impossible to get rid of herpes forever?

Herpes brain is an extremely dangerous pathology, characterized by inflammation of the gray and white matter as a result of tissue damage by the herpes simplex virus types 1 and 2. This disease is acute and is accompanied by disorders that are extremely difficult to correct in the future.

Herpes brain is an extremely dangerous pathology, characterized by inflammation of the gray and white matter as a result of tissue damage by the herpes simplex virus types 1 and 2.

A special risk group for developing this pathological condition includes newborn children and the elderly. In addition, herpes brain damage is often observed in those who suffer from immunodeficiency.

Classification of meningoencephalitis

There are several classifications of meningoencephalitis. One of the criteria is the root cause of the disease. Depending on it, meningoencephalitis is divided into the following types:

Primary. It develops as an independent disease as a result of the bite of an ixodid tick that carries an arbovirus; infection with rabies, neurosyphilis (penetration of Treponema pallidum), typhoid, herpes virus.
Secondary. It is a complication of other pathologies, such as measles, tuberculosis, chickenpox, purulent diseases of the ENT organs and other pathologies of an infectious nature.

There is another classification of meningoencephalitis associated with the cause of development, the only criterion in it is the type of pathogen. Depending on this factor, the disease occurs:

Bacterial. It is more common than other species. Causes purulent inflammation, which is provoked by Klebsiella, pneumococci, streptococci, meningococci, and Haemophilus influenzae.
Viral. Associated with damage to the body by herpes simplex virus, measles, cytomegalovirus, enterovirus, and rabies. Viral meningoencephalitis causes predominantly serous inflammation.
Gribkov. More often observed in people with weakened immune systems. It can be diagnosed against the background of neuroAIDS.
Protozoan. It is less common than other species and is provoked by toxoplasma, amoebae and other protozoan microorganisms.

According to the nature of the inflammatory process, hemorrhagic, purulent and serous meningoencephalitis are distinguished. In the first case, due to a violation of the permeability of the walls of the cerebral vessels, the discharge consists of blood impurities, in the second - pus with a predominance of leukocytes, in the third - clear cerebrospinal fluid. According to another classification, meningoencephalitis is divided into types depending on the nature of the course:

Chronic. The inflammation lasts for several months or years. It proceeds in waves - periods of remission are replaced by exacerbations.
Subacute. It develops slowly - over a period of several days to 1 week.
Fulminant. It occurs suddenly, develops over several hours and in most cases is fatal.
Spicy. Symptoms appear more slowly than with the fulminant form - within about 24-48 hours.

Symptoms of herpes brain

Herpetic tissue damage manifests itself with acute symptoms. After suffering an acute period of herpes, accompanied by rashes, the pathology does not enter a latent period. The latent course of herpes brain lesions can be observed from 2 to 20 days.

Subsequently, the patient experiences a process of virus reactivation. Because of this, the body temperature rises sharply above +39°C, and it is difficult to reduce it with medications.

Both adults and young children experience disturbances of consciousness of varying severity.

If the course is unfavorable, coma is possible. In addition, the following signs of damage to the brain and spinal cord may appear:

convulsions;
disturbances in the sensitivity of individual parts of the body;
visual and auditory hallucinations;
epileptic seizures;
Strong headache;
unsteadiness of gait;
memory loss;
increased sweating;
excited state;
vegetative disorders.

Depending on the form and severity of damage to the nerve trunks by herpes, the duration of the increase in acute symptoms can vary from several days to a week or more. The patient's condition becomes extremely serious.

General information about meningoencephalitis

This is the name of a condition in which two diseases develop in the body at once - meningitis and encephalitis. The first disease causes inflammation of the soft meninges, the second - the substances of the brain. Meningoencephalitis is a serious disease of an infectious nature. It can affect not only the brain, but also the spinal cord. Features of the spread of the disease:

Children are more susceptible to it because their immunity is less strong, and they are more often outdoors, where they can be bitten by a tick.
There are also cases of intrauterine infection, especially if in the first months of pregnancy a woman had chickenpox, rubella, or mumps.
Children are characterized by meningoencephalitis in the form of meningococcal infection. People get sick with it more often in the cold and damp seasons. The peak incidence occurs from March to May.

Reasons for appearance

Damage to brain structures by the herpes virus is rare. The following can contribute to the activation of the virus and the appearance of this pathology:

reduced immunity due to AIDS;
exhaustion;
severe vitamin deficiency;
hypothermia;
tuberculosis;
rheumatism.

The influence of these unfavorable factors causes a decrease in immunity. The body's defense mechanisms cannot suppress the virus. Once it enters the human body, herpes can no longer be completely eliminated, but if the immune system is in a normal state, the virus remains latent.

Herpetic encephalitis in children

The disease is dangerous for newborns and can result in death.

At the first signs of pathology in a child, urgent hospitalization is necessary.

With normal functioning of the immune system, the symptoms of herpetic encephalitis are often erased; the disease can be identified by disturbances in perception, hearing and vision.

Photo: Andrew Krasovitckii / Shutterstock.com

Herpes encephalitis and meningitis are severe inflammations of the brain tissue and meninges caused by herpes viruses. Damage to the brain and membranes is considered a consequence of acute herpetic infection of various types.

In the structure of pathogens of herpetic meningoencephalitis, herpes simplex and chickenpox viruses are the leaders. The disease often becomes a cause of disability.

Diagnosis and treatment

The characteristic clinical picture and data from instrumental and laboratory examinations allow an accurate diagnosis. To determine the problem, the following are assigned:

cerebrospinal fluid puncture;
biopsy;
general and biochemical blood tests.

Therapy should be carried out in a hospital setting. The patient requires intensive drug treatment. First of all, antiviral drugs are prescribed, including:

Gerpevir;
Acyclovir (more details);
Virolex;
Zovirax (more details).

The form and dosage of these medications are prescribed by the doctor individually. Among other things, immunomodulatory drugs, corticosteroids and interferons are prescribed to correct the functioning of the immune system.

To stabilize the condition, detoxification therapy can be performed. Medicines may be prescribed to help manage symptoms, including diuretics, anticonvulsants and antipyretics.

In most cases, the prognosis depends on the timely start of treatment.

Treatment of herpetic encephalitis

Treatment methods include urgent hospitalization of the patient. Therapy is not carried out at home. In most cases, the person requires resuscitation. The traditional method of treatment is the administration of an antiviral drug in large doses. Acyclovir is first injected and then taken orally.

Therapy directed against herpetic brain damage is supplemented with glucocorticoids, which reduce the severity of swelling and pain.

Urgent ventilation and the use of diuretics often become necessary.

Complications and rehabilitation

Brain herpes can have extremely adverse consequences. In this pathological condition, neurological disorders may remain after the completion of the acute course of the disease. Complications that often occur with this disease include:

migraine;
meningitis;
decreased mental activity;
muscle weakness;
partial memory loss;
visual, speech and hearing impairments;
attacks of dizziness;
epilepsy;
various mental disorders.

If rehabilitation is not carried out properly, these complications may persist for the rest of your life. If, after eliminating acute symptoms, a person is forced to work and is mentally overtired, takes alcohol or is exposed to other unfavorable factors, the consequences of the viral damage to brain tissue may become more pronounced.

Herpetic encephalitis

– extremely dangerous damage to brain tissue by the herpes virus. In the absence of targeted treatment, death occurs in approximately 80% of cases. Timely seeking medical help prevents the development of severe complications that will persist for a long time. To reduce the risk of encephalitis caused by herpes, it is necessary to maintain a high level of immunity: eat right, exercise regularly, and give up all bad habits.

Herpes brain is a disease that occurs as a result of penetration of the herpes virus under the meninges. In most cases, brain damage is caused by the form that causes rashes on the lips; in 5% of cases it causes genital herpes.

Children under 5 years of age, as well as older people (after 55), are most often affected. This is due to a decrease in immune resistance. The first category is characterized by the occurrence of a primary infection, but in adults there is activation of a virus that has been “sleeping” in the body for a long time.

What's happened

Herpes brain is more common between 2 and 30 years of age and in people over 50 years of age. The pathology is similar to acute encephalitis. The disease is caused by the herpes simplex virus and affects the brain.

The pathogen penetrates from the nasal mucosa through the olfactory neurons. When an infection takes hold, the brain becomes inflamed and characteristic swelling occurs.

For some time, the herpetic type of brain damage does not manifest itself in any way. The virus concentrates in the nervous tissue and is activated when the body's defenses are greatly reduced.

The acute stage manifests itself in a severe course, which can lead to coma.

In rare cases, necrosis of brain tissue occurs, which provokes irreversible consequences.

Herpetic encephalitis can be sluggish, without significant manifestations. At the same time, many people do not suspect that they have a dangerous pathology, but simply refer to a temporary illness. This type of disease is typical for people whose immune system produces enough antibodies to fight the infection.

Clinical picture

Symptoms of herpes brain begin to appear against the background of other diseases: external herpes, pharyngitis, stomatitis and other respiratory lesions. The clinical picture begins acutely. The medulla quickly swells and becomes inflamed, cells die and areas of necrosis form. Damage to brain tissue is of various types:

Diffuse: the entire brain or a large area of it is involved in the process. This pathology is typical for young children.
Focal: a limited part of the brain is affected.

The pathological process involves gray and white matter. Often the inflammation spreads to the cerebral cortex.

The main symptoms of herpetic encephalitis:

fever with a significant increase in temperature, sometimes up to 41 degrees;
Jacksonian seizures - convulsive muscle contractions that begin on one side, but soon cover the entire body;
nausea, vomiting that does not bring relief;
paralysis and paresis;
inability to normally control body movements (see);
unbearable headaches that are difficult to respond to medications;
the appearance of delusional states, aggressiveness.

If the course of the disease is very severe, or in the case where no treatment has been carried out, the pathological process spreads to the spinal cord. Symptoms of damage to the latter appear.

The mechanism of development and causes of pathology.
Learn about the symptoms and consequences of the disease.

Symptoms of brain herpes in young children are more severe than in adult patients. Often in the first phase, depression of consciousness quickly occurs, the child falls into a state from which it is difficult to get him out. The negative impact of infection on the brain manifests itself in the form of convulsions of the whole body, up to opisthotonus.

Seizures are very difficult to stop. And even if the child can be brought back to consciousness, there is a high risk of developing problems with written and spoken speech, and some motor skills may be lost. In such patients, memory almost always suffers, especially short-term memory.

Causes of the pathological process

In the international classification of diseases ICD-10, pathology is assigned code G04. Meningoencephalitis in children and adults is of an infectious, allergic or toxic nature. When the pathogen enters the brain cells, foci of inflammation are formed, which impair blood microcirculation. The volume of spinal fluid increases, which increases intracranial pressure. The membranes of the brain are damaged, which leads to the development of meningeal symptoms.

The cause of brain inflammation can be demyelinating diseases, which lead to tissue damage in the peripheral and central nervous system. Typically, the disease occurs as a result of the invasion of infectious pathogens:

bacteria – meningococci, streptococci, tuberculosis bacillus, listeria;
viruses - rabies, herpes, tick-borne encephalitis, chickenpox, measles, arboviruses.

The causative agents of toxoplasmosis and malaria also cause the development of meningoencephalitis.

Note! ENT pathologies and dental diseases of a purulent nature often lead to the development of encephalitic meningitis.

Pathology can manifest itself in primary and secondary forms. Primary encephalitic meningitis develops after infection with herpes, syphilis, and rabies. The secondary form develops as a complication after tuberculosis, chickenpox, rubella, and sinusitis.

The virus enters the body through a tick bite or as a result of the pathogen entering the nasopharynx. The method of infection depends on the viral type. A contact route of infection is also possible when the integrity of the cranial bones is compromised.

Meningeal encephalitis in newborns and young children is often diagnosed, since children's immune status is not sufficiently developed. The risk of developing the disease increases in the presence of intrauterine infections and prematurity. Young children have a hard time with the disease, the consequences of which manifest themselves in neurological disorders.

Chronic encephalitis

Chronic damage is characterized by sluggish development of pathology. The disease can develop for months without making itself felt. The only symptoms that indicate the disease are periodic increases in temperature to low-grade fever (37-38 degrees), weight loss, weakness, and drowsiness.

The asthenic state is manifested by quickly onset fatigue, headaches, and decreased performance. After approximately 6–8 months, the clinical picture begins to develop and the following symptoms appear:

muscle dystonia – too much tension or, conversely, hypotonicity;
transient paralysis, which is often localized only on one part of the body;
short-term seizures;
differences in reflexes on different sides of the body.

Unlike the acute course, chronic encephalitis does not cause disturbances in the consciousness and psyche of a person. Exceptions are advanced cases when there is deep damage to brain tissue.

Sluggish course of the disease

The disease becomes chronic due to chronic inflammation of the central nervous system, accompanied by periodic increases in temperature to 37–38 degrees and asthenic syndrome. This condition can last for months, and after about six months, sluggish encephalitis begins with focal brain disorders.

The main symptoms that may occur at the onset of this disease are:

short-term convulsions;
resulting paralysis of the muscles of one part of the body;
muscular dystonia;
asymmetry of reflexes.

Impaired consciousness in this form, as a rule, does not occur.

Despite the fact that herpetic encephalitis in this form is not violent, as in an acute case, the risk of death is higher. This happens for two reasons. Firstly, the diagnosis can be made quite late, often at the stage of signs of dementia. Secondly, this form is characterized by resistance of the herpes simplex virus to acyclovir, which leads to unproductive treatment.

After an illness, a person in most cases is left with neurological and mental consequences. Their main symptoms:

paralysis;
severe fatigue, weakness;
headaches, dizziness;
weakened memory and attention;
impaired coordination of movements;
dementia;
visual, hearing and speech impairments;
enuresis, encopresis;
drowsiness;
irritability, aggressiveness.

Although there are cases where the consequences of encephalitis are absent or mild. People could return to normal life. This is facilitated by the acute form of the disease (not chronic), adequate treatment (quickly started with high doses), the immune status of the body, its ability to recover, and the patient’s age.

As a result of his herpes encephalitis, Clive Wareing developed symptoms of memory loss. His sensory functions, speech and speech understanding are intact. Intelligence remained at the same level. But there was a gap between the transition of information from instant memory and back, and he was only able to remember anything for 30 seconds. Wareing lives in the present tense all the time, not knowing what happened a minute ago or a long time ago.

Certain conclusions can be drawn. Encephalitis of this type is a serious infectious disease that is accompanied by various neurological and psychiatric symptoms of varying severity. The success of treatment depends on the time of contacting a doctor and the type of different course of the disease. After an infection, the likelihood of clinical consequences occurring is high.

Diagnostics

To make an accurate diagnosis, a series of examinations are performed on the patient. To exclude traumatic or oncological causes, the following methods are used:

Magnetic resonance imaging;
rheoencephalography;
CT scan.

If more than 10 days have passed since infection, cerebrospinal fluid or blood tests are prescribed, which reveal an increase in the titer of antibodies to the herpes virus. Sometimes doctors prescribe a biopsy of the affected area of the brain. But since this method is associated with enormous risks, it is performed extremely rarely.

Diagnosis of herpetic encephalitis↑

During the infectious period, diagnosis is often difficult due to the similarity of the picture with influenza and other acute diseases of a viral nature. This leads to a fatal loss of time - the patient does not receive specific therapy against the herpes virus.

If GE is suspected, it is necessary to conduct virological tests as soon as possible and, if possible, detect antibodies to HSV-1. Alas, this does not guarantee ideal accuracy of diagnosis; there are cases when a blood test and tissue samples taken from the mucous membranes of the nasopharynx did not detect the presence of antibodies to HSV-1, and a serological study of brain tissue after the death of the patient demonstrated the presence of inclusions characteristic of GE.

After the addition of neurological symptoms, signs of encephalitis are confirmed using electroencephalography, computed tomography, MRI and cerebrospinal fluid examination.

Treatment of pathology

First of all, you need to get rid of the cause, that is, the virus. For this purpose, Acyclovir is prescribed. In the first 5-7 days, large doses of the drug are administered to quickly suppress the activity of the virus, then a maintenance dosage is prescribed to prevent relapses. In addition, antiviral drugs such as Cycloferon or the like are used for treatment.

All patients require symptomatic therapy:

to relieve swelling of the medulla, diuretics (Lasix, Furosemide, Mannitol) and glucocorticosteroid drugs (Hydrocortisone, Prednisolone) are prescribed;
in case of problems with respiratory function, the patient is transferred to a special device that performs artificial ventilation of the lungs;
To prevent attacks of aggression and overexcitation, the patient is sedated using Relanium, Aminazine or similar agents.

Learn about in children and newborns.
Read what it leads to: symptoms and treatment, complications of pathology.
All about: symptoms, treatment and complications. How do children become infected with meningococcus?

Herpes brain

If the brain is infected with herpes, the person dies. Scientists have shown that the virus makes its way to the brain through the nose. Probably, someday pharmacologists will be able to block the indestructible virus’s access to the central nervous system.

Window to the brain

The brain has two natural outlets - the eyes and the nose. Both the olfactory and visual analyzers can be compared to a bridge that connects the central nervous system with the environment. This bridge is used by viruses.

“Herpes, Borna disease, influenza A, and rabies viruses have been shown to enter the brain through the olfactory system,” write the authors of a new study that shows how herpes invades the brain. – The olfactory system connects to the limbic system, which includes the hippocampus, thalamus and amygdala. It is in these parts of the brain that the listed viruses are found.”

Scientists explain that all viruses presumably infect endothelial cells (those lining the nasal cavity) and in this way gain access to olfactory neurons and the brain. But the main target of brain viruses must be the specialized glial ensheathing cells that are located in the nasal cavity. They are very similar to astrocytes (radiant glial cells) and have a direct connection with neurons.

Brain herpes

According to WHO, the herpes simplex virus (HSV, Herpes Simplex) ranks second in prevalence, second only to the absolute world leader of infections - the influenza virus. Most people perceive “fever” on the lips as an ordinary and not entirely serious cosmetic problem. But some of the herpes viruses (there are eight types in total that pose a danger to humans) provoke cancer, corrode the cornea, and cause severe diseases of the lungs, nervous system and genital organs.

Herpes simplex virus type six (HSV-VI) bubbles not on the lips, but in the brain. Clinical and laboratory studies have linked the development of multiple sclerosis, Alzheimer's disease, Parkinson's disease, some types of epilepsy and encephalitis with HSV-VI infection.

“The virus remains latent for a long time, presumably in the tonsils,” the authors of the study continue. The salivary gland spits on herpes: the sixth member of the herpes family, just like the fifth, multiplies in it.

“In vitro studies have shown a pronounced tropism of herpes virus type six for glial cells,” the scientists continue. In simple terms, this infection reaches to the brain.

The route is laid through the nose

The results of the study, led by Erin Harberts of the National Institute of Neurological Disorders and Stroke, were published in PNAS. The authors showed that herpes type six enters the brain through the nose.

First, the biologists studied about fifty samples of brain and spinal cord tissue obtained from autopsies of patients who died of multiple sclerosis, brain tumors, and multiple system atrophy (a neurodegenerative disease similar to Parkinson's).

Erin Harberts' colleagues conducted a polymerase chain reaction (PCR). It turned out that the brain of each deceased was infected with herpes. True, the virus did not affect all parts of the central nervous system: the most vulnerable were the olfactory tubercles, the forebrain, the optic chiasm and the spinal cord.

At the next stage, biologists examined one hundred and twenty-six noses. They included patients with multiple sclerosis and those who had lost their sense of smell in the experimental cohort. The control group consisted of healthy volunteers. It turned out that the herpes virus was equally common in the noses of all participants in the experiment.

In herpes-positive patients and volunteers, doctors found the virus in the salivary gland. “The nasal cavity, like the salivary glands, serves as a reservoir for the multiplying herpes virus type six,” the scientists write, summing up this stage of the study.

In the next experiment, scientists cultured human parietal glial cells - the same ones that are supposed to be an intermediary between the nose and the brain. Erin Harberts' team infected the cells and showed that the virus felt comfortable in them and multiplied quickly. “Herpes makes its way to the brain through the salivary glands and nose, although it has not yet been possible to fully describe the path of the virus,” the authors conclude.

Erin Harberts' team plans to continue research. It is possible that, using the results of this and other work, pharmacologists will be able to block the virus’s access to the brain.

Encephalitis, which is caused by the herpes simplex virus, is a very common clinical manifestation of a severe generalized herpes infection that affects the entire nervous system of the human body. Occurs sporadically. The severity of this disease is associated with the necrotic nature of the process and the subsequent formation of foci of hemorrhagic decay of the brain substance. In addition to herpetic encephalitis in newborns, in most other cases the causative agent of herpetic encephalitis is the herpes virus type 1. The main route of spread of infection is airborne, but household contact is also possible.

CLINICAL PICTURE

The disease begins acutely, with a rise in body temperature. Meningeal symptoms quickly appear, and general epileptic seizures often occur. Focal symptoms are manifested by central mono- and hemiparesis, hyperkinesis. In the cerebrospinal fluid, pleocytosis with a predominance of lymphocytes (up to several hundred cells in 1 μl), an increase in protein content (up to 2-3 g/l), mild xanthochromia or a small admixture of erythrocytes is detected.

SYMPTOMS

Early clinical manifestations of encephalitis are not specific. The onset of the disease resembles an influenza infection. The first symptoms are an increase in body temperature to high levels, severe headaches, decreased or complete loss of appetite, nausea, and possibly repeated vomiting. A state of prostration appears. Further, if the source of inflammation is localized in the temporal or frontal lobes of the brain, adults and older children may experience inappropriate behavior, psychosensory disturbances, skin hyperesthesia, delirium syndrome, taste and olfactory hallucinations. All of the above symptoms in young children are almost impossible to recognize. Subsequently, the course of the disease is in many ways similar to the clinical picture of acute encephalopathy, which is expressed in an increasing disturbance of consciousness from somnolence and stupor to cerebral coma.

One of the main manifestations of encephalitis is local convulsive twitching or attacks of generalized tonic or clonic-tonic seizures, which in younger children can develop at the very beginning of the disease, which can cause errors in diagnosis. Within a few days, depending on the focus of the inflammatory process, focal neurological symptoms in the form of hemiparesis, various sensitivity disorders, and aphasia begin to intensify. In addition, symptoms such as drooping of the corner of the mouth, smoothness of the nasolabial fold on one side, unilateral blepharoptosis, anisocoria, and deviation of the tongue may be observed. As a manifestation of increasing intracranial pressure, examination of the fundus reveals a congestive optic disc. In most cases, a sign confirming the herpetic nature of encephalitis is the appearance of a vesicular rash on the skin of the body around the end of the first week of the disease. If left untreated, the disease begins to progress steadily and in most cases has a poor prognosis.

A significant number of surviving patients develop severe persistent residual effects from the neuropsychic sphere in the form of intellectual impairment and the development of paralysis, paresis and contractures.

TREATMENT

Treatment should be carried out exclusively by a neurologist. Self-medication is unacceptable. Etiotropic therapy for herpetic encephalitis includes antiviral treatment with acyclovir (Zovirax, Virolex). This therapy should be based on the results of a clinical examination of the patient. Laboratory specific examination methods are time-consuming and cannot provide early diagnosis. Therefore, treatment with acyclovir should be started as early as possible, only if the herpetic nature of the disease is suspected, as well as with encephalitis of unknown etiology. To reduce body temperature, physical cooling methods are used - applying ice to the head and on the area of large vessels, wiping the surface of the body with alcohol or a 1-2% solution of vinegar or wrapping in a wet sheet, administering antipyretic drugs such as paracetamol, aspirin, cefekon and etc., introduction of lytic mixtures.

An inflammatory process involving brain tissue, and often the meninges and subarachnoid space, caused by the presence of microorganisms in the brain tissue (as well as the further development of meningitis).

2. Source of infection and route of transmission (depending on the etiological factor; the reservoir is usually people, only in the case of rabies are wild animals (foxes, squirrels, bats) and dogs, less often cats; in the case of amoebas - contaminated water. The route of infection is in depending on the pathogen, by airborne droplets or direct contact with a patient (or the patient’s secretions), carriers, in the case of rabies, a bite of a sick animal or direct contact of damaged skin or mucous membranes with the saliva of an animal.

3. Epidemiology: incidence of viral encephalitis ≈1.6/100,000/year (550–650 cases per year). Seasonality depends on the type of virus (TBE, VZV, enteroviruses). Risk factors: stay in closed communities, use of public baths and swimming pools, agammaglobulinemia, impaired cellular immunity, contact with stray and wild animals (rabies), stay in areas endemic for TBE, contact with the sick; risk factors for fungal infections of the central nervous system →section. 18.6.1.

CLINICAL PICTURE AND NATURAL COURSE to top

In many cases, prodromal symptoms (flu-like, diarrhea, fever, lymphadenopathy) and/or symptoms of the underlying disease (eg, measles, mumps, chickenpox) are initially present. Herpetic encephalitis has a particularly severe and dynamic course (usually there are no herpes simplex rashes on the skin or mucous membranes). The clinical picture is dominated by confusion, fever of varying severity and focal symptoms: disorders of consciousness qualitative (psychotic syndromes, personality disorders) and quantitative (reduction of consciousness up to and including deep coma); headache, nausea and vomiting, bradycardia (symptoms of cerebral edema and increased intracranial pressure →section 2.29); seizures of focal and general convulsions; paresis and spastic paralysis, as well as other symptoms of pyramidal tract involvement (central motor neuron damage syndrome); paresis and paralysis of cranial nerves (usually III, VI, IV and VII); flaccid paralysis (indicative of damage to the brain stem); cerebellar symptoms (most often during chickenpox - inflammation of the cerebellum); memory impairment, even deep amnestic syndromes; aphasia, most often motor type or mixed; vegetative symptoms - excessive sweating, alternating deceleration and acceleration of heart rate, hypothermia and hyperthermia, drooling and hydrophobia (for example, with rabies).

With rabies, encephalitis can develop, which can be clinically manifested by psycho-motor agitation (excited form) or flaccid paralysis (paralytic form). In the excited form, attacks of psychomotor agitation, hallucinations, and disturbances of consciousness are observed; during the period between attacks the patient is conscious. Seizures can be triggered by external factors - acoustic, visual or tactile stimuli. They can be complicated by the appearance of general convulsions, respiratory arrest and acute circulatory arrest. In this phase of rabies, pathognomonic symptoms are also observed: hydrophobia and aerophobia, which lead to sharp contractions of the diaphragm and auxiliary respiratory muscles. Some patients do not have an arousal phase, and the clinical picture is dominated by flaccid paralysis.

DIAGNOSTICS up

Additional examination methods

1. MRI (preferred) or CT scan of the head: mandatory in every patient with suspected encephalitis. Changes can be seen in the early stages (especially on MRI), their location and nature may indicate a possible etiology of infection or help exclude other causes of neurological symptoms. In the acute phase there are signs of cerebral edema.

2. General analysis of CSF → section. 27.2: elevated blood pressure only, slight increase in mononuclear cell count and/or protein concentration. When accompanied by meningitis, changes in the CSF depend on the etiology. Increased intracranial pressure (eg cerebral edema) is a contraindication for lumbar puncture → section. 24.12; if there are symptoms of cerebral edema or focal → indications for lumbar puncture based on MRI or CT.

3. Microbiological studies: as for meningitis → section. 18.7.1; FE diagnostics →Sect. 18.6.2; in case of suspicion of negleriosis - microscopic examination of non-centrifuged fluid (Giemsa, PAS or hematoxylin and eosin staining; visualization of motile amoebae). The basis for determining the etiology of viral infections of the CNS is the detection of viral genetic material in the cerebrospinal fluid using PCR or RT-PCR; if the clinical picture indicates herpetic encephalitis and the PCR result is negative → a repeat test should be considered after 3–7 days. In the case of flavivirus infection, the duration of viremia is short (2–7 days after infection), so molecular studies are of limited use in this case (serological tests are mainly used). When diagnosing rabies: determination of antigens, molecular studies, bioassays; the virus can be isolated from saliva, cerebrospinal fluid, urine, and posthumously from brain tissue.

4. Serological tests (not used in patients with weakened immune systems): specific IgM in the CSF (diagnosis of TBE, HSV, VZV, EBV), if necessary, specific IgG in the CSF and serum (concentration in the CSF, which is 20 times higher than the concentration in serum, is confirmation of CNS infection). The result is usually negative during the first 1–2 weeks. diseases.

5. EEG: indicated for all patients. A rather specific EEG picture in case of HSV encephalitis (often ahead of the changes obtained during neuroimaging).

Differential diagnosis

Meningitis, brain tumor (abscess, subdural empyema, intracranial hematoma, primary or metastatic neoplasm, cysticercosis and echinococcosis of the brain), stroke or subarachnoid hemorrhage, cerebral vasculitis (isolated or in the process of systemic diseases), metabolic disorders (hypoglycemia or hyperglycemia, hyponatremia, hypocalcemia), intoxication (medicines, drugs), hepatic or uremic encephalopathy, epilepsy and status epilepticus, psychoses, so-called. parainfectious (post-infectious) encephalitis (an autoimmune process accompanying a viral disease, or, very rarely, associated with certain vaccinations, causes multifocal demyelination, usually characterized by mild or moderate severity; the presence of viruses is not detected in the CSF; must be distinguished from multiple sclerosis; main diagnostic MRI matters).

TREATMENT to the top

Etiotropic therapy

1. Acyclovir IV 10 mg/kg every 8 hours (infusion rules → Chapter 18.1.6) - must be used empirically as soon as possible in all cases of encephalitis, especially in severe cases, without waiting for virological confirmation (effectiveness in herpetic encephalitis higher, the earlier treatment is started). Continue treatment for 3 weeks.

2. In justified cases of suspicion or confirmation of a specific etiology of encephalitis, the following should be considered:

1) CMV → ganciclovir IV (5 mg/kg infusion every 12 hours for 3 weeks) possibly in combination with foscarnet IV (60 mg/kg body weight every 8 hours or 90 mg/kg every 12 hours) ; it is also necessary to consider the use of ganciclovir in a patient with impaired cellular immunity with encephalitis of unknown etiology;

2) Varicella-Zoster virus (VZV) → acyclovir IV 10–15 mg/kg every 8 hours for 10–14 days (alternatively ganciclovir);

3) human herpes virus type 6 (HHV-6) in a patient with impaired cellular immunity → ganciclovir or foscarnet.

4) fungal infections →1146.

Symptomatic therapy

As with meningitis → section. 18.6.1. It's important.

OBSERVATION top

Resolution of symptoms and improvement in the general condition of the patient indicate the effectiveness of treatment. Regular CSF monitoring is not necessary. If there is no improvement or complications occur → repeat CSF examination and brain imaging studies (optimally MRI) are necessary. Post-inflammatory changes in the cerebrospinal fluid can persist for a long time after the resolution of the acute phase of the disease.

COMPLICATIONS to the top

In the acute phase - status epilepticus, brain herniation (a consequence of increased intracranial pressure), SIADH → section. 8.2. Late complications - permanent paresis and paralysis, epilepsy, psychotic disorders, memory impairment, dementia, aphasia.

FORECAST to top

With encephalitis, the prognosis is unfavorable, especially high mortality with herpetic infection (without specific treatment 70–80%, if treatment was started on time, before loss of consciousness - 30%). Inflammation of the brain or cerebellum during chickenpox →1092; mycoses of the central nervous system →1147. Mortality due to infection with N. fowleri, Acantamoeba sp. and B. mandrillaris is >95%.

PREVENTION to the top

1. Vaccination: against measles, mumps and rubella, chickenpox, influenza, polio, tick-borne encephalitis, rabies and Japanese encephalitis virus.

2. Passive immunoprophylaxis: in specific situations, specific varicella zoster immunoglobulin (VZIG), rabies immunoglobulin (RIG) or gammaglobulin for the prevention of measles.

Non-specific methods

1. Avoid contact with wild animals and stray dogs and cats (rabies prevention).

2. Nonspecific methods of protection against ticks →section. 18.5.1 (prevention of TBE).

3. The obligation to report to the regional executive authorities in the field of healthcare and the management of Rospotrebnadzor in the constituent entity of the Federation: yes.

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Herpetic infection is an infection caused by herpesviruses type 1 and 2 - a chronic relapsing disease included in the group of TORCH - infections, which are characterized by damage to the skin, mucous membranes, eyes, and nervous system.

Infection caused by herpes viruses is widespread. The infection rate in the population is very high. According to the World Health Organization (WHO), herpesvirus infection ranks second among human viral diseases, second only to influenza.

Susceptibility to infection is universal, regardless of gender and age.

Increases in the disease are recorded in the autumn-winter period.

Epidemiological studies conducted over the past 10 years have shown that by the age of 15, 80% of children are infected, and by the age of 30, 90% of the population have antibodies to viruses of one type or another.

The causative agent of the infection is herpes simplex virus type 1 or 2 (HSV 1 or HSV 2). Once the virus enters a cell, it causes its death. The virus can persist in individual cells for a long time, but upon subsequent activation of the virus, the cell will die.

It is believed that HSV-1 more often affects the respiratory tract, and HSV-2 – the urogenital system, but despite this, the role of HSV-1 in the development of genital herpes is increasing.

Herpes simplex viruses are unstable to physical and chemical factors, are easily destroyed by ultraviolet and x-rays, and are sensitive to ethyl alcohol and ether. At low temperatures (-20-70°C) the virus persists for decades.

Sources of infection are virus carriers and patients with various forms of the disease.

Ways of transmission of infection:

Virus transmission factors are: saliva, blood, tear fluid, sperm, vaginal and cervical secretions, various organs and tissues used in transplantation, urine, medical instruments.

The virus enters the body through damaged areas of the skin and mucous membranes, then, at the site of introduction of the virus, viral particles multiply. Primary infection causes a latent (hidden, sluggish) infection.

Clinical picture.

The clinical manifestations of herpes infection are highly variable. They depend on the location of the lesion, its prevalence, the state of the immune system, the type of virus, as well as the mechanism of infection.

According to the mechanism of infection, herpes infection can be primary or recurrent.

The primary form is an acute disease that occurs upon first contact with the herpes simplex virus.

By location of the lesion:

Skin – herpes simplex, eczema herpetiformis;
Mucous membranes of the oropharynx - stomatitis, pharyngitis, tonsillitis;
Upper respiratory tract – acute respiratory disease;
Eyes – keratoconjunctivitis;
Urogenital tract – urethritis, cystitis, vulvovaginitis;
Nervous system – meningitis, encephalitis, meningoencephalitis;
Internal organs – hepatitis, glomerulonephritis, pneumonia.

Genital herpes develops in young people after the onset of sexual activity. Primary genital herpes has a more severe and prolonged course. The rashes are abundant and occupy a large affected area. With primary genital herpes, there is an increase in temperature, general weakness, and irritability. Vesicular rashes appear in the genital area and persist for up to 8 days.

The influence of the herpes simplex virus on pregnancy and childbirth.

Primary infection and relapses during pregnancy can lead to stillbirth, miscarriages, and the formation of defects in the fetus. Infection is most dangerous in the third trimester.

With primary infection of the mother during pregnancy, infection of the fetus occurs in 5% of cases. Most often, a child becomes infected during childbirth (85%) or after childbirth (10%).

Infection of a child with HSV during childbirth can cause the subsequent development of herpes infection in the newborn.

The main danger is the release of the virus from the genital mucosa at the time of childbirth. The release of the virus may be accompanied by a rash in the genital area, or may not be accompanied by any symptoms.

Consequences of herpes virus infection for a child:

spread of the virus throughout the body, affecting the brain, lungs, liver, adrenal glands, skin, eyes, and mouth;
damage to the central nervous system (decreased appetite, convulsions, increased excitability);
damage to the skin, mucous membrane of the eyes, mouth.

Prevention of herpes virus infection:

An important principle of preventing this disease is to stop close contact with a sick person during an exacerbation.

And:

do not use other people’s personal hygiene items;
after contact with an area affected by herpes (after applying antiviral cream), you must wash your hands thoroughly;
A patient with a herpes virus infection should have separate utensils and use a personal towel;
Prevention of HSV-1 comes down to following the general rules for preventing respiratory diseases. Prevention of HSV-2 corresponds to the prevention of sexually transmitted infections (use of condoms during sexual intercourse), use of antiseptic solutions after sexual intercourse.

Prevention of infection during pregnancy:

exclude sexual contact with a partner who has herpetic rashes;
in the third trimester of pregnancy, refrain from sexual intercourse if your partner has ever had herpetic rashes.

These encephalitis are of particular interest to psychiatrists, both due to the high prevalence of herpes and the high incidence of mental disorders. In the existing literature, there are many works that note that herpetic viral encephalitis can manifest itself with psychopathological syndromes that precede the appearance of neurological symptoms, making it difficult to correctly diagnose the underlying disease.

The encephalitis in question is caused by the herpes simplex virus, types 1 and 2, the first of which more often leads to brain damage.

Psychopathological symptoms of herpetic viral lesions of the brain are largely determined by the localization of the pathological process. At one time, A. S. Shmaryan (1940) noted in cases of hemorrhagic encephalitis quite subtle disorders of the tissue of the temporal lobe of the brain. Currently, some studies also mention disruption of dopaminergic structures and neurohormonal centers.

In order to diagnose damage to the central nervous system by the herpes virus, immunological (serological), morphological and virological research methods are used, as well as tissue analysis to detect viral DNA.

Neuromorphologically, with herpetic encephalitis, there are signs of hyperemia and cerebral edema, pinpoint hemorrhages, foci of necrosis (mainly in the gray matter of the temporo-fronto-parietal regions); signs of degeneration and swelling of neurons, perivascular cellular infiltration. In typical cases, characteristic acidophilic intranuclear inclusions are also found. In later stages, cysts may be detected after the hemorrhagic lesions have softened. To carry out virological identification of herpetic lesions of the central nervous system, the method of fluorescent antibodies and the study of brain cells in tissue culture are used.

A CT scan reveals areas of reduced density of considerable extent that do not have clear boundaries and are most often located in the cerebral cortex, temporal, frontal and parietal lobes. In some cases, diffuse brain damage and signs of edema occur.

In typical cases, the clinical picture of herpetic encephalitis at the onset of the disease is characterized by fever, moderate intoxication and catarrhal symptoms of the upper respiratory tract. After a few days, as a rule, there is a new rise in body temperature with an increase in signs of intoxication and the development of general cerebral symptoms (headache, meningeal phenomena, sometimes repeated convulsive attacks, etc.). Against this background, disorders of consciousness of varying depths arise - from difficulties in comprehending the surroundings and incomplete orientation to more pronounced states of stupor, stupor and coma. With repeated epileptic seizures, patients remain in a state of post-seizure stupor for a long time, which can develop into stupor and coma. During this period, the development of delirious disorders is noted, manifested by episodes of psychomotor agitation with elementary visual hallucinations and an affect of fear. Increased motor agitation and hyperkinesis during the reduction of hallucinatory disorders is characteristic of the subcomatose delirium variant.

A comatose state often develops at the height of the disease, the severity of neurological disorders increases, including focal ones - hemiparesis, pyramidal signs, hyperkinesis, changes in muscle tone of the extrapyramidal type, decerebrate rigidity, etc. In this case, resuscitation measures are usually carried out, including mechanical ventilation, tracheostomy. In patients who survive a prolonged coma, they may subsequently develop, as with traumatic brain injury, apallic syndrome and akinetic mutism syndrome.

The subsequent stage of restoration of mental functions takes from 2 to 24 months or more. The severity of psychoorganic disorders gradually decreases. In this case, Klüver-Bussy syndrome may be detected, characterized by severe gnostic disorders (the inability to optically or tactilely identify objects), a tendency to take all objects (even dangerous ones) into the mouth, hypermetamorphosis (distraction of attention by any stimulus), hypersexuality, disappearance of feelings of fear and shame, dementia . This syndrome was first described by American researchers H. Kliiver and R. Visu after operations to remove both temporal lobes (with the limbic system).

The late stage of herpetic encephalitis is characterized by residual symptoms of encephalopathy in the form of asthenoorganic, convulsive and psychopathic syndromes. Affective disorders of a non-psychotic level are less common. Cases of hallucinatory-paranoid and bipolar affective psychoses, as well as more complex psychopathological syndromes of the schizophrenia-like type (with catatonic inclusions) have been described. Only in 30% of cases is it possible to achieve complete recovery of mental health.

Herpetic encephalitis, accompanied predominantly by mental disorders, was analyzed in detail in the clinical and differential diagnostic aspect based on literature data by E. P. Dekonenko and A. V. Lebedev (1997). At the early stage of herpetic encephalitis, psychopathological symptoms may be similar to manifestations of schizophrenia. In such cases, after the prodromal period, against the background of low-grade fever, thinking disorders (fragmentation, incoherence) and catatonic symptoms appear. Neurological disorders are mild or even absent. The difficulties of differential diagnosis are aggravated by the fact that the disease is often preceded by emotional stress. When prescribed antipsychotics, such patients may develop mutism and catatonic stupor, and subsequently amentia, leading to death. In young children, undiagnosed herpes infection may present as “febrile seizures.” Schizophrenia-like symptoms in herpetic encephalitis sometimes have similarities with the picture of febrile schizophrenia, which is rarely taken into account in the differential diagnostic approach to the latter. In addition, chronic herpetic infection aggravates the course of schizophrenia.

When distinguishing mental disorders in herpetic encephalitis from endogenous psychoses, it is important to pay attention to disturbances of consciousness (including an early sign - disorientation), the occurrence of convulsive seizures and other neurological symptoms, indicating not only the presence, but also the topic of organic brain damage. Laboratory tests are also of great importance to establish high titers of antibodies to the herpetic virus.

When establishing the viral nature of the disease, it is necessary to start antiherpetic treatment as early as possible - the prescription of vidarabine, acyclovir (Zovirax), corticosteroid drugs (to prevent cerebral edema), as well as symptomatic psychotropic drugs (with great caution!).

The prognosis of the disease in cases of herpetic encephalitis is largely determined by treatment. There is evidence in foreign literature that in the absence of adequate therapy, the mortality rate of patients can reach 50-100%. After active treatment, the prognosis can be favorable - the signs of psycho-organic syndrome almost completely disappear or there are slightly pronounced manifestations of it. Mental disorders may be limited to mild depression and autism. There are cases of complete practical recovery.

Herpes is a viral disease with a characteristic rash of grouped blisters on the skin and mucous membranes, most often affecting the mucous membranes of the face, skin, eyes, mucous membranes of the genital organs, and the central nervous system (encephalitis, meningitis). There are 8 types of herpes viruses found in humans.

Herpes simplex is manifested by a group of crowded blisters with transparent contents on an inflamed base. Herpes is preceded by itching, burning of the skin, sometimes chills, and malaise. Herpes zoster is characterized by pain along the nerve and headache. After a few days, rashes appear in the form of grouped blisters on the area of skin along the nerve, first with transparent and then purulent bloody contents. Lymph nodes enlarge, body temperature rises, and general condition is disturbed. According to scientific research, herpes is a stimulating factor for the development of Alzheimer's disease. Scientists have proven that the herpes simplex virus is found in the brains of almost 70% of patients with Alzheimer's disease.

Herpes is one of the most common human diseases, caused by the herpes simplex virus. In the world, 90% of the population is infected with herpes viruses. According to numerous European studies, by the age of 18, more than 90% of urban residents are infected with one or more strains of at least 7 clinically significant viruses. It has been established that women aged 20-35 years are at risk, in which the incidence of genital herpes is 135.7 cases per 100,000 population of a given sex and age.

Currently, no guaranteed cure for herpes has been found. However, there are drugs that, when taken regularly, can effectively suppress the symptoms of virus infection, its reproduction and development. That is, with appropriate treatment, the patient’s quality of life can be improved.

Timely treatment is the prevention of the development of possible complications of herpetic infection: pain syndrome, which develops when the nervous system is involved in the infectious process, the spread of infection, when almost all organ systems can be involved in the infectious process, pathologies of pregnancy, fetus and newborn.
Herpes brain