Abstract
The role of adjunctive corticosteroids in reducing morbidity and mortality of viral CNS infections remains poorly defined. Clinicians are often left in a quagmire regarding steroid use in complex and rapidly evolving viral CNS infections. Limited studies have explored the underlying mechanisms behind the potential benefit of steroids. Here, we describe steroid use in three cases of viral CNS disease: varicella zoster virus (VZV), Powassan virus, and influenza A-associated acute necrotizing encephalopathy.
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Alawadhi A, Saint-Martin C, Bhanji F, Srour M, Atkinson J, Sébire G (2018) Acute hemorrhagic encephalitis responding to combined decompressive craniectomy, intravenous immunoglobulin, and corticosteroid therapies: association with novel RANBP2 variant. Front Neurol 9:130. https://doi.org/10.3389/fneur.2018.00130
Aurelius E, Forsgren M, Gille E, Sköldenberg B (2002) Neurologic morbidity after herpes simplex virus type 2 meningitis: a retrospective study of 40 patients. Scand J Infect Dis 34:278–283. https://doi.org/10.1080/00365540110080485
Deigendesch N, Stenzel W (2018) Acute and chronic viral infections. In: Kovacs GG, Alafuzoff I (eds). Handb Clin Neurol Camb pp 227–243
El Khoury MY, Camargo JF, White JL, Backenson BP, Dupuis AP II, Escuyer KL, Kramer L, St. George K, Chatterjee D, Prusinski M, Wormser GP, Wong SJ (2013) Potential role of deer tick virus in Powassan encephalitis cases in Lyme disease-endemic areas of New York, USA. Emerg Infect Dis 19:1926–1933. https://doi.org/10.3201/eid1912.130903
Fitch MT, van de Beek D (2008) Drug insight: steroids in CNS infectious diseases–new indications for an old therapy. Nat Clin Pract Neurol 4:97–104. https://doi.org/10.1038/ncpneuro0713
John CC, Carabin H, Montano SM, Bangirana P, Zunt JR, Peterson PK (2015) Global research priorities for infections that affect the nervous system. Nature 527:S178–S186. https://doi.org/10.1038/nature16033
Kamei S, Sekizawa T, Shiota H, Mizutani T, Itoyama Y, Takasu T, Morishma T, Hirayanagi K (2005) Evaluation of combination therapy using acyclovir and corticosteroid in adult patients with herpes simplex virus encephalitis. J Neurol Neurosurg Psychiatry 76:1544–1549. https://doi.org/10.1136/jnnp.2004.049676
Khetsuriani N, Holman RC, Anderson LJ (2002) Burden of encephalitis-associated hospitalizations in the United States, 1988–1997. Clin Infect Dis 35:175–182. https://doi.org/10.1086/341301
Martinez-Torres F, Menon S, Pritsch M, Victor N, Jenetzky E, Jensen K, Schielke E, Schmutzhard E, de Gans J, Chung CH, Luntz S, Hacke W, Meyding-Lamade U, GACHE Investigators (2008) Protocol for German trial of acyclovir and corticosteroids in herpes-simplex-virus-encephalitis (GACHE): a multicenter, multinational, randomized, double-blind, placebo-controlled German, Austrian and Dutch trial [ISRCTN45122933]. BMC Neurol 8:40. https://doi.org/10.1186/1471-2377-8-40
Momméja-Marin H, Lafaurie M, Scieux C, Galicier L, Oksenhendler E, Molina JM (2003) Herpes simplex virus type 2 as a cause of severe meningitis in immunocompromised adults. Clin Infect Dis 37:1527–1533. https://doi.org/10.1086/379520
Nakano A, Yamasaki R, Miyazaki S, Horiuchi N, Kunishige M, Mitsui T (2003) Beneficial effect of steroid pulse therapy on acute viral encephalitis. Eur Neurol 50:225–229. https://doi.org/10.1159/000073864
Nagel MA, Cohrs RJ, Mahalingam R, Wellish MC, Forghani B, Schiller A, Safdieh JE, Kamenkovich E, Ostrow LW, Levy M, Greenberg B, Russman AN, Katzan I, Gardner CJ, Hausler M, Nau R, Saraya T, Wada H, Goto H, de Martino M, Ueno M, Brown WD, Terborg C, Gilden DH (2008) The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features. Neurology 70:853–860. https://doi.org/10.1212/01.wnl.0000304747.38502.e8
Oshima M, Azuma H, Suzutani T, Ikeda H, Okuno A (2001) Direct and mononuclear cell mediated effects on interleukin 6 production by glioma cells in infection with herpes simplex virus type 1. J Med Virol 63:252–258. https://doi.org/10.1002/1096-9071(200103)63:3%3c252::aid-jmv1009%3e3.0.co;2-e
Piantadosi A, Rubin DB, McQuillen DP, Hsu L, Lederer PA, Ashbaugh CD, Duffalo C, Duncan R, Thon J, Bhattacharyya S, Basgoz N, Feske SK, Lyons JL (2016) Emerging cases of Powassan virus encephalitis in New England: clinical presentation, imaging, and review of the literature. Clin Infect Dis 62:707–713. https://doi.org/10.1093/cid/civ1005
Rotbart HA, Brennan PJ, Fife KH, Romero JR, Griffin JA, McKinlay MA, Hayden FG (1998) Enterovirus meningitis in adults. Clin Infect Dis 27:896–898. https://doi.org/10.1086/517162
Singh RR, Sedani S, Lim M, Wassmer E, Absoud M (2015) RANBP2 mutation and acute necrotizing encephalopathy: 2 cases and a literature review of the expanding clinico-radiological phenotype. Eur J Paediatr Neurol 19:106–113. https://doi.org/10.1016/j.ejpn.2014.11.010
Solomon IH, Spera KM, Ryan SL, Helgager J, Andrici J, Zaki SR, Vaitkevicius H, Leon KE, Wilson MR, DeRisi JL, Koo S, Smirnakis SM, De Girolami U (2018) Fatal Powassan encephalitis (deer tick virus, lineage II) in a patient with fever and orchitis receiving rituximab. JAMA Neurol 75:746–750. https://doi.org/10.1001/jamaneurol.2018.0132
Sung SWA, Whittier S, Kulas K, Kramer LD, Flam R, Roberts JK, Tsiouris S (2013) Powassan meningoencephalitis, New York, New York, USA. Emerg Infect Dis 19:1549–1551. https://doi.org/10.3201/eid1909.121846
Togashi T, Matsuzono Y, Narita M, Morishima T (2004) Influenza-associated acute encephalopathy in Japanese children in 1994–2002. Virus Res 103(1–2):75–78. https://doi.org/10.1016/j.virusres.2004.02.016
Tunkel AR, Glaser CA, Bloch KC, Sejvar JJ, Marra CM, Roos KL, Hartman BJ, Kaplan SL, Scheld WM, Whitley RJ, Infectious Diseases Society of America (2008) The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 47:303–327. https://doi.org/10.1086/589747
Vargas WS, Merchant S, Solomon G (2012) Favorable outcomes in acute necrotizing encephalopathy in a child treated with hypothermia. Pediatr Neurol 46:387–389. https://doi.org/10.1016/j.pediatrneurol.2012.03.001
Vora NM, Holman RC, Mehal JM, Steiner CA, Blanton J, Sejvar J (2014) Burden of encephalitis-associated hospitalizations in the United States, 1998–2010. Neurology 82:443–451. https://doi.org/10.1212/WNL.0000000000000086
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Kiran Thakur is supported by the National Institute of Health, NINDS K23 NS105935-01 and NIH/NICHD 1R01HD074944-01A1.
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Adam Kroopnick: study conceptualization, data collection, initial analyses, and writing, review, and revision of the manuscript, Dan Tong Jia: data collection, initial analyses, and writing, review, and revision of the manuscript, Kathryn Rimmer: drafted the initial manuscript and reviewed and revised the manuscript, Vivian Ssonko Namale: reviewed and revised the manuscript, Carla Kim: reviewed and revised the manuscript, Ugoada Ofoezie: reviewed and revised the manuscript, Kiran Thakur: conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript.
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Kroopnick, A., Jia, D.T., Rimmer, K. et al. Clinical use of steroids in viral central nervous system (CNS) infections: three challenging cases. J. Neurovirol. 27, 727–734 (2021). https://doi.org/10.1007/s13365-021-01008-5
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DOI: https://doi.org/10.1007/s13365-021-01008-5