医学
病毒性脑膜炎
脑膜脑炎
脑炎
红细胞增多
水痘带状疱疹病毒
肠道病毒
脑脊液多细胞增多
病毒性脑炎
病毒学
单纯疱疹病毒
脑膜炎
巨细胞病毒
病因学
无菌性脑膜炎
免疫学
病毒
疱疹病毒科
病毒性疾病
病理
儿科
细菌性脑膜炎
作者
Guy Handley,Stephanie Pankow,Jennifer Dien Bard,Rebecca Yee,Masayuki Nigo,Rodrigo Hasbun
标识
DOI:10.1016/j.jcv.2021.104936
摘要
Hallmarks of cytomegalovirus (CMV) meningoencephalitis include fever, altered mental status, or meningismus with pleocytosis, elevated protein and hypoglycorrhachia on cerebrospinal fluid (CSF) analysis. Magnetic resonance imaging may show ventriculitis, ependymitis or periventricular enhancement. Studies are limited comparing clinical and laboratory characteristics to other viral etiologies.This multi-center, retrospective cohort analysis reviewed patients with CMV meningitis or encephalitis and compared clinical features, laboratory findings and outcomes to the most common viral causes of meningoencephalitis.Patients with encephalitis or aseptic meningitis and detectable genetic material by polymerase chain reaction were identified. Clinical characteristics, laboratory findings and neuroimaging were collected from the electronic medical record. Data analysis was performed comparing CMV to other viral etiologies.485 patients were evaluated and included cases of CMV (n = 36) which were compared with herpes simplex virus (n = 114), enterovirus (n = 207), varicella zoster virus (n = 41) and West Nile virus (n = 81). Human immunodeficiency virus (HIV) infection was seen more frequently in CMV infection compared with all other viral etiologies. Clinical presentations and CSF findings of other viral etiologies differ compared with CMV. Hypoglycorrhacia occurred more often with CMV compared with other viral pathogens. Outcomes were significantly worse compared with enterovirus, herpes simplex virus and varicella zoster virus but not West Nile virus.CMV meningoencephalitis occurs most often in patients with HIV and encephalitis occurs more frequently than meningitis. Clinical and laboratory findings differ compared with other viral etiologies and can support consideration of CMV in the differential diagnosis of patients with meningoencephalitis.
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