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CLINICAL REVIEW

Cytomegalovirus Encephalitis

Jose R. Arribas, MD; Gregory A. Storch, MD; David B. Clifford, MD; and Alexandros C. Tselis, MD, PhD

1 October 1996 | Volume 125 Issue 7 | Pages 577-587

Purpose: To review the pathologic and clinical features of and establish the frequency of cytomegalovirus encephalitis in adults and to review the methods available for diagnosis and treatment.

View larger version (145K): [in this window] [in a new window]   Figure 1. Pathologic lesions associated with cytomegalovirus encephalitis. A. Isolated cytomegalic cells (arrows) in the molecular layer of the cerebellum (original magnification, x 50). B. Microglial nodule (thick arrow) with embedded cytomegalic inclusion cell (thin arrow) in the white matter of the temporal lobe. (Hematoxylin and eosin stain; original magnification, x 40.) C. Focal necrosis in medulla involving the medial lemniscus and pyramid (asterisk). (Luxol fast blue stain with hematoxylin and eosin counterstain; original magnification, x 2.5.) D. Magnified view of the edge of the lesion seen in part C. Numerous cytomegalic inclusion cells (arrows) can be seen. (Original magnification, x 40.) E. Cytomegalovirus ventriculitis. Several cytomegalic inclusion cells can be seen at the aqueduct. The ependyma is disrupted with cytomegalic cells (arrows). (Hematoxylin and eosin stain; original magnification, x 25.).

 
Data Source: MEDLINE search of all English-language articles from January 1965 to August 1995.

Study Selection: Articles dealing with cytomegalovirus infection of the brain in adults. We also reviewed all unselected autopsies of these populations to establish the frequency of cytomegalovirus encephalitis in recipients of organ transplants and in patients infected with the human immunodeficiency virus (HIV).

Data Extraction: Epidemiologic and pathologic characteristics, clinical manifestations, diagnostic methods, pathogenetic mechanisms, and use of anticytomegalovirus treatments.

Data Synthesis: Of 676 patients receiving a diagnosis of cytomegalovirus encephalitis, 574 (85%) were infected with HIV, 81 (12%) had other causes of immunosuppression, and 21 (3%) were otherwise healthy. Cytomegalovirus encephalitis was confirmed during autopsy in 12% of HIV-infected patients and 2% of transplant recipients. The most common lesion was µglial nodule encephalitis, but the clinical findings corresponding to this pathologic entity are not well defined. In contrast, the pathologic entity of cytomegalovirus ventriculoencephalitis, found almost exclusively in patients with advanced HIV infection, has distinct clinical features that allow recognition even in patients with HIV encephalopathy. Polymerase chain reaction has been shown to be useful for diagnosis of cytomegalovirus encephalitis.

Conclusions: Cytomegalovirus encephalitis is an important opportunistic infection in HIV-infected patients but is rarely recognized in other groups. Cytomegalovirus ventriculoencephalitis has emerged as a unique entity in patients with advanced HIV infection. Recent developments in diagnostic techniques allow early recognition and may make more aggressive approaches to therapy possible.

Author and Article Information

From Washington University School of Medicine, St. Louis, Missouri; and the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Acknowledgments: The authors thank Philip Dodge, MD, for reading the manuscript and William J. Kupsky, MD, for providing the photographs in Figure 1.
Grant Support: In part by Public Health Service grants PO1-N53728-01 and T32-NS-01780 and National Institutes of Health grant AI25903.
Current Author Addresses: Dr. Arribas: Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110.

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