中樞神經(jīng)系統(tǒng)感染(2)-預(yù)覽頁(yè)
【正文】 ates along nerve axons軸突 to sensory ganglia神經(jīng)節(jié) , where it persists in a latent form and may be subsequently reactivated. ? It is not clear whether HSV type 1 encephalitis, the most mon type in adults, represents a primary infection or a reactivation of latent infection. ? Neonatal新生兒的 HSV encephaltis usually results from acquisition獲得 of type 2 virus during passage through the brith canal of a mother with active genital生殖器的lesions. ? Central nervous system involvement by HSV type 2 in adults usually causes meningitis, rather than encephalitis. Pathology ? HSV tpye 1 encephalitis is an acute, necrotizing引壞死的 , asymmetric不對(duì)稱的 hemorrhagic出血性的 process with lymphocytic and plasma cell漿細(xì)胞 reaction. ? Usually involves the medial temporal and inferior frontal lobes. ? Intranuclear inclusions核內(nèi)包涵體 may be seen in neurons神經(jīng)元 and glia神經(jīng)膠質(zhì) . ? Patients who recover康復(fù)期 may show cystic囊的necrosis壞死 of the involved regions. 嗜酸性 Cowdry A型包涵體 Clinical Finding A Symptoms and Signs ? The clinical syndrome may include headache, stiff neck, vomiting, behavioral disorders, memory loss, anosmia嗅覺(jué)喪失 , aphasia, hemiparesis輕偏癱 , and focal or generalized seizures. ? Active herpes labialis唇皰疹 is seen occasionally, but does not reliably implicate HSV as the cause of encephalitis. ? HSV encephalitis is uaually rapidly progressive over several days and may result in a or death. ? The most mon sequelae 后遺癥 in patients who survive are memory and behavior disturbances, reflecting the predilection 嗜好 , 偏愛(ài) of HSV for limbic structures. Laboratory Findings Laboratory FindingsCSF ? The CSF in HSV tpye 1 encephalitis most often shows increased pressure ? lymphocytic or mixed lymphocytic and polymorphonuclear多形核白細(xì)胞 pleocytosis( 50~100 white blood cells/mL) ? mild protein elevation, and normal glucose. ? Red blood cells, xanthochromia 黃變 , and decreased glucose are seen in some cases. Laboratory FindingsVIRUS ? The virus generally cannot be isolated from the CSF, but viral DNA has been detected by the polymerase chain reaction聚合酶鏈反應(yīng) in some cases. HSV抗體檢定 ? ELASA是現(xiàn)今國(guó)際上通用的 HSV抗體檢測(cè)方
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