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|Other names||Herpes meningoencephalitis|
|Specialty||Infectious disease, neurology|
Meningoencephalitis (/ - -, - -, - -/,; from Greek μῆνιγξ meninx, "membrane", ἐγκέφαλος, enképhalos "brain", and the medical suffix -itis, "inflammation"), also known as herpes meningoencephalitis, is a medical condition that simultaneously resembles both meningitis, which is an infection or inflammation of the meninges, and encephalitis, which is an infection or inflammation of the brain.
Signs and symptoms
Specific types include:
Veterinarians have observed meningoencephalitis in animals infected with listeriosis, caused by the pathogenic bacteria L. monocytogenes. Meningitis and encephalitis already present in the brain or spinal cord of an animal may form simultaneously into meningeoencephalitis. The bacterium commonly targets the sensitive structures of the brain stem. L. monocytogenes meningoencephalitis has been documented to significantly increase the number of cytokines, such as IL-1β, IL-12, IL-15, leading to toxic effects on the brain.
Meningoencephalitis may be one of the severe complications of diseases originating from several Rickettsia species, such as Rickettsia rickettsii (agent of Rocky Mountain spotted fever (RMSF)), Rickettsia conorii, and Rickettsia africae. It can cause impairments to the cranial nerves, paralysis to the eyes, and sudden hearing loss. Meningoencephalitis is a rare, late-stage manifestation of tick-borne ricksettial diseases, such as RMSF and Human monocytotropic ehrlichiosis (HME), caused by Ehrlichia chaffeensis (a species of rickettsiales bacteria).
- Tick-borne encephalitis.
- West Nile virus.
- Epstein-Barr virus.
- Varicella-zoster virus.
- Herpes simplex virus type 1.
- Herpes simplex virus type 2.
- Rabies virus.
- Mumps, a relatively common cause of meningoencephalitis. However, most cases are mild, and mumps meningoencephalitis generally does not result in death or neurologic sequelae.
- HIV, a very small number of individuals exhibit meningoencephalitis at the primary stage of infection.
- Antibodies targeting amyloid beta peptide proteins which have been used during research on Alzheimer's disease.
- Anti-N-methyl-D-aspartate (anti-NMDA) receptor antibodies, which are also associated with seizures and a movement disorder, and related to Anti-NMDA receptor encephalitis
- NAIM or "Nonvasculitic autoimmune inflammatory meningoencephalitis" (NAIM). They can be divided into GFAP- and GFAP+ cases. The second is related to the Autoimmune GFAP Astrocytopathy.
- Primary amoebic meningoencephalitis, e.g., Naegleria fowleri, Balamuthia mandrillaris, Sappinia diploidea
- Trypanosoma brucei
- Toxoplasma gondii (sporozoa)
Amoebic pathogens exist as free-living protozoans. Nevertheless, these pathogens cause rare and uncommon CNS infections. N. fowleri produces primary amoebic meningoencephalitis (PAM). The symptoms of PAM are indistinguishable from acute bacterial meningitis. Other amoebae cause granulomatous amoebic encephalitis (GAE), which is a more subacute and can even a non-symptomatic chronic infection. Amoebic meningoencephalitis can mimic a brain abscess, aseptic or chronic meningitis, or CNS malignancy.
- Granulomatous meningoencephalitis.
- The fungus, Cryptococcus neoformans, can be symptomatically manifested within the CNS as meningoencephalitis with hydrocephalus being a very characteristic finding due to the unique thick polysaccharide capsule of the organism.
Clinical diagnosis includes evaluation for the presence of recurrent or recent herpes infection, fever, headache, altered mental status, convulsions, disturbance of consciousness, and focal signs.
CSF, EEG, CT, MRI are responsive to specific antivirus agent.
Definite diagnosis – besides the above, the following are needed: CSF: HSV－antigen, HSV－Antibody, brain biopsy or pathology: Cowdry in intranuclear
CSF: the DNA of the HSV(PCR)
cerebral tissue or specimen of the CSF:HSV
except other viral encephalitis
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Symptomatic therapy can be applied as needed. High fever can be treated by physical regulation of body temperature. Seizure can be treated with antiepileptic drugs. High intracranial pressure can be treated with drugs such as mannitol.
If caused by an infection then the infection can be treated with antibiotic drugs.
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- Amebic Meningoencephalitis at eMedicine
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