They have a great tendency to affect various parts of the nervous system like brain, covering of brain called meninges, cranial nerves, spinal cord, spinal nerves and roots resulting in various symptoms. Usually all of us are infected at some point of time with Herpes virus.
However our immune system keeps the infection in check and doesn't allow the virus to cause any damage. However at times it can cause a primary infection of CNS or more commonly it gets reactivated in conditions of stress, febrile illness or when the immune system becomes weak. Hence patients with a weaker immune system due to conditions like Diabetes mellitus, post renal transplant, cancer and last but not the lease AIDS infection are more prone for Herpes infections. Also new born can acquire infection through their mother.
Affection of the brain leads to a dreadful condition called Encephalitis which results in features like fever, headache, confusion, behavioural changes like agitation and psychotic state. Convulsions can also occur. Clinical history and various tests like MRI Brain, Electroencephalogram(EEG) and Cerbrospinal fluid(CSF) study lead to a definitve diagnosis of Herpes simplex encephalitis. This entity requires critical care management alongwith Antiviral drug like Aciclovir. Patients when treated early drastically respond to Aciclovir with complete recovery. Apart from enecphalitis, another acute condition is HSV meningitis. It presents as fever, headache, neck pain and vomiting. Consciousness may be altered if disease is serious. Meningitis usually has a milder course compared to encephalitis. Few patients improve spontaneously, others improve with antiviral agents.
Herpes zoster as we have heard it so commonly is nothing but a reactivation of dormant viral infection in our body. As a result, there are fluid filled eruptions which occur over skin. They classically involve on one side of a body along the path of the nerve. They are very painful. Over a period of few days, they scab and heal. Treatment with Antiviral drugs like Aciclovir and Famciclovir results in faster clinical recovery. Involvement of eye called as Herpes zoster opthalmicus requires special care to prevent vision loss. Another common complication of Herpes zoster is Post Herpetic neuralgia which is nothing but a sharp shooting electric shock like pain on one side along the distribution of nerve. It is quite troublesome but has a good response to drugs like Carbemazepine and Gabapentin.
Other complications of Herpes infection include involvement of the spinal cord called Myelitis and involvement of the spinal nerve and nerve roots or radicles. Spinal cord involvement presents as a viral illness followed by weakness and numbness in either both lower limbs or all 4 limbs. Patient also has difficulty in urination requiring catheterization. It is also diagnosed by doing MRI of the spine and CSF study. Again here, when antiviral agents are started at the earliest, recovery is faster. Physiotherapy aids in the recovery.
Herpes zoster can also affect the radicles and a part of spinal cord called anterior horn cell. This results in weakness in lower limbs leading to difficulty in walking. There is also severe pain in limbs. Numbness in limbs may or may not be present. Alongwith difficulty in walking, thinning of muscles can occur. This condition is managed with antiviral agents and oral or intravenous steroids alongwith physiotherapy.
To conclude, Herpes virus commonly affect human beings. They get activated when immune system is weaker resulting in various neurological manifestations. And the best thing is that it is completely curable. Earlier the diagnosis, earlier the treatment and better the recovery.
(Data Courtesy: by Dr Tushar Raut, Neurologist from SevenHills Hospital)
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