Table 1 Clinical features, diagnosis, and treatment of similar cases reported in the literature
From: Encephalitis associated with human herpesvirus-7 infection in an immunocompetent adult
Clinical diagnosis/Immune status | Age | Gender | Presentation | Evolution before treatment | Microbiological HHV-7 diagnosis | CSF | Primoinfection vs reactivation | Specific Treatment | Reference |
|---|---|---|---|---|---|---|---|---|---|
Encephalitis and flaccid paralysis/Immunocompetent | 19 | Male | Severe headache, vomiting, dizziness, and urinary retention | Ataxia, impaired pupillary reflexes, reduced level of consciousness, and flaccid paralysis of the lower limbs progressing to quadriparesis | HHV-7 DNA in CSF (PCR [12]) and low avidity HHV-7 IgG | 65 leucocytes/μl (63 lymphocytes + 2 neutrophils) and 2 red blood cells/μl, elevated protein of 80 mg/dl, and 48,6 mg/dl of glucose (blood glucose 90 mg/dl) | P | - | Ward KN 2002 [6] |
Acute myeloradiculopathy/Immunocompetent | 26 | Male | Progressive motor weakness, tingling in the extremities, and dysphasia | Cranial nerve involvement and autonomic dysfunctions | HHV-7 DNA in CSF by real time-PCR and increase in anti-HHV-7 titers from 1:16 to 1:64 (IFA) | Normal at admission with an increase in protein of 89 mg/dl and a modest pleocytosis (8 cells/μl) by day 20. | R | Intravenous immunoglobulin (400 mg/kg/day) for 5 days | Mihara T 2005 [8] |
Encephaloradiculomyelitis associated to HHV-7and CMV co-infection/Immunocompetent | 51 | Male | Fever and gradual loss of strength in lower limbs | Disorientation and confusion, flaccid paraplegia, urinary retention, and constipation | HHV-7 DNA in CSF (nested PCR)a and anti-HHV-7 IgG but not IgM in serum (IFA) | Pleocytosis (250 cells/μl) with 93% lymphocytes, 10 red blood cells/μl, high protein levels (950 mg/dl) and normal glucose. | R | Ganciclovir and dexamethasone | Ginanneschi F 2007 [9] |
Acute myelitis/Immunocompetent | 34 | Male | Fever, urinary retention, and weakness in the lower limbs | - | HHV-7 RNA in CSF (PCR-Microarray, Entherpex®, Genomica) | 35 leucocytes/μl (predominantly monocytes) elevated protein of 75 mg/dl. | - | Methylprednisolone (1 g/day) and ganciclovir | Miranda M 2011 [10] |
Neurological disorder/Immunocompetent | 27 | Male | Persistent headache and fever | - | HHV-7 RNA in CSF (PCR-Microarray, Entherpex®, Genomica) | 160 leucocytes/μl (predominantly monocytes) elevated protein of 75 mg/dl | - | - | Miranda M 2011 [10] |
Encephalitis with polymyeloradiculopathy/Immunocompetent | 26 | Male | Headache and fever, dizziness, blurred vision, cervical and lumbar pain, and somnolence | Flaccid paralysis of right arm and lower limbs appeared on 5th evolution day | HHV-7 DNA in CSF (Multiplex Nested PCR) | 110 leucocytes/μl (lymphocytes + monocytes) and 100 red blood cells/μl, elevated protein of 82 mg/dl, and 60 mg/dl of glucose (blood glucose, 108 mg/dl) | P or R or PE | Intravenous immunoglobulin Ganciclovir | Current case |
Acute myelitis/Bone marrow recipient | 47 | Male | Pyrexia and urinary retention | Spastic paraparesis | HHV-7 DNA in CSF (PCR [12]) and high avidity HHV-7 IgG before transplant | 48 leucocytes/μl (predominantly lymphocytes), 235 red blood cells/μl, elevated protein of 1.22 g/l, and 52.2 mg/dl of glucose (blood glucose mg/dl 99) | R | Methylprednisolone (1 g/day) | Ward KN 2002 [7] |
Acute myelitis/HIV-infected | 40 | Male | Asymmetric paresthesia and hypoesthesia in lower limbs | Flaccid paraparesis and severe lower-limb hypoesthesia | HHV-7 DNA in CSF (PCR-Microarray, Clart® Entherpex, Genomica) | 1 lymphocyte, 0 erythrocytes, 25,88 mg/dl proteins and 59 mg/dl glucose | P or R | Foscarnet | Escobar-Villalba A 2016 [11] |