An overview of viral infections of the nervous system in the immunosuppressed
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NEUROLOGICAL UPDATE
An overview of viral infections of the nervous system in the immunosuppressed Peter G. E. Kennedy1 Received: 18 September 2020 / Revised: 4 October 2020 / Accepted: 7 October 2020 © The Author(s) 2020
Abstract Several viruses have the capacity to cause serious infections of the nervous system in patients who are immunosuppressed. Individuals may be immunosuppressed because of primary inherited immunodeficiency, secondary immunodeficiency due to particular diseases such as malignancy, administration of immunosuppressant drugs or organ or bone marrow transplantation. The viruses capable of such opportunistic infection of the nervous system include herpes simplex virus (HSV), VaricellaZoster virus (VZV), Cytomegalovirus (CMV), Epstein –Barr virus (EBV), Human Herpes virus type 6 (HHV-6), JC virus (JCV), enterovirus, measles virus and Covid-19. In most cases it seems likely that immunological defence mechanisms in the immunosuppressed are deficient which creates a suitable environment for certain viruses to become opportunistic in the nervous and other systems. Further research is required both to understand these opportunistic mechanisms in more detail and also to determine how many virus infections are modified by specific inborn errors of immunological responses. Keywords Virus · Nervous system · Immunosuppression · Infection · PCR · Immunodeficiency
Introduction An individual may become immunocompromised as a result of multiple factors. These include the administration of immunosuppressant drugs given for various medical conditions, an underlying disease such as Human Immunodeficiency Virus (HIV) infection or malignancy such as lymphoma which affects the immune system producing secondary immunodeficiency, various primary immunodeficiency syndromes such as severe combined immunodeficiency (SCID) with defects in T cells, B cells, and NK cells [1], or from organ or bone marrow transplantation. In practice, these factors are often present in the same patient so they do not act in isolation as in the case of a patient who receives immunosuppressant drugs to suppress organ rejection after bone marrow or organ transplantation. Immunosuppressant drugs include corticosteroids, chemotherapy for malignant diseases or for autoimmune and inflammatory
* Peter G. E. Kennedy [email protected] 1
Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G61 1QH, Scotland, UK
conditions, targeted monoclonal antibody therapy, and drugs given as anti-rejection therapy [2, 3]. Viruses may reactivate under conditions of immunosuppression from various causes primarily because the immune mechanisms that normal suppress or limit viral replication become disrupted. In the situation of latent virus infection which is kept in check by the immune system the virus may reactivate and cause neurological disease. For example, in the case of Varicella Zoster (VZV) infection, following primary infection (chicken pox) the virus becomes la
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