ABSTRACT
Viral infections of the central nervous system (CNS) can result in significant morbidity and mortality. Treatment advances are limited to herpesvirus infections where therapy with the nucleoside analogues acyclovir and ganciclovir (and its prodrug valganciclovir) have led to significant improvement in outcome. Of all infections of the CNS, those caused by herpes simplex virus (HSV) are among the most devastating. Neonatal HSV infections occur in the first moth of life and are usually the consequence of the fetus coming in contact with infected maternal genital secretions. Treatment with acyclovir has resulted in a significant decrease in morbidity and mortality. Long-term suppressive treatment results in improved neurologic outcome. Similarly, the treatment of herpes simplex encephalitis with acyclovir results in the decrease in mortality and improved morbidity. However, overall, mortality remains approximately 30% and only 30% of survivors return to normal function. The treatment of congenital cytomegalovirus infections has led to significant improvement with six months of valganciclovir therapy, impacting primarily on hearing but also on neurodevelopment. In spite of improved outcome in the treatment of herpes simplex and cytomegalovirus infections of the CNS, advances are mandatory both with improved medications and combination therapies. Further, NO therapies exist for such devastating disease of the brain as rabies and West Nile Virus encephalitis.
