Skip to main content

Advertisement

SpringerLink
Log in

Infections of the central nervous system of suspected viral origin: A collaborative study from Finland

  • Clinical Report
  • Published:
Journal of NeuroVirology Aims and scope Submit manuscript

Abstract

We studied 3231 patients with acute central nervous system (CNS) symptoms of suspected viral origin to elucidate the current etiologic spectrum. In 46% of the cases, a viral finding was observed. Varicella-zoster virus (VZV) was the main agent associated with encephalitis, as well as meningitis and myelitis. VZV comprised 29% of all confirmed or probable etiologic agents. Herpes simplex virus (HSV) and enteroviruses accounted 11% each, and influenza A virus 7%. VZV seems to have achieved a major role in viral infections of CNS. In encephalitis in our population, VZV is clearly more commonly associated with these neurological diseases than HSV. The increase in VZV findings may in part be a pseudophenomenon due to improved diagnostic methods, however, a true increase may have occurred and the pathogenetic mechanisms behind this should be elucidated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Ahtiluoto S, Mannonen L, Paetau A, Rautiainen P, Muttilainen M, Vaheri A, Koskiniemi M (2000). In situ hybridization detection of human herpesvirus 6 in brain tissue from fatal encephalitis. Pediatrics 105: 431–433.

    Article  CAS  PubMed  Google Scholar 

  • Bale JF Jr (1993). Viral encephalitis. Contemp Clin Neurol 77: 25–42.

    Google Scholar 

  • Beghi E, Nicolosi A, Kurland LT, et al (1984). Encephalitis and aseptic meningitis, Olmsted County, Minnesota, 1950–1981: Epidemiology. Ann Neurol 16: 283–294.

    Article  CAS  PubMed  Google Scholar 

  • Echevarria JM, Casas I, Martinez-Martin P (1997). Infections of the nervous system caused by varicella-zoster virus: A review. Intervirology 40: 72–84.

    Article  CAS  PubMed  Google Scholar 

  • Färkkilä M, Koskiniemi M, Leikola M, Vaheri A (1997). Epidemilogy of acute encephalitis during 25 years in Southern Finland. Neurol Infect Epidemiol 2: 25–31.

    Google Scholar 

  • Färkkilä M, Koskiniemi M, Vaheri A (1993). Clinical spectrum of neurological herpes simplex virus infections. Ada Neurol Scand 87: 325–328.

    Article  Google Scholar 

  • Gilden DH, Kleinschmidt-DeMasters BK, LaGuardia JJ, Mahalingam R, Cohrs RJ (2000). Neurologic complications of the reactivation of varicella-zostervirus. N Engl J Med 342: 635–645.

    Article  CAS  PubMed  Google Scholar 

  • Guffond T, Dewilde A, Lobert P-E, Caparros-Lefebvre D, Hober D, Wattre P (1994). Significance and clinical relevance of the detection of herpes simplex virus DNA by polymerase chain reaction in cerebrospinal fluid from patients with presumed encephalitis. Clin Infect Dis 18: 744–749.

    CAS  PubMed  Google Scholar 

  • Heisler MB, Richmond JB (1994). Lessons from Finlands successful immunization program. N Engl J Med 331: 1446–1447.

    Article  CAS  PubMed  Google Scholar 

  • Jemsek J, Greenberg SB, Taber L, Harvey D, Gershon A, Couch RB (1983). Herpes zoster-associated encephalitis: Clinicopathologic report of 12 cases and review of the literature. Medicine (Baltimore) 62: 81–97.

    CAS  Google Scholar 

  • Julkunen I, Kleemola M, Hovi T (1984). Serological diagnosis of influenza A and B infections by enzyme immuno assay: Comparison with the complement fixation tst. J Virol Methods 1: 7–14.

    Article  Google Scholar 

  • Kennard C, Swash M (1981). Acute viral encephalitis: Its diagnosis and outcome. Brain 104: 129–148.

    Article  CAS  PubMed  Google Scholar 

  • Kleinschmidt-DeMasters BK, Amlie-Lefond C, Gilden DH (1996). The pattern of varicella zoster virus encephalitis. Human Pathol 27: 927–938.

    Article  CAS  Google Scholar 

  • Kondo K, Nagafuji H, Hata A, Tomomori C, Yamanishi K (1993). Association of human herpesvirus 6 infection of the central nervous system with recurrence of febrile convulsions. J Infect Dis 167: 1197–200.

    CAS  PubMed  Google Scholar 

  • Koskiniemi M (1993). CNS manifestations associated with Mycoplasma pneumoniae infections. Summary of cases at the University of Helsinki and review. Clin Infect Dis Suppl 17: S52-S57.

    Google Scholar 

  • Koskiniemi M, Gencay M, Salonen O, Puolakkainen M, Färkkilä M, Saikku P, Vaheri A, and the Study Group (1996). Chlamydia pneumoniae associated with central nervous system infections. Eur Neurol 36: 160–163.

    Article  CAS  PubMed  Google Scholar 

  • Koskiniemi M, Mannonen L, Kallio A, Vaheri A (1997). Luminometric microplate hybridization for detection of varicella-zoster virus PCR product from cerebrospinal fluid. J Virol Methods 63: 71–79.

    Article  CAS  PubMed  Google Scholar 

  • Koskiniemi M, Manninen V, Vaheri A, Sainio K, Eistola P, Karli P (1981). Acute encephalitis: A survey of epidemiological, clinical and microbiological features covering a twelve-year period. Acta Med Scand 209: 115–120.

    Article  CAS  PubMed  Google Scholar 

  • Koskiniemi M, Piiparinen H, Leikola M, Färkkilä M, Vaheri A, and the Study Group (1995). Poor antibody production in fatal herpes encephalitis. J Infect Dis 171: 1692–1693.

    CAS  PubMed  Google Scholar 

  • Koskiniemi M, Rautonen J, Lehtokoski-Lehtiniemi E, Vaheri A (1991). Epidemiology of encephalitis in children: A 20-year survey. Ann Neurol 29: 492–497.

    Article  CAS  PubMed  Google Scholar 

  • Koskiniemi M, Vaheri A (1982). Acute encephalitis of viral origin. Scand J Infect Dis 14: 181–187.

    CAS  PubMed  Google Scholar 

  • Koskiniemi M, Vaheri A (1989). Effect of measles, mumps, rubella vaccination on pattern of encephalitis in children. Lancet 1: 31–34.

    Article  CAS  PubMed  Google Scholar 

  • Koskiniemi M, Vaheri A, Manninen V, Valtonen S, Ketonen L, Taskinen E, et al (1980). Herpes simplex virus encephalitis: New diagnostic and clinical features and results of therapy. Arch Neurol 37: 763–767.

    CAS  PubMed  Google Scholar 

  • Lakeman FD, Whitley RJ (1995). Diagnosis of herpes simplex encephalitis: Application of polymerase chain reaction to cerebrospinal fluid from brain-biopsied patients and correlation with disease. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. J Infect Dis 171: 857–863.

    CAS  PubMed  Google Scholar 

  • Lennette EH, Magoffin RL, Knouf EG (1962). Viral central nervous system disease. JAMA 179: 687–695.

    CAS  PubMed  Google Scholar 

  • Lennette EH, Magoffin RL, Schmidt NJ (1959). Viral disease of the central nervous system. JAMA 171: 1456–1464.

    CAS  Google Scholar 

  • Levine D, Lauter CB, Lerner M (1978). Simultaneous serum and CSF antibodies in herpes simplex virus encephalitis. JAMA 240: 356–360.

    Article  CAS  PubMed  Google Scholar 

  • MacCallum FO, Chinn IJ, Gostling JVT (1974). Antibodies to herpes-simplex virus in the cerebrospinal fluid of patients with herpetic encephalitis. J Med Microbiol 7: 325–331.

    Article  CAS  PubMed  Google Scholar 

  • Meyer HM, Johnson RT, Crawford IP, Dascomb HE, Rogers NG (1960). Central nervous system syndromes of “viral” etiology. Am J Med 29: 334–347.

    Article  PubMed  Google Scholar 

  • Muir P, vanLoon AM (1997). Enterovirus infections of the central nervous system. Intervirology 40: 153–166.

    Article  CAS  PubMed  Google Scholar 

  • Nahmias AJ, Whitley RJ, Visintine AN, Takei Y, Alford CA Jr (1982). Collaborative Antiviral Study Group. Herpes simplex virus encephalitis: Laboratory evaluation and their diagnostic significance. J Infect Dis 145: 829–836.

    CAS  PubMed  Google Scholar 

  • Peltola H, Heinonen OP, Valle M, Paunio M, Virtanen M, Karanko V, et al (1994). The elimination of indigenous measles, mumps, and rubella from Finland by a 12-year, two-dose vaccination program. N Engl J Med 331: 1397–1402.

    Article  CAS  PubMed  Google Scholar 

  • Rantalaiho T, Färkkilä M, Vaheri A, Koskiniemi M. (2001). Acute encephalitis from 1967–1991. J Neurol Sci 184: 169–177.

    Article  CAS  PubMed  Google Scholar 

  • Reiber H, Lange P (1991). Quantification of virus-specific antibodies in cerebrospinal fluid and serum: Sensitive and specific detection of antibody synthesis in brain. Clin Chem 37: 1153–1160.

    CAS  PubMed  Google Scholar 

  • Rowley AH, Whitley RJ, Lakeman FD, Wolinsky SM (1990). Rapid detection of herpes-simplex-virus DNA in cerebrospinal fluid of patients with herpes simplex encephalitis. Lancet 335: 440–441.

    Article  CAS  PubMed  Google Scholar 

  • Sköldenberg B, Alestig K, Burman L, Forkman A, Lövgren K, Norrby R, et al (1984). Acyclovir versus vidarabine in herpes simplex encephalitis. Lancet 8405: 707–711.

    Article  Google Scholar 

  • Smith H (1981). Acute viral encephalitis. BMJ 283: 935–936.

    Article  CAS  PubMed  Google Scholar 

  • Socan M, Beovic B, Kese D (1994). Chlamydia pneumoniae and meningoencephalitis. N Engl J Med 331: 406.

    Article  CAS  PubMed  Google Scholar 

  • Suga S, Yoshikawa T, Asano Y, et al (1993). Clinical and virological analyses of 21 infants with exanthem subitum (roseola infantum) and central nervous system complications. Ann Neurol 33: 597–603.

    Article  CAS  PubMed  Google Scholar 

  • Tyler KL (1994). Polymerase chain reaction and the diagnosis of viral central nervous system diseases. Ann Neurol 36: 809–811.

    Article  CAS  PubMed  Google Scholar 

  • Vaheri A, Keski-Oja J, Salonen E-M, Koskiniemi M (1982). Cerebrospinal fluid IgG bands and virus-specific IgG, IgM, and IgA antibodies in herpes simplex virus encephalitis. J Neuroimmunol 3: 247–261.

    Article  CAS  PubMed  Google Scholar 

  • Vesanen M, Piiparinen H, Kallio A, Vaheri A (1996). Detection of herpes simplex virus DNA in cerebrospinal fluid samples using the polymerase chain reaction and microplate hybridization. J Virol Methods 59: 1–11.

    Article  CAS  PubMed  Google Scholar 

  • Wahlberg P, Saikku P, Brummer-Korvenkontio M (1989). Tick-borne viral encephalitis in Finland. The clinical features of Kumlinge disease during 1959–1987. J Intern Med 225: 173–177.

    Article  CAS  PubMed  Google Scholar 

  • Weller TH (1983). Varicella and herpes zoster. Changing concepts of the natural history, control, and importance of a Not-So-Benign virus (Second of two parts). N Engl J Med 309: 1362–1368.

    Article  CAS  PubMed  Google Scholar 

  • Whitley RJ (1990). Viral encephalitis. Review article. N Engl J Med 323: 242–249.

    Article  CAS  PubMed  Google Scholar 

  • Whitley RJ, Alford CA, Hirsch MS, Schooley RT, Luby JP, Aoki FY, et al (1986). Vidarabine versus acyclovir therapy in herpes simplex encephalitis. N Engl J Med 314: 144–149.

    Article  CAS  PubMed  Google Scholar 

  • Whitley RJ, Soong S-J, Hirsch MS, Karchmer AW, Dolin R, Galasso G, et al (1981). Herpes simplex encephalitis: Vidarabine therapy and diagnostic problems. N Engl J Med 304: 313–318.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Haartman Institute, Department of Virology, University of Helsinki, POB 21, FIN-00014, Finland

    Marjaleena Koskiniemi, Timo Rantalaiho, Heli Piiparinen, Suvi Koskiniemi, Laura Mannonen, Mirja Puolakkainen & Antti Vaheri

  2. Helsinki University Central Hospital, Helsinki, Finland

    Marjaleena Koskiniemi, Carl-Henrik von Bonsdorff, Markus Färkkilä, Asko Järvinen, Esko Kinnunen, Marketta Muttilainen, Kimmo Linnavuori, Jukka Porras, Mirja Puolakkainen, Kirsti Räihä, Eeva-Marjatta Salonen, Pentti Ukkonen, Antti Vaheri & Ville Valtonen

Authors
  1. Marjaleena Koskiniemi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Timo Rantalaiho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heli Piiparinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carl-Henrik von Bonsdorff
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Markus Färkkilä
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Asko Järvinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Esko Kinnunen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Suvi Koskiniemi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Laura Mannonen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Marketta Muttilainen
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kimmo Linnavuori
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jukka Porras
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Mirja Puolakkainen
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Kirsti Räihä
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Eeva-Marjatta Salonen
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Pentti Ukkonen
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Antti Vaheri
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Ville Valtonen
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Study Group

Corresponding author

Correspondence to Marjaleena Koskiniemi.

Additional information

Study Group: Marjo-Riitta Aine, Matti Junes, Central Hospital of Lapland, Rovaniemi; Vilho Myllylä, Heikki Rantala, Anne Saari, Oulu University Hospital, Oulu; Roger Byring Lauri Hakamies, Harri Kivelä, Bjarne Udd, Vaasa Central Hospital, Vaasa; Merja Kaislakoski, Kirsi Mustonen, Annamari Juntunen, Central Hospital of North Karelia, Joensuu; Heidi Fagerström, Dag Nyman, Åland Central Hospital, Mariehamn; Niilo-Pekka Huttunen, Taneli Sarasoja, Central Hospital of Central Finland, Jyväskylä; Eila Herrgård, Matti Korppi, Juho Nuutinen, Kuopio University Hospital, Kuopio; Juhani Grönlund, Ulla Kaski, Ritva Norja, Central Hospital of South Pohjanmaa, Seinäjoki; Christine Hedman, Ulla-Maija Ritanen-Mohammed, Central Hospital of Päijät-Häme, Lahti; Helena Pesonen, Ari Saarinen, Kajaani Central Hospital, Kajaani; Ilkka Pieninkeroinen, Tiina Wallden, Central Hospital of Kymenlaakso, Kotka; Pentti Lautala, Raili Saari, Jussi Valpas, Central Hospital of South Karelia, Lappeenranta; Juhani Sankala, Hannu Kilpeläinen, Savonlinna Central Hospital, Savonlinna; Pirkko Karttunen, Matti Pere, Anja Selonen, Jaakko Taalas, Mikkeli Central Hospital, Mikkeli; Seppo Mannila, Kari Uotila, Central Hospital of Kanta-Häme, Hämeenlinna; Seppo Tuisku, Markus Väre, Central Hospital of Central Pohjanmaa, Kokkola, Finland.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Koskiniemi, M., Rantalaiho, T., Piiparinen, H. et al. Infections of the central nervous system of suspected viral origin: A collaborative study from Finland. Journal of NeuroVirology 7, 400–408 (2001). https://doi.org/10.1080/135502801753170255

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1080/135502801753170255

Keywords

Search

Navigation