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10 Influenza Virus, Enteroviruses, and Other Epidemic Viruses

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Abstract:

Epidemic encephalitis was first recognized in the form of von Economo’s encephalitis lethargica (EL) in the same decade as World War I and the great pandemic of influenza. More recently, enterovirus 71 (EV-71) has caused outbreaks of hand-foot-and-mouth (HFM) disease in association with a rapidly lethal brain stem encephalitis. Molecular techniques have clarified the relationships of the 66 enteroviruses now recognized. EV-70 and EV-71 have significant effects on the nervous system. Infection with EV-70 can result in the rapid appearance of an acute hemorrhagic conjunctivitis (AHC). Among the nonpolio enteroviruses, echoviruses 30, 11, 7, and 9, EV-70 and EV-71, and coxsackievirus B5 are the most common neurotropic and neurovirulent agents. Recent studies, including clinical trials, have demonstrated the activity of the compound pleconaril against many clinically significant enteroviruses. The differential diagnosis is broad and includes the polyneuritis of Guillain-Barrė, other enteroviruses, and other viral causes of brain stem encephalitis. The disease was often characterized by the development of new manifestations after an apparently disease-free interval. Most significant among the late manifestations was postencephalitic Parkinsonism. Certain cases have had a relationship to viral infection, such as the fatigue associated with Epstein-Barr virus infection, or have followed viral infection, such as the postviral fatigue syndrome. In considering the potential role of viruses, Greenlee and Rose concluded that the chronic fatigue syndrome is a heterogeneous group of disorders and that "a complex relationship may exist between the physical, psychological, and social factors leading to chronic incapacitation."

Citation: Booss J, Esiri M. 2003. 10 Influenza Virus, Enteroviruses, and Other Epidemic Viruses, p 143-162. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch10
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Figures

Image of FIGURE 10.1
FIGURE 10.1

Low-power view of myelin-stained section of the cervical spinal cord in acute poliomyelitis. There is pallor reflecting edema and inflammation selectively affecting the anterior horns (arrows).

Citation: Booss J, Esiri M. 2003. 10 Influenza Virus, Enteroviruses, and Other Epidemic Viruses, p 143-162. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch10
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Image of FIGURE 10.2
FIGURE 10.2

Low-power view of myelin-stained section of the medulla in acute bulbar poliomyelitis. Pallor of staining reflecting edema and inflammation is seen in focal regions of the reticular formation (arrows).

Citation: Booss J, Esiri M. 2003. 10 Influenza Virus, Enteroviruses, and Other Epidemic Viruses, p 143-162. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch10
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Image of FIGURE 10.3
FIGURE 10.3

Focus of neuronophagia in the tegmentum of the pons in acute poliomyelitis. Lymphocytic cuffing is seen around a small vessel, top right. Hematoxylin and eosin stain.

Citation: Booss J, Esiri M. 2003. 10 Influenza Virus, Enteroviruses, and Other Epidemic Viruses, p 143-162. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch10
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Image of FIGURE 10.4
FIGURE 10.4

Perivascular cuffing in acute poliomyelitis. The section has been treated with an antibody to IgA and shows plasma containing IgA and lymphocytes in the perivascular space and neuropil. Counterstained with hematoxylin.

Citation: Booss J, Esiri M. 2003. 10 Influenza Virus, Enteroviruses, and Other Epidemic Viruses, p 143-162. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch10
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Image of FIGURE 10.5
FIGURE 10.5

Case of EL with 1 week history; male aged 15 years. Periaqueductal region of midbrain with ependymal surface at top left. Intense congestion with red cell diapedesis and parenchymal inflammation. Hematoxylin and eosin.

Citation: Booss J, Esiri M. 2003. 10 Influenza Virus, Enteroviruses, and Other Epidemic Viruses, p 143-162. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch10
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Image of FIGURE 10.6
FIGURE 10.6

Substantia nigra from same case as Fig. 10.5. Degenerate pigmented neurons are surrounded by inflammatory cells (arrows). Hematoxylin and eosin stain.

Citation: Booss J, Esiri M. 2003. 10 Influenza Virus, Enteroviruses, and Other Epidemic Viruses, p 143-162. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch10
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Image of FIGURE 10.7
FIGURE 10.7

(a) Lower-power view of substantia nigra from the same case as Fig. 1.7. The few large neurons present represent the severely depleted neuronal population, (b) Normal substantia nigra for comparison. Luxol fast blue/cresyl violet stain.

Citation: Booss J, Esiri M. 2003. 10 Influenza Virus, Enteroviruses, and Other Epidemic Viruses, p 143-162. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch10
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Tables

Generic image for table
TABLE 10.1

Mechanisms of transmission of epidemic viral and putative viral diseases

Citation: Booss J, Esiri M. 2003. 10 Influenza Virus, Enteroviruses, and Other Epidemic Viruses, p 143-162. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch10
Generic image for table
TABLE 10.2

Neurological syndromes associated with influenza

Citation: Booss J, Esiri M. 2003. 10 Influenza Virus, Enteroviruses, and Other Epidemic Viruses, p 143-162. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch10
Generic image for table
TABLE 10.3

Enterovirus syndromes

Citation: Booss J, Esiri M. 2003. 10 Influenza Virus, Enteroviruses, and Other Epidemic Viruses, p 143-162. In Viral Encephalitis in Humans. ASM Press, Washington, DC. doi: 10.1128/9781555817831.ch10

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