Neurologic Alterations Due to Respiratory Virus Infections

Bohmwald, Karen; Gálvez, Nicolás M. S.; Ríos, Mariana; Kalergis, Alexis M.

Most recently, cases of adults with acute encephalitis and hMPV detection have been described. The first report was published the year 2015 in Australia, in a 47-year-old man (Fok et al., 2015) . The man was found unconscious after 2 days of respiratory symptoms and immediately hospitalized. PCR testing of CSF elicited no presence of classical CNS pathogens (HSV, varicella zoster virus, enterovirus) and eventually nasopharyngeal aspirates were positive for hMPV and no other respiratory viruses, although at this point, not enough CSF was left for further testing. No evident sequelae were detected during the following months (Fok et al., 2015) . Remarkably, lesions found in the MRI analysis were similar to the ones described in the previously reported cases (Schildgen et al., 2005; Sánchez Fernández et al., 2012) . Then the year 2017, two reports-one associating hMPV respiratory infection, the other one indicating the presence of hMPV genetic material in CSF-were published. Early during that year, Jeannet et al. (2017) described the case of a 61-year-old Swiss man with influenza-like symptoms, which eventually suffered from a headache and seizures. MRI was inconclusive, and PCR analysis was negative for CSF samples, although nasopharyngeal swabs were positive for hMPV and no other respiratory virus (Jeannet et al., 2017) . Then, later that year, the case of a 32-year-old man was reported, although the case dated from 3 years before its publication. The man was admitted with unspecific low backache and fever, MRI was normal, and no unusual symptoms were detected (Tan and Wee, 2017) . Eventually, the patient de-saturated and respiratory failure was diagnosed, with posterior mechanical ventilation. Bronchoalveolar lavages and CSF PCRs were both positive for hMPV (Tan and Wee, 2017) . The patient was treated for 1 week with ribavirin (unspecific antiviral) and eventually respiratory symptoms subdued, although he exhibited reduced cognition and intermittent agitation as sequelae. He began rehabilitation, but there was not a significant improvement throughout the following 6 months (Tan and Wee, 2017) .