key: cord-0903860-u70ueicf
authors: Di Nora, A.; Pizzo, F.; Costanza, G.; Ruggieri, M.; Falsaperla, R.
title: Human herpes 6 encephalitis in co-infection with Covid-19
date: 2022-05-02
journal: Acta Neurol Belg
DOI: 10.1007/s13760-022-01961-w
sha: 87a490c005d85b96c81c628d0e2d233175444c30
doc_id: 903860
cord_uid: u70ueicf

nan

been reported in immunocompetent individuals, all infants younger than 3 years [1] . The damage seems related to the indirect effects of cytokine release rather than from direct viral CNS infection [2] . Thus, a co-infection viral may worse cytokine release and contribute to clinical manifestations.

Many neurological manifestations are described in children affected by Covid-19 and some cases reported encephalitis. Although, most of these reports have had normal neuroimaging. Interestingly, a single study reported a neonatal case affected by seizures and MRI suggestive of viral encephalitis [3] .

Diverse and different pathophysiological mechanisms behind neurologic manifestations associated with SARS-CoV-2 infection have been supposed. Some authors proposed an immune-mediated mechanism, reporting Guillain-Barré syndrome or acute disseminated encephalomyelitis [4] . Others supposed the possibility of invasion of Sars-Cov19 because the virus binds the surface spike protein to the human angiotensin-converting enzyme 2 receptor (ACE-2) and ACE-2 is present in the brain vascular endothelium [5] . Differently, others correlate the neurologic features with a severe state of inflammation. Our experience contributes to giving value to this last hypothesis.

Finally, it is interesting observing that multiple studies have been published regarding coinfections with other respiratory pathogens or bacterial infections among patients with COVID-19 [6] . To date, it is the first case of HSV-6 encephalitis in the context of co-infection with Sars-Cov19. In addition, it is a rare study decribing MRI abnormality in a child with COVID-19-associated encephalitis (Fig. 1) .

Human herpesvirus-6 infection in children. A prospective study of complications and reactivation

Cytokine and chemokine responses in the blood and cerebrospinal fluid of patients with human herpesvirus 6B-associated acute encephalopathy with biphasic seizures and late reduced diffusion

MR imaging findings in a neonate with COVID-19-associated encephalitis

Guillain-Barré syndrome associated with SARS-CoV-2 infection in a pediatric patient

Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target

The complexity of co-infections in the era of COVID-19

We thank the family for taking part in the investigation as well as giving consent for publication of the data and the imagines.Author contributions Each author has done a substantial contribution to the conception or design of the work and to revise it critically for important intellectual content. In addition, each author has approved the final of the version to be published. Conversely, each author is agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.Funding No funding sources.

The authors have no ethical conflicts to disclose.

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