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Granerod J, Huang Y, Davies NWS, Sequeira PC, Mwapasa V, Rupali P, Michael BD, Solomon T, Easton A. Global Landscape of Encephalitis: Key Priorities to Reduce Future Disease Burden. Clin Infect Dis 2023; 77:1552-1560. [PMID: 37436770 PMCID: PMC10686956 DOI: 10.1093/cid/ciad417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 07/13/2023] Open
Abstract
Encephalitis affects people across the lifespan, has high rates of mortality and morbidity, and results in significant neurological sequelae with long-term consequences to quality of life and wider society. The true incidence is currently unknown due to inaccurate reporting systems. The disease burden of encephalitis is unequally distributed across the globe being highest in low- and middle-income countries where resources are limited. Here countries often lack diagnostic testing, with poor access to essential treatments and neurological services, and limited surveillance and vaccination programs. Many types of encephalitis are vaccine preventable, whereas others are treatable with early diagnosis and appropriate management. In this viewpoint, we provide a narrative review of key aspects of diagnosis, surveillance, treatment, and prevention of encephalitis and highlight priorities for public health, clinical management, and research, to reduce the disease burden.
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Affiliation(s)
- Julia Granerod
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, United Kingdom
- Dr JGW Consulting Ltd., London, United Kingdom
| | - Yun Huang
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, United Kingdom
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, United Kingdom
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | | | | | - Victor Mwapasa
- University of Malawi, College of Medicine, Blantyre, Malawi
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Benedict D Michael
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, United Kingdom
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, United Kingdom
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Tom Solomon
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, United Kingdom
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, United Kingdom
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- The Pandemic Institute, Liverpool, United Kingdom
| | - Ava Easton
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, United Kingdom
- The Encephalitis Society, Malton, United Kingdom
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Rohani H, Arjmand R, Mozhgani SH, Shafiee A, Javad Amini M, Forghani-Ramandi MM. The Worldwide Prevalence of Herpes Simplex Virus Encephalitis and Meningitis: A Systematic Review and Meta-Analysis. Turk Arch Pediatr 2023; 58:580-587. [PMID: 37553966 PMCID: PMC10724770 DOI: 10.5152/turkarchpediatr.2023.23007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/21/2023] [Indexed: 08/10/2023]
Abstract
Given the relatively high frequency of central nervous system infections and considerable mor- tality and morbidity reported to be caused by herpes simplex viruses among the other viral agents, having a clear knowledge about their epidemiological profile seems necessary. This systematic review and meta-analysis aimed to determine the relative frequency and preva- lence of herpes simplex encephalitis and meningitis in patients tested for viral etiologies. A comprehensive systematic review was performed in PubMed, Scopus, and Web of Science databases, searching for studies on the prevalence and relative frequency of herpes sim- plex virus 1 and herpes simplex virus 2 encephalitis and meningitis. Seventy-one studies were included. Overall, the prevalence of herpes simplex virus encephalitis among patients tested was 8% (95% confidence interval, 6%-11%; I2 = 98%) and the prevalence of herpes simplex virus meningitis among aseptic patients tested was 4% (95% confidence interval, 3%-7%; I2 = 95%), and a significant difference was observed by region. The results of our subgroup analysis for herpes simplex virus encephalitis revealed a prevalence of 8% for pediatric patients and ado- lescents and 12% for adults. The results for herpes simplex virus meningitis showed a prevalence of 4% for pediatric patients and adolescents and 9% for adults. We observed significant differ- ences in the frequency of herpes simplex virus 1 and herpes simplex virus 2 detection rates by region. Having high rates of missed cases due to inadequate, highly sensitive paraclinical tests performed on patients with suspected viral central nervous system infection is one of the pos- sible factors. More studies are needed to detect the possible flaws in the process of diagnosis in different regions.
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Affiliation(s)
- Hoorieh Rohani
- Student Research Committee, Alborz University of Medical Sciences Faculty of Medicine, Karaj, Iran
| | - Reza Arjmand
- Department of Pediatrics, Imam Ali Hospital, Alborz University of Medical Sciences, Alborz, Karaj, Iran
| | - Sayed-Hamidreza Mozhgani
- Department of Microbiology, Alborz University of Medical Sciences Faculty of Medicine, Karaj, Iran
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Arman Shafiee
- Student Research Committee, Alborz University of Medical Sciences Faculty of Medicine, Karaj, Iran
| | - Mohammad Javad Amini
- Student Research Committee, Alborz University of Medical Sciences Faculty of Medicine, Karaj, Iran
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Zaman K, Yunus M, Aziz AB, Feser J, Mooney J, Tang Y, Ellison DW, Thaisomboonsuk B, Zhang L, Neuzil KM, Marfin AA, Letson GW. Antibody persistence and immune memory response following primary vaccination and boosting with live attenuated SA 14-14-2 Japanese encephalitis vaccine (CD-JEV) in Bangladesh: A phase 4 open-label clinical trial. Vaccine X 2022; 10:100143. [PMID: 35243320 PMCID: PMC8857502 DOI: 10.1016/j.jvacx.2022.100143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/22/2021] [Accepted: 01/25/2022] [Indexed: 11/30/2022] Open
Abstract
Despite a lack of measurable antibody four years after primary vaccination, the anamnestic response to a booster dose of live, attenuated SA 14-14-2 Japanese encephalitis vaccine indicates immunity persists. Live, attenuated SA 14-14-2 Japanese encephalitis vaccine is safe and well-tolerated.
Introduction Japanese encephalitis (JE) virus is one of the leading causes of viral encephalitis across temperate and tropical zones of Asia. The live attenuated SA 14-14-2 JE vaccine (CD-JEV) is one of three vaccines prequalified by the World Health Organization (WHO) to prevent JE. WHO currently recommends a single CD-JEV dose for infants in endemic settings. However, in the absence of long-term immunogenicity data, WHO has indicated a need for long-term immunogenicity studies to inform optimal dosing schedules and determine the need for booster doses. Methods This Phase 4, open-label clinical study measured neutralizing antibody (NAb) titers in Bangladeshi children three and four years after primary CD-JEV vaccination and 7 and 28 days after a booster CD-JEV vaccination given four years after primary vaccination. The study also assessed the tolerability and safety of the booster dose. A NAb titer of ≥1:10 was considered seroprotective. Results Of 560 children vaccinated between 10 and 12 months of age with CD-JEV three years earlier and enrolled in this study from 30 July 2015 through 03 January 2016, 52 (9.3%; 95% CI: 7.2–12.0) had a seroprotective titer at enrollment. One year later, of 533 children, 66 (12.4%; 95% CI: 9.9–15.5) had a seroprotective titer before receiving a booster dose. Of 524 children who received a booster CD-JEV dose, 479 (91.4%; 95% CI: 88.7–93.5) and 514 (98.1%; 95% CI: 96.5–99.0) were seroprotected 7 and 28 days later, respectively. The geometric mean titer (GMT) was 6 (95% CI: 6–6) at baseline, 105 (95% CI: 93–119) 7 days post-booster, and 167 (95% CI: 152–183) 28 days post-booster. No vaccine-associated neurologic adverse events or other serious adverse events were noted following the booster dose. Conclusions Although most children did not have measurable antibody titers three and four years after a single primary CD-JEV dose, more than 90% of seronegative children had a strong anamnestic response within one week of a booster dose. This suggests that these children were immune despite the absence of measurable NAb prior to their booster. ClinicalTrials.gov Identifier: NCT02514746.
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Affiliation(s)
- K Zaman
- International Centre for Diarrheal Disease Research, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Md Yunus
- International Centre for Diarrheal Disease Research, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Asma B Aziz
- International Centre for Diarrheal Disease Research, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Jodi Feser
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Suite 200, Seattle, Washington 98121, USA
| | - Jessica Mooney
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Suite 200, Seattle, Washington 98121, USA
| | - Yuxiao Tang
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Suite 200, Seattle, Washington 98121, USA
| | - Damon W Ellison
- Armed Forces Research Institute of Medicine Sciences, 315/6 Rajvithi Rd., Bangkok 10400, Thailand
| | - Butsaya Thaisomboonsuk
- Armed Forces Research Institute of Medicine Sciences, 315/6 Rajvithi Rd., Bangkok 10400, Thailand
| | - Lei Zhang
- Chengdu Institute of Biological Products Co., Ltd., 379, 3rd, Jinhua Road, Jinjiang District, Chengdu 61002, China
| | - Kathleen M Neuzil
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Suite 200, Seattle, Washington 98121, USA
| | - Anthony A Marfin
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Suite 200, Seattle, Washington 98121, USA
| | - G William Letson
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Suite 200, Seattle, Washington 98121, USA
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Damiano RF, Guedes BF, de Rocca CC, de Pádua Serafim A, Castro LHM, Munhoz CD, Nitrini R, Filho GB, Miguel EC, Lucchetti G, Forlenza O. Cognitive decline following acute viral infections: literature review and projections for post-COVID-19. Eur Arch Psychiatry Clin Neurosci 2022; 272:139-154. [PMID: 34173049 PMCID: PMC8231753 DOI: 10.1007/s00406-021-01286-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 06/21/2021] [Indexed: 12/15/2022]
Abstract
Recently, much attention has been drawn to the importance of the impact of infectious disease on human cognition. Several theories have been proposed, to explain the cognitive decline following an infection as well as to understand better the pathogenesis of human dementia, especially Alzheimer's disease. This article aims to review the state of the art regarding the knowledge about the impact of acute viral infections on human cognition, laying a foundation to explore the possible cognitive decline followed coronavirus disease 2019 (COVID-19). To reach this goal, we conducted a narrative review systematizing six acute viral infections as well as the current knowledge about COVID-19 and its impact on human cognition. Recent findings suggest probable short- and long-term COVID-19 impacts in cognition, even in asymptomatic individuals, which could be accounted for by direct and indirect pathways to brain dysfunction. Understanding this scenario might help clinicians and health leaders to deal better with a wave of neuropsychiatric issues that may arise following COVID-19 pandemic as well as with other acute viral infections, to alleviate the cognitive sequelae of these infections around the world.
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Affiliation(s)
- Rodolfo Furlan Damiano
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP, 05403-903, Brazil.
| | - Bruno F. Guedes
- Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Cristiana Castanho de Rocca
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | - Antonio de Pádua Serafim
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | | | - Carolina Demarchi Munhoz
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Geraldo Busatto Filho
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | - Eurípedes Constantino Miguel
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | - Giancarlo Lucchetti
- Department of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Orestes Forlenza
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
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Chang T, Moloney T, Jacobson L, Malavige N, Lohitharajah J, Wanigasinghe J, Peach S, Woodhall M, Berretta A, Waters P, Vincent A. Significance of neuronal autoantibodies in comparison to infectious etiologies among patients presenting with encephalitis in a region with a high prevalence of infections. Ann Indian Acad Neurol 2022; 25:473-478. [PMID: 35936609 PMCID: PMC9350781 DOI: 10.4103/aian.aian_280_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 09/19/2021] [Accepted: 12/09/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Methods: Results: Conclusions:
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Wanigasinghe J, Jayawickrama A, Sumanasekera N. Herpes Simplex Virus-2 Encephalitis Complicated with Multiple Cranial Neuritis and Dysautonomia. J Pediatr Neurosci 2021; 16:344-346. [PMID: 36531770 PMCID: PMC9757526 DOI: 10.4103/jpn.jpn_239_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/22/2020] [Accepted: 12/29/2020] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Herpes simplex encephalitis (HSE) is mainly caused by herpes simplex virus-1 infection (HSV-1). Herpes simplex virus-2 (HSV-2) infection is rare except in neonates or the immune-compromised. Cranial neuritis is rarely reported in association with HSE. This case study in an eleven-month-old followed by a literature review on cranial neuritis in HSE in children is presented due to the rarity of both situations. CASE REPORT An eleven-month old otherwise healthy infant presented with encephalitis due to HSV-2 infection which was complicated with dysautonomia manifesting as blood pressure fluctuations and tachycardia, and cranial neuritis manifesting as unilateral ptosis and palatal palsy. The clinical presentation of brain stem encephalitis was confirmed by the Magnetic Resonance Imaging findings of hyperintense foci and contrast enhancement in the medulla oblongata. Following treatment with acyclovir, he made a complete recovery. He did not have any clinical or laboratorial evidence suggestive of immune deficiency. CONCLUSION HSV-2 infection can occur beyond the neonatal age group even in the absence of immune compromise. The brainstem encephalitis manifesting as cranial neuritis and autonomic dysfunction made a complete recovery.
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Affiliation(s)
| | - Ashan Jayawickrama
- Department of Paediatrics, University of Colombo Colombo 7, Colombo, Sri Lanka
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Bentes AA, Maia De Castro Romanelli R, Crispim APC, Marinho PES, Loutfi KS, Araujo ST, Campos E Silva LM, Guedes I, Martins Alvarenga A, Santos MA, Geessien Kroon E. Neurological manifestations due to dengue virus infection in children: clinical follow-up. Pathog Glob Health 2021; 115:476-482. [PMID: 34223795 PMCID: PMC8635603 DOI: 10.1080/20477724.2021.1942680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The aim was to assess neurological complications in children with an invasive neurological disease by dengue virus (DENV) and the time to resolve symptoms after hospital discharge. A prospective study was conducted at a referral hospital for infectious diseases in Brazil between March 2014 and July 2019. All children hospitalized with neurologic manifestations and DENV RNA detected by real-time reverse transcription-polymerase chain reaction (RT-qPCR) in cerebrospinal fluid (CSF) were followed up until complete resolution of neurological complications. On average, they were followed up for 16 months. Among 56 DENV-positive children, 39% had some neurologic complications after hospital discharge and found that 19.6% were discharged with anticonvulsants due to seizures, 10.7% developed motor complications (e.g. muscle weakness, paresis, ataxia, and walking disability), 5.4% had headaches, and 14.3% had sleep disorders. Among the 56 children, only three had a clinical diagnosis of dengue because the symptoms are nonspecific and 35% showed no change in cerebrospinal fluid (CSF). The average time to resolve complications was 5.9 months (ranging from 1 m to 32 m). These results should alert physicians to the difficulties of a clinical diagnosis of an infection that causes neurological complications after discharge in a significant number of children. RT-qPCR's etiological diagnosis of DENV infection enabled better clinical follow-up for early intervention in children with neurological complications.
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Affiliation(s)
- Aline Almeida Bentes
- Departamento De Pediatria, Universidade Federal De Minas Gerais, Minas Gerais, Brazil
- Hospital Infantil João Paulo II, FHEMIG, Minas Gerais, Brazil
| | | | - Ana Paula Correa Crispim
- Laboratório De Vírus, Departamento De Microbiologia, Universidade Federal De Minas Gerais, Minas Gerais, Brazil
| | | | | | - Sara Tavares Araujo
- Faculdade De Medicina, Universidade Federal De Minas Gerais, Minas Gerais, Brazil
| | | | - Isabela Guedes
- Faculdade De Medicina, Universidade Federal De Minas Gerais, Minas Gerais, Brazil
| | | | | | - Erna Geessien Kroon
- Laboratório De Vírus, Departamento De Microbiologia, Universidade Federal De Minas Gerais, Minas Gerais, Brazil
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Analysis of the Effect of Incentive Nursing Intervention in Children with Severe Viral Encephalitis and Myocarditis during Rehabilitation Based on Diffusion Weighted MRI. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:9993264. [PMID: 34094044 PMCID: PMC8140845 DOI: 10.1155/2021/9993264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/23/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022]
Abstract
Background Severe viral encephalitis in children causes a viral infection that damages their central nervous system. This situation arises the mental abnormalities, sudden rise in body temperature, disturbance of consciousness, and so forth in children, which can be life-threatening. Objective This work aimed at exploring the effect of diffusion weighted MRI on children with severe viral encephalitis and myocarditis. Methods This work presents a diffusion weighted MRI scanning method that involves scanning through a serial imaging device, axial scanning, and sagittal and coronal scanning. 60 children with severe viral encephalitis and myocarditis who admitted to Brain Hospital of Hunan Province from April 2017 to May 2020 were deemed as research subjects. All the children underwent CT and MRI examination, blood routine examination, and cerebrospinal fluid examination after admission. This work uses the random number table method to classify the subjects into control group and observation group, each consisting of 30 cases. Children in the control group were provided with the routine nursing intervention, whereas children in the observation group were subjected to incentive nursing intervention. The baseline data, ECG monitoring indicators, body abnormalities, and clinical symptom relief time of the two groups of children were compared and the results of diffusion weighted MRI scans were analyzed and the ADC values were counted. Results The two groups of children were compared on the basis of baseline data, and the variation was not statistically substantial (P > 0.05). The cases of children in the control group had higher heart rate and respiration, and physical dysfunction, language dysfunction, unconsciousness, and nervous dysfunction were more than those in the observation group. However, the cases of blood oxygen saturation were less than those of the observation group. After nursing intervention done for the control group, remission time of clinical symptoms such as convulsion, physical dysfunction, unconsciousness, and nerve dysfunction was longer relative to the observation group (all P < 0.05 are considered). Conclusion The diffusion weighted MRI had diagnostic significance for severe viral encephalitis and myocarditis. For children with severe viral encephalitis and myocarditis, clinical incentive nursing intervention was particularly imperative. It can not only help children to relieve symptoms and control the deterioration of the disease in a short time but also help improve the quality of life of the children and the confidence of family members to cope with the disease.
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Wijayabandara M, Appuhamy S, Weerathunga P, Chang T. Effective treatment of osmotic demyelination syndrome with plasmapheresis: a case report and review of the literature. J Med Case Rep 2021; 15:6. [PMID: 33430956 PMCID: PMC7798224 DOI: 10.1186/s13256-020-02573-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/03/2020] [Indexed: 11/21/2022] Open
Abstract
Background Treatment options for chronic osmotic demyelination syndrome are limited to case reports and only a very few show complete recovery. We report a case of complete recovery of chronic osmotic demyelination syndrome with plasmapheresis. Case presentation A 43-year-old Sri Lankan man presented with fever, repeated vomiting, unsteady gait, increased tonicity of his right upper limb and paucity of speech for three days. He was treated in the local hospital with antibiotics and antivirals as per central nervous system infection. He had hyponatraemia, which was rapidly corrected with hypertonic saline from 97 to 119 mmol/L. He was transferred to our hospital because of progressive reduction of consciousness, rapidly worsening rigidity and bradykinesia of all four limbs and worsening dysarthria and bradyphrenia. Magnetic resonance imaging of the brain was compatible with osmotic demyelination syndrome. He was commenced on plasmapheresis twenty-two days after rapid correction of sodium. He regained independent mobility with complete resolution of rigidity, bradykinesia and speech dysfunction after five cycles of alternate day plasmapheresis. Conclusion Plasmapheresis can be considered as an effective treatment modality in chronic osmotic demyelination syndrome.
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Affiliation(s)
| | - Shenal Appuhamy
- University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Praveen Weerathunga
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Thashi Chang
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Predictors of Outcome in Clinically Diagnosed Viral Encephalitis Patients: A 5-Year Prospective Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2832418. [PMID: 32724798 PMCID: PMC7366193 DOI: 10.1155/2020/2832418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/20/2020] [Indexed: 12/12/2022]
Abstract
Background Viral encephalitis is the most common infectious disease of the central nervous system and is associated with high morbidity, mortality, and disability. The objective of this study was to analyze the clinical characteristics, auxiliary examinations, therapeutic management, and outcomes of patients clinically diagnosed with viral encephalitis and identify the outcome predictors. Methods We conducted a prospective observational study by collecting information from patients clinically diagnosed with viral encephalitis at the First Affiliated Hospital of Chongqing Medical University and Yongchuan Hospital of Chongqing Medical University from January 2013 to December 2018. Univariate and multivariate analyses were performed to identify factors that influenced good patient outcomes (mRS < 3) and poor patient outcomes (mRS ≥ 3) at discharge. Results In total, 216 patients were enrolled in the study. The multivariate analysis suggested that the following factors were associated with a poor outcome: Glasgow Coma Scale (GCS) score (OR 0.154, 95% CI (0.078-0.302), and P < 0.001), focal neurological deficits (OR 9.403, 95% CI (1.581-55.928), and P = 0.014), and total length of hospital stay (OR 1.119, 95% CI (1.002-1.250), and P = 0.045). However, neurological intensive care unit (NICU) treatment, status epilepticus, and abnormal electroencephalogram (EEG) findings did not influence the prognosis of patients. Conclusion Our study suggests that low GCS scores at admission, focal neurological deficits at admission, and a prolonged total hospital stay are predictors of a poor outcome at discharge in clinically diagnosed viral encephalitis patients. Whether early and effective neurological rehabilitation can improve the prognosis of viral encephalitis patients with focal neurological deficits remains to be confirmed in further studies.
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Pushpakumara PD, Jeewandara C, Wijesinghe A, Gomes L, Ogg GS, Goonasekara CL, Malavige GN. Identification of Immune Responses to Japanese Encephalitis Virus Specific T Cell Epitopes. Front Public Health 2020; 8:19. [PMID: 32117854 PMCID: PMC7029616 DOI: 10.3389/fpubh.2020.00019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/21/2020] [Indexed: 01/16/2023] Open
Abstract
Background: Due to the similarity between the dengue (DENV) and the Japanese encephalitis virus (JEV) there is potential for immune cross-reaction. We sought to identify T cell epitopes that are specific to JEV and do not cross react with DENV. Methodology: 20mer peptides were synthesized from regions which showed >90% conservation. Using IFNγ cultured ELISpot assays, we investigated JEV-specific T cell responses in DENV- and JEV- non-immune individuals (DENV-JEV- = 21), JEV seronegative and had not received the JE vaccine, but who were DENV seropositive (DENV+JEV- = 22), JEV+(seropositive for JEV and had received the JE vaccine), but seronegative for DENV (DENV-JEV+ = 23). We further assessed the responses to these peptides by undertaking ex vivo IFNγ assays and flow cytometry. Results: None of DENV-JEV- individuals responded to any of the 20 JEV-specific peptides. High frequency of responses was seen to 6/20 peptides by individuals who were JEV+ but DENV-, where over 75% of the individuals responded to at least one peptide. P34 was the most immunogenic peptide, recognized by 20/23 (86.9%) individuals who were DENV-JEV+, followed by peptide 3 and peptide 7 recognized by 19/23 (82.6%). Peptide 34 from the NS2a region, showed <25% homology with any flaviviruses, and <20% homology with any DENV serotype. Peptide 20 and 32, which were also from the non-structural protein regions, showed <25% homology with DENV. Ex vivo responses to these peptides were less frequent, with only 40% of individuals responding to peptide 34 and 16-28% to other peptides, probably as 5/6 peptides were recognized by CD4+ T cells. Discussion: We identified six highly conserved, T cell epitopes which are highly specific for JEV, in the Sri Lankan population. Since both JEV and DENV co-circulate in the same regions and since both JE and dengue vaccines are likely to be co-administered in the same geographical regions in future, these JEV-specific T cell epitopes would be useful to study JEV-specific T cell responses, in order to further understand how DENV and JEV-specific cellular immune responses influence each other.
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Affiliation(s)
- Pradeep Darshana Pushpakumara
- Department of Preclinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Rathmalana, Sri Lanka
| | - Chandima Jeewandara
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Ayesha Wijesinghe
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Laksiri Gomes
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Graham S Ogg
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Charitha Lakshini Goonasekara
- Department of Preclinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Rathmalana, Sri Lanka
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Role of NS1 antibodies in the pathogenesis of acute secondary dengue infection. Nat Commun 2018; 9:5242. [PMID: 30531923 PMCID: PMC6286345 DOI: 10.1038/s41467-018-07667-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 11/13/2018] [Indexed: 12/16/2022] Open
Abstract
The role of NS1-specific antibodies in the pathogenesis of dengue virus infection is poorly understood. Here we investigate the immunoglobulin responses of patients with dengue fever (DF) and dengue hemorrhagic fever (DHF) to NS1. Antibody responses to recombinant-NS1 are assessed in serum samples throughout illness of patients with acute secondary DENV1 and DENV2 infection by ELISA. NS1 antibody titres are significantly higher in patients with DHF compared to those with DF for both serotypes, during the critical phase of illness. Furthermore, during both acute secondary DENV1 and DENV2 infection, the antibody repertoire of DF and DHF patients is directed towards distinct regions of the NS1 protein. In addition, healthy individuals, with past non-severe dengue infection have a similar antibody repertoire as those with mild acute infection (DF). Therefore, antibodies that target specific NS1 epitopes could predict disease severity and be of potential benefit in aiding vaccine and treatment design. The antibody response during infection with dengue virus is a key component involved in the pathogenesis during secondary infection. Here the authors show antibodies targeting NS1 and the epitopes targeted can be associated with disease severity during human infection.
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