A case of human herpesvirus 6B encephalitis after liver transplantation and literature review / 国际生物医学工程杂志

Human herpesvirus-6 (HHV-6) is a ubiquitous virus. The incidence of HHV-6 after liver transplantation is estimated to be 22% ? 54%; it may present with fever, hepatitis, pneumonia, encephalitis, and myelosuppression and has a poor prognosis. HHV-6(+) recipients had a mortality rate of 29%, significantly higher than that of HHV-6(?) recipients (6%). Since most infections are asymptomatic, HHV-6 monitoring is not routinely performed in clinical practice, which means clinicians often ignore the diagnosis of HHV-6 and eventually delay diagnosis and treatment. In this paper, a case of human herpesvirus 6B encephalitis after liver transplantation was retrospectively analyzed, and the literature related to this disease was reviewed to improve the understanding of this disease.

Stenotrophomonas Maltophila : A Rare Cause of Bacteremia in a Patient of Viral Encephalitis

Stenotrophomonas maltophila is an important Nosocomial Bacterial Pathogen. It is ubiquitous, non-fermentative gram negative bacillus previously known as Pseudomonas maltophila or Xanthomonas maltophila. It is usually of low virulence but now a day there is increased frequency of its isolation from hospitalized patients, especially patient with immunocompromised status. S maltophila infections include Bacteremia, Pneumonia, Urinary tract infection, Endocarditis, Meningitis, Peritonitis, Ocular infections, Septic arthritis & Cystic fibrosis. Treatment of S. maltophila infection is often difficult as it is resistant to commonly used antimicrobial agents and this antimicrobial resistance may emerge during therapy. Herewith we are reporting a case of bacteremia in a patient with viral encephalitis caused by Dengue Virus. Patient was treated successfully with Co-trimoxazole plus ticarcillin+clavulanic acid along with other supportive measures.

Evaluation of multiplex PCR for viral central nervous system infection in children / 中国小儿急救医学

Objective:To evaluate the clinical significance of molecular detection testing multiple pathogens in children with viral central nervous system infections.Methods:We retrospectively included 176 children who were suspected with central nervous system infection at Shanghai Children′s Medical Center from January 2017 to May 2021.Film Array Meningitis/Encephalitis Panel(FA-M/E) was used to test cerebrospinal fluid samples of these children.The results were analyzed compared with clinical symptoms and cerebrospinal fluid indices.Results:There were 34 samples with positive FA-M/E virus detection(19.32%, 34/176). Among the 34 samples, enterovirus was the most common pathogen(27 cases, 79.41%). In different combinations, the sensitivity and positive predictive value were all less than 90%.The median time for antiviral drugs used in FA-M/E virus-positive and negative children was 4.5(0, 8.5)d and 2.6(0, 2.0)d, respectively.The difference was statistically significant( P<0.05). Conclusion:Molecular tests of multiple pathogens can quickly and sensitively detect pathogens.It can improve the efficacy of clinical diagnosis of viral central nervous system infection.

Seroprevalence and risk factors associated with seropositivity for equine encephalomyelitis virus in horses in Rio Grande do Norte, Brazil

The present objective was to investigate the presence of anti-equine viral encephalomyelitis (EVE) antibodies and the possible risk factors for its dissemination in horses raised in the East and West Potiguar mesoregions of the state of Rio Grande do Norte, Brazil. Serological diagnosis for neutralizing antibodies against Eastern (EEEV), Western (WEEV) and Venezuelan (VEEV). Equine viral encephalomyelitis was performed using a seroneutralization technique on 811 blood samples from horses from ninety properties and sixteen municipalities between July 2018 and February 2019. Factors associated with EVE were evaluated using an investigative epidemiological questionnaire, and the data were statistically analyzed using the Epi Info 3.5.2 software with a confidence level of 95%. The seroprevalence of anti-EVE antibodies was 14.2% (115), with 10.36% (84) for EEEV, 6.9% (56) for WEEV, and null for EVE. When analyzing risk factors, it can be concluded that horses raised in properties that do not clean installations and/or rent out their pasture are more likely to have anti-EVE antibodies. These results show evidence that horses raised in the East and West Potiguar mesoregions were exposed to EEEV and WEEV, thus reinforcing the importance of vaccination and serological survey of nonvaccinated horses as a means of monitoring the disease.

Encefalite herpética associada a mieloma múltiplo: desafio diagnóstico / Herpetic encephalitis associated with multiple myeloma: a diagnostic challenge

O mieloma múltiplo é a segunda neoplasia onco-hematológica mais comum, correspondendo a 1% das neoplasias malignas. Trata-se de uma condição subdiagnosticada, assim como a encefalite herpética. Entretanto, é comum a relação do mieloma com infecções, em decorrência do acometimento da imunidade humoral. A encefalite viral herpética tem como principal agente o vírus do herpes simples 1. O caso foi descrito baseado em um raciocínio clínico, visando contribuir para uma melhor caracterização do quadro clínico e do diagnóstico de duas entidades clínicas que possuem baixa suspeição diagnóstica e elevada morbimortalidade. Durante o curso da investigação, foram propostas variadas etiologias como responsáveis pelo rebaixamento do nível de consciência, levando a uma pesquisa de um espectro mais amplo de hipóteses diagnósticas, as quais precederam a confirmação do diagnóstico final. O quadro clínico atípico descrito apresentou obstáculos à suspeição diagnóstica correta, pois a ausência dos sinais e sintomas característicos de ambas as doenças levaram à pesquisa de um arsenal mais amplo de diagnósticos diferenciais. Assim, o atraso no diagnóstico e o início tardio do tratamento foram fatores que contribuíram para o prognóstico reservado do paciente. A associação dessas doenças é pouco descrita na literatura, de modo que mais estudos acerca do assunto se fazem necessários. (AU)

Multiple myeloma is the second most common onco-hematologic neoplasm, accounting for 1% of malignant neoplasms. As herpetic encephalitis, it is an underdiagnosed condition. However, the relation of myeloma with infections is common, due to the involvement of humoral immunity. Herpetic encephalitis has as its main etiological agent the herpes simplex virus 1. The case was described based on a clinical reasoning, aiming to contribute to a better characterization of the clinical picture and diagnosis of two entities that have low rates of diagnostic suspicion and high rates of morbidity and mortality. During the course of investigation, several etiologies were proposed as responsible for the decreased level of consciousness, leading to a search for a broader range of diagnostic hypotheses, which preceded confirmation of the final diagnosis. The atypical clinical picture described presented obstacles to the correct diagnostic suspicion, as the absence of symptoms and signs characteristic of both diseases led to the search for a broader arsenal of differential diagnoses. Thus, delayed diagnosis and late treatment were factors that contributed to the patient's reserved prognosis. The association of these diseases is poorly described in the literature, so further studies on that subject are required. (AU)

Diagnostic value of 18F-fulorodeoxyglucose marked positron emission computed tomography in anti- N-methyl-daspartate receptor encephalitis and viral encephalitis / 中华神经医学杂志

The clinical manifestations of anti- N-methyl-daspartate (NMDA) receptor encephalitis and viral encephalitis are similar but the treatments and prognoses are different, so the early differentiation of the two diseases is very important. Early diagnosis is affected by delayed antibody detection and false negative detection, while routine auxiliary tests lack specificity; therefore, they have limited value in identification. The 18F-fulorodeoxyglucose (FDG) marked positron emission computed tomography (PETCT) is highly sensitive to abnormal cerebral metabolism in the early stage of anti-NMDA receptor encephalitis, showing a characteristic metabolic pattern of frontal or temporal lobe increase metabolism and occipital decrease metabolism. The number of patients who underwent 18F FDG PETCT examination for viral encephalitis was small; different kinds of viral encephalitis show different brain metabolism, but there was no characteristic hypometabolism of the occipital lobe. This paper reviews the cerebral metabolic characteristics of 18F-FDG PETCT in anti-NMDA receptor encephalitis and viral encephalitis.

Viral encephalitis: a practical review on diagnostic approach and treatment / Encefalite viral: uma revisão prática sobre abordagem diagnóstica e tratamento

Abstract Objectives To review the diagnostic criteria for encephalitis and encephalopathy of presumed infectious etiology, as well as the diagnostic workup for viral encephalitis and its treatment approaches. The authors also intended to summarize relevant information on specific viruses frequently found in Brazil. Source of data Literature search on Pubmed/MEDLINE using the following keywords: "viral", "encephalitis", "child", or "adolescents", filtering for articles on humans and in English. Summary of data Viral encephalitis is the most common cause of encephalitis and is responsible for high rates of morbidity, permanent neurologic sequelae, and according to the virus, may have high mortality rates. The most common etiologies are herpesviruses 1 and 2 (HSV-1 and HSV-2), non-polio enterovirus, and arboviruses (in Brazil, dengue, Zika, and chikungunya). Other relevant etiologies are seasonal influenza, cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), and the re-emergent measles. Conclusion Clinical data, laboratory results, and neuroimaging findings support the diagnosis of encephalitis and the specific viral etiology. To increase the likelihood of etiologic confirmation, it is important to know the best approach to collecting samples and to choose the best identification technique for each virus. The differential diagnosis of viral encephalitis includes other infections and immune-mediated inflammatory central nervous system disorders.

Resumo Objetivos Revisar os critérios diagnósticos para encefalite e encefalopatia de etiologia infecciosa presumida, assim como a investigação diagnóstica para encefalite viral e suas abordagens terapêuticas. Além disso, pretendemos resumir tópicos relevantes sobre os vírus específicos frequentemente encontrados no Brasil. Fonte de dados Pesquisa bibliográfica feita nos bancos de dados Pubmed/Medline utilizando as seguintes palavras-chave: "viral", "encephalitis", "child" ou "adolescents", limitando os artigos a estudos em humanos e escritos em inglês. Resumo dos dados A encefalite viral é a causa mais comum de encefalite e é responsável por altas taxas de morbidade, sequelas neurológicas permanentes e, de acordo com o vírus, altas taxas de mortalidade. As etiologias mais comuns são herpes vírus 1 e 2 (HSV-1 e HSV-2), enterovírus não pólio e arbovírus (no Brasil, Dengue, Zika e Chikungunya). Outras etiologias relevantes são a influenza sazonal, o citomegalovírus (CMV), o vírus Epstein-Barr (EBV), o herpes vírus humano 6 (HHV-6) e o sarampo reemergente. Conclusão Dados clínicos, resultados laboratoriais e de neuroimagem apoiam o diagnóstico de encefalite e a etiologia viral específica. Para aumentar a probabilidade de confirmação etiológica, é importante conhecer a melhor abordagem para coletar amostras e escolher a melhor técnica de identificação para cada vírus. O diagnóstico diferencial de encefalite viral inclui outras infecções e distúrbios inflamatórios do sistema nervoso central imunomediados.

Clinical Profile and Predictor of Adverse Outcome in Children with Acute Encephalitis Syndrome: A Cross Sectional Study.

Background: Acute Encephalitis Syndrome (AES) isdefined as a person of any age at any time of year, withthe acute onset of fever and a change in mental statussuch as confusion, disorientation, coma or inability totalk and/or new onset of seizures (excluding simplefebrile seizure). Most cases of AES are due to viralencephalitis, which is more prevalent in South EastAsia. Aim and Objectives: to study clinical profile andrisk factors for adverse outcome of AES in children inAcharya Vinoba Bhave Rural Hospital (AVBRH).Material and Methods: This cross-sectional,observational study was conducted in children withAES admitted in Pediatric Intensive Care Unit (PICU)of AVBRH over period of 2 years (August 2017- July2019). Data collection were done by using predesigned,structured proforma and analyzed by using SPSSversion 22. Results: Of the 80 cases enrolled in the study31.25% were between 10-15 years. In this study male tofemale ratio was 1.5. Mostly subjects were residing inrural area (54.1%), with a common presentation of fever(100%), altered sensorium (73.7%) and convulsion(71.25%). Mortality was observed in 23.7% cases out ofwhich 40(50%) had viral etiology (other than dengue),21(26.25%) had dengue, 5(6.2%) had malaria. Thosewho presented with shock and required mechanicalventilation and had deranged Liver Function Test (LFT)profile have statistically significant correlation withmortality. Conclusion: Majority of cases were in the agegroup 10-15 years, with male predominance. DerangedLFT, presence of shock significantly associated withmortality among children with AES. Viral encephalitisis an important cause of AES

Etiological Evaluation of Convulsions in Children between 1 Month to 5 Years of Age in Tertiary Care Hospital, Guntur.

Introduction: Seizure is a common problem evaluated inpediatric emergency department. The different causes ofseizures are febrile seizures, CNS infections, metabolic,developmental defects, traumatic brain injury, vascularaccidents, brain tumors and idiopathic or epilepsy. Currentresearch aimed to study the etiology of convulsions in childrenbetween 1 month to 5 years of age admitted in pediatricward, Government General Hospital, Guntur. To assess thecommon incidence of convulsions in children of age 1 to 5years admitted to pediatric ward, Department of Pediatrics,Government General Hospital, Guntur.Material and methods: Our study was retrospective,descriptive study. 100 cases admitted to pediatric ward,Government General Hospital, Guntur with convulsions in theage group of 1 month to 5 years during the period of July 2018and April 2019. Study was done by detailed history, throughphysical examination and relevant investigations includingcomplete blood counts, serum electrolytes, serum glucose,serum calcium, CSF analysis, EEG and neuroimaging (CT/MRI brain) studies. Variables recorded were demographics,clinical presentation, laboratory investigations, EEG andneuroimaging.Results: The most common cause of seizures in our study wasfebrile seizures (32%). About 24% cases were due to epilepsy(idiopathic or unprovoked) and 33% cases were symptomaticseizures of various causes like CNS infection, metabolic,traumatic, vascular etc.Remaining 11% were due to othermiscellaneous causes.Conclusion: This was the hospital based retrospective,descriptive study to know the etiology of convulsions inchildren between 1 month to 5 years. Convulsions in childrencan be due to various underlying pathology. In our study mostcommon cause of convulsions was febrile seizures, followedby epilepsy and symptomatic seizures of infective etiology ofCNS, viral encephalitis being the most common.

Changes of Caveolin-1, matrix metalloproteinase-9 and interleukin-1β in cerebrospinal fluid of children with bacterial meningitis or viral encephalitis / 中华实用儿科临床杂志

Objective@#To investigate the changes and clinical significance of Caveolin-1, matrix metalloproteinase-9(MMP-9) and interleukin-1β(IL-1β)in cerebrospinal fluid of children with bacterial meningitis or viral encephalitis.@*Methods@#Thirty-six cases of children with bacterial meningitis, 42 cases of children with viral encephalitis, and 20 cases of children with non-nervous system infection were selected from September 2016 to June 2018 at the Third Affiliated Hospital of Zhengzhou University.The levels of Caveolin-1, MMP-9 and IL-1β in cerebrospinal fluid were detected by using enzyme linked immunosorbent assay(ELISA).@*Results@#Cerebrospinal fluid Caveolin-1, MMP-9 , IL-1β levels in the acute phase of bacterial meningitis were(49.06±8.96) ng/L, (134.79±18.88) μg/L, (100.02±14.67) μg/L, respectively, and (29.13±7.25) ng/L, (18.69±7.23) μg/L, (47.57±8.95) μg/L in recovery phase, which were higher than those of the controls[(11.18±2.24) ng/L, (11.53±3.54) μg/L, (39.75±7.08) μg/L)], and the differences were significant (all P<0.05). Cerebrospinal fluid Caveolin-1, MMP-9, IL-1β levels in the acute phase of viral encephalitis were (42.71±10.48) ng/L, (62.78±17.39) μg/L, (57.97±11.28) μg/L, respectively, and (29.13±7.25) ng/L, (18.69±7.23) μg/L, (47.57±8.95) μg/L in recovery phase, which were higher than those of controls, and the differences were significant (all P<0.05). The levels of Caveolin-1, MMP-9 and IL-1β in cerebrospinal fluid of bacterial meningitis group and viral encephalitis group were significantly higher than those of convalescent group (all P<0.05). The levels of Caveolin-1, MMP-9, IL-1β in cerebrospinal fluid of bacterial meningitis group were significantly higher than those in viral encephalitis group (all P<0.05) in the acute phase, and no significant difference was found in the recovery phase(all P>0.05). Cerebrospinal fluid Caveolin-1, MMP-9, IL-1β showed no significant difference among children with different severity of intracranial infection.Correlation analysis showed that there was a positive correlation between Caveolin-1, MMP-9 and IL-1 β levels in cerebrospinal fluid of acute in bacterial meningitis group and viral encephalitis group(Caveolin-1 and MMP-9: R2=0.239, P<0.05; MMP-9 and IL-1β: R2=0.766, P<0.01; Caveolin-1 and IL-1β: R2=0.245, P<0.05).@*Conclusions@#Caveolin-1, MMP-9 and IL-1 β involved in the pathogenesis of intracranial infection in children, and the effects of different pathogens on intracranial infection were different.

The supervision of postencephalitic epilepsy after viral encephalitis / 中华实用儿科临床杂志

Viral encephalitis(VE), one of important causes of postencephalitic epilepsy, is the common infectious disease of central nervous system.Although there are many researches of the clinical features and the medical effects about VE with epilepsy, it is scarce to find relative reports about the epilepsy in the sequelae stage.VE and epilepsy can cause heavy economic and psychological burden to the patients themselves, their family and society, so the epidemiology, the clinical feature, the therapy, the prognosis and the current status of follow-up studies of postencephalitic epilepsy after VE are summarized in order to provide the basis for the follow-up supervision.

Changes and significances of vascular endothelial cadherin, procalcitonin in serum and cerebrospinal fluid of children with viral encephalitis or bacterial meningitis / 中华实用儿科临床杂志

Objective@#To investigate the changes and clinical significance of vascular endothelial (VE)-cadherin and procalcitonin (PCT) in serum and cerebrospinal fluid (CSF) of children with viral encephalitis or bacterial meningitis(BM).@*Methods@#A total of 42 cases of children with viral encephalitis(viral encephalitis group), 36 cases of children with BM(BM group), and 20 cases of children with non-nervous system injury(control group) were selected from September 2016 to June 2018 at the Third Hospital of Zhengzhou University.The serum and CSF levels of VE-cadherin and PCT levels of the 3 groups were detected by using enzyme-linked immunosorbent assay.@*Results@#The levels of VE-cadherin in the serum of viral encephalitis group, BM group and control group at the acute phase were (5.60±1.17) mg/L, (7.08±1.01) mg/L and (2.52±0.68) mg/L respectively, and the levels of VE-cadherin in CSF of viral encephalitis group, BM group and control group were (6.00±1.09) mg/L, (6.97±1.11) mg/L and(1.93±0.88) mg/L, respectively.The levels of PCT in the serum of viral encephalitis group, BM group and control group at the acute phase were (0.26±0.11) μg/L, (0.82±0.17) μg/L and (0.27±0.13) μg/L, respectively, and the levels of PCT in the CSF of viral encephalitis group, BM group and control group were (0.25±0.11) μg/L, (0.72±0.14) μg/L, (0.28±0.17) μg/L, respectively.As a result, the levels of VE-cadherin and PCT in the serum and CSF of BM group showed significant increase, compared with viral encephalitis group and control group in the acute phase(F=124.94, 163.21, 151.62, 127.37, all P<0.01). The levels of VE-cadherin in the serum and CSF of viral encephalitis group were also significantly higher than that of control group (all P<0.01), but there was no difference between viral encephalitis group and control group about the levels of PCT in the serum and CSF (all P>0.05). The levels of VE-cadherin in the serum of viral encephalitis group and BM group after treatment were (2.34±0.81) mg/L and (2.67±1.29) mg/L, and were(2.55±0.92) mg/L and(2.39±0.74) mg/L in the CSF.The levels of PCT in the serum of viral encephalitis group and BM group after treatment were (0.25±0.11) μg/L, (0.30±0.17) μg/L, and the levels of PCT in the CSF of viral encephalitis group and BM group were(0.22±0.10) μg/L and (0.27±0.12) μg/L.After effective treatment, the levels of VE-cadherin, PCT in serum and CSF of BM group and viral encephalitis group were almost equal, and the difference was not statistically significant(F=1.83, 0.76, 2.72, 3.89, all P>0.05). In the receiver operating characteristic (ROC) curve, the area under the ROC curve of VE-cadherin in serum and CSF was 0.896 and 0.912, and was 0.670 and 0.668 of PCT respectively.@*Conclusions@#VE-cadherin may be involved in the early stage of intracranial infection, and it may be helpful in differentiation of virus or bacterial infection with PCT.VE-cadherin has a good diagnostic value for intracranial infection.

Comparison of detection rates of herpes virus and enterovirus in paired cerebrospinal fluid and serum specimens of patients with viral encephalitis / 中华实验和临床病毒学杂志

Objective@#To compare the detection rate of herpes virus and enterovirus (EV) in paired cerebrospinal fluid and serum samples of patients with viral encephalitis.@*Methods@#A total of 109 paired cerebrospinal fluid and serum specimens were collected from patients who were clinically diagnosed with suspected viral meningitis in Children′s Hospital of Hunan from December 2017 to February 2018. One-step nested real-time fluorescence quantitative reverse transcription polymerase chain reaction (RT-PCR) and real-time fluorescence quantitative PCR were used to detect enterovirus and herpes virus respectively and the detection rates of different virus and sample types were analyzed. SPSS 17.0 was used for statistical analysis of the test result .@*Results@#Among the 109 pairs of specimens, the positive rates of human herpes virus type 6 (HHV6), herpes simplex virus-1 (HSV1), Epstein-Barr virus (EBV), cytomegalovirus (CMV) and enterovirus group A type 71(EV-A71) in serum were 7.34%, 4.59%, 7.34%, 9.17% and 10.09%, respectively, and in cerebrospinal fluid were 5.50%, 2.75%, 0, 5.50%, and 6.42%, respectively. The result showed that there were statistically significant differences between the two types of specimens for herpes virus and enterovirus (P<0.05). In cerebrospinal fluid and serum samples, the longest time for EV-A71 positive detection was 2 and 7 days after onset, respectively; the longest time for CMV positive detection was 3 and 26 days after onset, respectively; the longest time for HHV6 positive detection was 7 and 8 days after onset, respectively; the longest time for HSV1 positive detection was both 12 days after the onset; in serum samples, the longest time for EBV positive detection was10 days after onset, but in cerebrospinal fluid, no EBV was detected within 10 days of onset.@*Conclusions@#EV-A71 is the most prevalent pathogen causing viral encephalitis in hunan, the overall positive rate of virus in serum samples was higher than that in cerebrospinal fluid samples. Virus stays longer in serum than in cerebrospinal fluid. It is suggested that the time is of great significance for the pathogen detection of children with viral encephalitis, the specimen type can be selected reasonably according to the time of onset.

Effects of edaravone combined with antiviral drug in the treatment of viral encephalitis / 中华实验和临床病毒学杂志

Objective@#To explore the treatment effects of edaravone combined with antiviral drugs on 30 adult cases with viral encephalitis.@*Methods@#Sixty adult patients with viral encephalitis in our hospital were selected for the study and were divided into control group and observation group according to the admission number, with 30 cases in each group. Control group was treated with conventional antiviral drugs, and observation group was given antiviral drugs combined with edaravone. Another 30 healthy people admitted to the hospital in the same period for physical examination were included in healthy group. The clinical efficacy and time to normalization of clinical manifestations (fever, headache, vomiting, EEG abnormalities) were recorded in observation group and control group, and the oxidative stress indicators [catalase (CAT), lipids peroxide (LPO)] and nerve injury indexes [neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP)] were compared between observation group, control group and healthy group before treatment and after 2 weeks of treatment. The neurological deficit [National Institutes of Health Stroke Scale (NIHSS)] was observed in observation group and control group.@*Results@#The clinical efficacy in observation group was significantly better than that in control group (P<0.05), and the normal recovery times of fever, headache, vomiting and abnormal EEG were lower than those in control group (P<0.05). After 2 weeks of treatment, the partial oxidative stress index (serum CAT) in observation group and control group was higher than that before treatment (P<0.05) while partial oxidative stress index (serum LPO), nerve injury indexes (serum NSE, GFAP) and neurological defect (NIHSS score) were lower than those before treatment (P<0.05), and the changes in observation group were greater than those in control group (P<0.05). The serum CAT levels in the two groups before and after treatment were lower than those in healthy group (P<0.05), and the levels of LPO, NSE and GFAP were higher than those in healthy group (P<0.05).@*Conclusions@#Edaravone combined with antiviral drugs has significant treatment effects in the treatment of adult viral encephalitis. It can not only reduce the body’ s oxidative stress response, but also reduce nerve injury and improve neurological deficit, and it has a certain application value.

Application of N-methyl-aspartate receptor antibody level, brainstem auditory evoked potential and magnetic resonance imaging in the differential diagnosis of encephalitis in children / 中华实验和临床病毒学杂志

Objective@#To explore the clinical value of serum N-methyl-aspartate receptor (NMDAR) antibody level, brainstem auditory evoked potential (BAEP) and magnetic resonance imaging (MRI) in the differential diagnosis of viral encephalitis and anti-NMDAR encephalitis.@*Methods@#The clinical data of 68 children patients with encephalitis were retrospectively analyzed. The patients diagnosed with viral encephalitis were included in V group (n=52), and the patients diagnosed with anti-NMDAR encephalitis were included in N group (n=16). The clinical characteristics, serum NMDAR antibody level, and BAEP and MRI findings were compared between the two groups.@*Results@#The age, disease duration, abnormal behavior rate, sleep disorder rate and epileptic seizure rate in V group were significantly lower than those in N group [(6.62±1.20)Y/O vs.(8.46±1.85)Y/O, (3.53±0.71)d vs.(4.49±0.82)d, 30.77%(16/52)vs. 75.00%(12/16), 21.15%(11/52)vs. 62.50%(10/16), 26.92%(14/52)vs. 56.25%(9/16), t=4.681, t=4.560, χ2=9.882, χ2=7.958, χ2=4.701], while the abnormal rate of video EEG was significantly higher than that in N group [51.92(27/52)vs. 81.25%(13/16), χ2=4.345] (all P<0.05). There were no significant differences in gender, rates of prodromic infection symptoms, cognitive impairment, fever, headache, convulsion and incidence rate of meningeal irritation sign (P>0.05). The serum NMDAR antibody level in V group was significantly lower than that in N group [(3.40±0.69) ng/ml vs.(13.95±2.78) ng/ml t=25.319)] (P<0.05). There were no significant differences in the BAEP apparent involvement range and central auditory neurological damage between the two groups (P>0.05), but the peripheral auditory nerve damage and total BAEP abnormality rate in V group were significantly lower than those in N group [3.85%(4/104)vs. 21.88%(7/32), 6.73%(7/104)vs. 28.12%(9/32), 30.77%(16/52)vs. 62.50%(10/16), χ2=10.699, χ2=10.790, χ2=5.216] (all P<0.05). There were no significant differences in MRI signal intensity, lesion involvement range and total abnormal rate between the two groups (all P>0.05).@*Conclusions@#There were significant differences in serum NMDAR antibody level and BAEP test results among children patients with viral encephalitis or anti-NMDAR encephalitis, and they are helpful for early differential diagnosis.

Pathogen spectrum of viral encephalitis in children living in Hebei province, China from May to December 2017 / 中华实验和临床病毒学杂志

Objective@#To investigate the pathogenic characteristics of viral encephalitis in children living in Hebei province.@*Methods@#We randomly collected cerebrospinal fluid specimens from a total of 399 children diagnosed with viral encephalitis in Hebei Children′s Hospital from May to December 2017. Real-time fluorescence quantitative PCR and Sanger sequencing were used to detect viral nucleic acids in cerebrospinal fluid by an automatic laboratory station. Statistical analysis was performed on the experimental data using SPSS 21.0 software and the clinical data were analyzed. Comparison of infection rates of EV encephalitis in different months, using line × column chi-square test. The MRI and EEG positive rates of different viral encephalitis and viral encephalitis patients not infected with the virus were analyzed by Fisher′s exact probability test. The positive rate of infection with different viruses and non-virus agents was analyzed by Fisher′s exact probability test.@*Results@#The result showed that 80 of 399 samples were positive, and the positive rate was 20.05%. It included 22 cases of enterovirus, 4 cases of influenza A virus, 3 cases of mumps virus, 2 cases of herpes simplex virus type 1, 1 case of herpes simplex virus type 2, 4 cases of EB virus, 7 cases of cytomegalovirus, 7 cases of herpes zoster virus, 8 cases of adenovirus, 14 cases of human herpesvirus type 6. Eight cases had combined viral infection. Eight cases had concurrent infections: 3 cases had enterovirus and herpesvirus type 6 concurrent infection, 1 case had enterovirus and Japanese encephalitis virus concurrent infection and 1 case had herpes simplex virus type 2 and adenovirus, 1 case had influenza A virus herpesvirus type 6, 1 case had mumps virus and herpesvirus type 6, 1 case had mumps virus and herpesvirus type 6, 1 case had herpes simplex virus type 1 and herpes zoster virus concurrent infections. Children with EV viral encephalitis in Hebei Province were highly prevalent in May and June (P=0.016). HHV6 virus encephalitis was more susceptible to infection than non-HHV6 virus (P=0.016); The rate of MRI positive findings in patients with different viral encephalitis was not statistically significant (P>0.05). The result of EEG of different viral encephalitis were P>0.05, which was not statistically significant.@*Conclusions@#EV was the most common pathogen of children with viral encephalitis in Hebei province. Encephalitis caused by influenza A virus cannot be ignored in clinical practice.

Treatment of an adult case with Japanese encephalitis / 中华实验和临床病毒学杂志

Objective@#The features of clinical, laboratory and radiologic examinations of an adult patient with Japanese encephalitis (JE) were analyzed to understand the differences in clinical characteristics between adult and children patients, and to investigate the method of etiological tests.@*Methods@#The clinical, laboratory tests and radiographic data of an adult case with JE requiring hospitalization were analyzed retrospectively and the related literature was reviewed.@*Results@#The clinical presentation of patients with JE was nonspecific, the patient presented with fever, consciousness and cognitive impairment, convulsion and meningeal irritation. Its main test indicator is IgM antibody of Japanese encephalitis virus(JEV) in acute cerebrospinal fluid and serum specimens.Craniocerebral MRI is an important auxiliary examination for JE, the common sites involved are thalamus, basal ganglia and cerebral cortex, of which thalamus is almost 100% affected.@*Conclusions@#The clinical presentation of patients with JE was nonspecific. Clear diagnosis should be accompanied by the combination of epidemiology, laboratory tests and specific antibodies detection. Neural damages commonly occur in thalamus.

Changes of Caveolin-1, matrix metalloproteinase-9 and interleukin-1β in cerebrospinal fluid of children with bacterial meningitis or viral encephalitis / 中华实用儿科临床杂志

Objective To investigate the changes and clinical significance of Caveolin-1,matrix metalloproteinase-9 (MMP-9) and interleukin-1β (IL-1β) in cerebrospinal fluid of children with bacterial meningitis or viral encephalitis.Methods Thirty-six cases of children with bacterial meningitis,42 cases of children with viral encephalitis,and 20 cases of children with non-nervous system infection were selected from September 2016 to June 2018 at the Third Affiliated Hospital of Zhengzhou University.The levels of Caveolin-1,MMP-9 and IL-1β in cerebrospinal fluid were detected by using enzyme linked immunosorbent assay (ELISA).Results Cerebrospinal fluid Caveolin-1,MMP-9,IL-1β levels in the acute phase of bacterial meningitis were(49.06 ± 8.96) ng/L,(134.79 18.88)μg/L,(100.02 ± 14.67) μg/L,respectively,and (29.13 ± 7.25) ng/L,(18.69 ± 7.23) μg/L,(47.57 ± 8.95)pg/L in recovery phase,which were higher than those of the controls [(11.18 ± 2.24) ng/L,(11.53 ± 3.54) μg/L,(39.75 ± 7.08) μg/L)],and the differences were significant (all P ＜ 0.05).Cerebrospinal fluid Caveolin-1,MMP-9,IL-1β levels in the acute phase of viral encephalitis were (42.71 ± 10.48) ng/L,(62.78 ± 17.39) μg/L,(57.97 ± 11.28) μg/L,respectively,and (29.13 ± 7.25) ng/L,(18.69 ± 7.23) μg/L,(47.57 ± 8.95) μg/L in recovery phase,which were higher than those of controls,and the differences were significant (all P ＜ 0.05).The levels of Caveolin-1,MMP-9 and IL-1β in cerebrospinal fluid of bacterial meningitis group and viral encephalitis group were significantly higher than those of convalescent group (all P ＜ 0.05).The levels of Caveolin-1,MMP-9,IL-1β in cerebrospinal fluid of bacterial meningitis group were significantly higher than those in viral encephalitis group (all P ＜ 0.05) in the acute phase,and no significant difference was found in the recovery phase(all P ＞ 0.05).Cerebrospinal fluid Caveolin-1,MMP-9,IL-1β showed no significant difference among children with different severity of intracranial infection.Correlation analysis showed that there was a positive correlation between Caveolin-1,MMP-9 and IL-1 β levels in cerebrospinal fluid of acute in bacterial meningitis group and viral encephalitis group (Caveolin-1 and MMP-9:R2 =0.239,P ＜ 0.05;MMP-9 and IL-1β:R2 =0.766,P ＜0.01;Caveolin-1 and IL-1β:R2 =0.245,P ＜ 0.05).Conclusions Caveolin-1,MMP-9 and IL-1 β involved in the pathogenesis of intracranial infection in children,and the effects of different pathogens on intracranial infection were different.

The supervision of postencephalitic epilepsy after viral encephalitis / 中华实用儿科临床杂志

Viral encephalitis(VE),one of important causes of postencephalitic epilepsy,is the common infec-tious disease of central nervous system. Although there are many researches of the clinical features and the medical effects about VE with epilepsy,it is scarce to find relative reports about the epilepsy in the sequelae stage. VE and epi-lepsy can cause heavy economic and psychological burden to the patients themselves,their family and society,so the epidemiology,the clinical feature,the therapy,the prognosis and the current status of follow-up studies of postencepha-litic epilepsy after VE are summarized in order to provide the basis for the follow-up supervision.

Clinical characteristics of viral encephalitis & meningoencephalitis during influenza epidemic in Taiyuan city / 中国神经精神疾病杂志

Objective To investigate the epidemiology of viral encephalitis&meningoencephalitis and its clinical characteristics during influenza epidemics in Taiyuan city (between November 2017 and February 2018). Methods A total of 112 patients of viral encephalitis & meningoencephalitis from Shanxi Provincial People's Hospital between October 2016 to March 2018 were recruited. Patients were divided into influenza season (n=46)and non－influenza season (n=66). The clinical characteristics of 46 patients with viral meningititis in the influenza season (IS group) were compared with those in the control group of 66 cases in the non－influenza season (NI group). The Logistic regression analysis was used to study the difference between the clinical features of the IS group and the NI group. Results The incidence of hospitalized patients with viral meningititis was significantly higher in epidemic season than in the non－epidemic season. The regression analysis demonstrated that in the IS group the adolescents were 3.879 times older than other age groups, and the symptoms of mental disorder were 2.843 times that of the symptoms without mental disorder, and the duration less than 2 weeks was 3.001 times the duration greater than 2 weeks. Conclusion Although the incidence of hospitalization in patients with viral encephalitis&meningoencephalitis is increased during the influenza season, there is no outbreak of viral meningititis. In this influenza season, adolescents are susceptible to the viral encephalitis &meningoencephalitis and more prone to mental disorder. However, the prognosis of the disease is relatively good.