Validation of the Clinical Assessment Scale in Autoimmune Encephalitis in Chinese Patients.

Background and Objectives: The Clinical Assessment Scale in Autoimmune Encephalitis (CASE) is a scale for assessing severity in autoimmune encephalitis. We aimed to validate the CASE score in a Chinese population and evaluate its clinical significance. Methods: Patients diagnosed with autoimmune encephalitis were recruited between June 2014 and May 2019 from two hospitals. CASE and modified Rankin Scale (mRS) scores were obtained. Data regarding clinical features, treatment, and available information were gathered from the hospital information system. Results: Of the 176 patients with autoimmune encephalitis, 11 died and 14 had tumors. Ten patients received second-line treatment. The CASE scores of patients receiving second-line treatment were significantly higher (median CASE: 15) than in those receiving first-line treatment (median CASE: 8) (p<0.001). Twenty-two patients had poor functional status (mRS>2). Areas under the curve of CASE on whether functional status was poor at 1 year were 0.89 (p<0.001). Sixty patients were admitted to the intensive care unit (ICU), and the CASE scores were positively correlated with days in the ICU (r=0.58, p<0.001). There was no statistically significant association between the CASE scores and relapse (p=0.39>0.05). Additionally, the CASE scores were positively associated with the mRS scores (r=0.85 p<0.001). Conclusions: The CASE score is suitable for the comprehensive assessment of Chinese patients with autoimmune encephalitis, which may help clinicians to select the appropriate intervention and estimate the disease severity and prognosis.

[Trends on the epidemics of acute meningitis and encephalitis among population under 18 years-old in Shijiazhuang city, 2007-2017].

Objective: To understand the trends on the epidemics of acute meningitis and encephalitis (AME) among children under 18 years-old in Shijiazhuang city, 2007-2017. Methods: Surveillance programs on acute meningitis and encephalitis (AMES) had been conducted in population less than 18 years-old, since 2007. Hospitals at county level or above in Shijiazhuang had been included to carry out the epidemiologic surveillance, including 6 on pathogens, regarding AMES. Qualitative description was performed to describe the epidemiologic patterns and pathogenic spectrums. Annual percent change (APC) was used to demonstrate the secular trends of AME. Results: In 2007-2017, 11 222 locally developed AME cases that younger than 18 years-old, were reported in Shijiazhuang, with the annual average incidence rate as 108.62/100 000 (1 021/939 974) and APC as 4.81%(95%CI: 3.90%-5.93%)(t=23.01, P<0.001). Age-specific incidence appeared the highest among 4-5 years-old (242.96 cases per 100 000 children per year). Significant differences were found among children of other aged years except aged 0- years (aged 1- years t=20.21, P=0.004; aged 2- years t=19.41, P=0.006; aged 3- years t=23.50, P<0.001; aged 4- years t=31.76, P<0.001; aged 5- years t=18.53, P=0.008; aged 10-17 years t=12.82, P=0.023). The ratio of male to female was 1.46 ∶ 1 (6 652/4 570). The ratio of urban to rural cases was 0.28 ∶ 1 (2 456/8 766). A total of 57.73% (6 478/11 222) of the cases were seen between June and September. The overall positive rate of pathogens was 20.07% (658/3 123) among these patients. The top five pathogens appeared as Enterovirus (44.68%, 264/658), Cryptococcus neoformans (9.12%, 60/658), Japanese encephalitis virus (8.66%, 57/658), Streptococcus pneumoniae (6.99%, 47/658) and Varicella-zoster virus (6.69%, 44/658). Conclusions: AME seriously harms the health of population under 18 years-old in Shijiazhuang city, with aged 3- years, aged 4- years in particular. Continued improvement on surveillance and expanded immunization are important to AME prevention and control.

Association of Interleukin 10 Gene Polymorphisms with Autoimmune Thyroid Disease: Meta-Analysis.

The aim of this study was to perform a meta-analysis of eligible studies and to derive a precise estimate of the association between interleukin 10 (IL10) polymorphisms and susceptibility to autoimmune thyroid disease (AITD). Meta-analyses were conducted on the associations between AITD and the -1082 G/A (rs1800896), -819 C/T (rs1800871) and -592 C/A (rs1800872) polymorphisms in IL10, and the haplotype of these polymorphisms and AITD. A total of 2903 AITD patients and 3060 controls in 10 eligible studies were included in the meta-analysis. This meta-analysis showed significant associations between IL10 at the -1082 G allele and overall AITD (OR: 1.44, 95% CI 1.13-1.82, P = 0.003), but no association between the IL10 -592 C allele and the -819 C allele and AITD. Subgroup studies demonstrated significant associations between the -1082 G allele and susceptibility to Graves' disease. Ethnicity-specific meta-analysis revealed significant associations between the -1082 G allele and AITD susceptibility in Asian populations; however, in Middle Eastern populations, no association was evident. Meta-analysis of the IL10 haplotype revealed an association between the ATA haplotype and AITD (OR: 1.17, 95% CI 1.00-1.36, P = 0.04). Meta-analysis demonstrates that the IL10 polymorphisms are associated with susceptibility to AITD.

Antibodies to neural and non-neural autoantigens in Japanese patients with CNS demyelinating disorders.

Anti-aquaporin 4 (AQP4) antibodies (Abs) are essential in neuromyelitis optica spectrum disorders (NMOSD), but the relationship between CNS demyelinating disorders (CNSDD) and other neural Abs remains unclear. Here we screened anti-neural Abs in the sera of 70 Japanese CNSDD patients. While two had only demyelinating events among three anti-N-methyl-d-aspartate receptor (NMDAR) Ab-positive subjects, the other subject who also had anti-AQP4 Abs experienced episodes of anti-NMDAR encephalitis and of NMOSD. Major lesions in the three anti-contactin-associated protein 2 Ab-positive subjects were infratentorial, including one co-carrying anti-AQP4 Abs. Thus, autoantibodies can be clinically silent, but multiple autoantibodies may participate in the pathogenesis.

Encephalitis-associated hospitalizations among American Indians and Alaska Natives.

Encephalitis produces considerable morbidity in the United States, but morbidity rates among American Indian/Alaska Native (AI/AN) people have not been described. Hospitalization records listing an encephalitis diagnosis were analyzed by using Indian Health Service direct/contract inpatient data. For 1998-2010, there were 436 encephalitis-associated hospitalizations among AI/AN people, an average annual age-adjusted hospitalization rate of 3.1/100,000 population. The rate for infants (11.9) was more than double that for any other age group. Death occurred for 4.1% of hospitalizations. Consistent with reports for the general U.S. population, the rate was high among infants and most (53.9%) hospitalizations were of unexplained etiology. The average annual rate during the study period appeared lower than for the general U.S. population, due particularly to lower rates in the elderly. Future community-based surveillance and mortality studies are needed to confirm these findings and examine reasons underlying the low rates of encephalitis in AI/AN people.