Anti-N-methyl-D-aspartate receptor encephalitis that developed after herpes encephalitis: a case report and literature review.

Herpes encephalitis (HE) is among the most common forms of viral encephalitis. Earlier publications indicate the development of acyclovir-refractory choreoathetosis in patients with HE. These reports suggest the development of secondary autoimmunity in the pathogenesis of HE. Combined methylprednisolone and acyclovir treatment reduced the appearance of brain abnormalities relative to treatment with acyclovir alone in a mouse model of encephalitis. We describe a case of a 19-month-old previously healthy girl presenting with sudden onset seizures and loss of consciousness. Initial polymerase chain reaction (PCR) tests for the presence of herpes simplex virus (HSV) were negative as were the tests for the limbic encephalitis antibodies. Steroids were administered with acyclovir to treat suspected autoimmune encephalitis as a result of the patient history of varicella vaccination. HSV PCR testing was positive on the 5th day; however, steroid treatment was continued due to the positive response seen in the patient. Steroid therapy was reduced on the 25th day of treatment due to the development of upper respiratory tract infection and the patient developed orofacial dyskinesia and choreoathetoid movements on the 28th day. Antibodies against N-methyl-d-aspartate receptor were detected in the in the serum and cerebrospinal fluid (CSF) on the 28th day. This case is an example of the emergence of autoimmune symptoms in the pathogenesis of HE.

[Investigation of immunoglobulin isotypes in patients with fasciolosis]. / Fasciolosisli hastalarda immünoglobulin tiplerinin arastirilmasi.

The relation between the duration of human fasciolosis and development of humoral immune response has not yet been clarified. This study was conducted to investigate the relation between different immunoglobulin isotypes and the period of disease in fasciolosis patients and also to evaluate the diagnostic value of immunoglobulin isotypes. The 50 patients (30 female, 20 male; age range: 18-70 years) included to the study were evaluated in 3 groups (3-6 months, 7-12 months and > 12 months) according to the duration of their signs and symptoms such as abdominal pain, fever, eosinophilia, detection of eggs in stool and radiological findings. An in-house enzyme-linked immunosorbent assay (ELISA) based on Fasciola hepatica excretory-secretory (ES) antigens was used for the determination of anti-F. hepatica specific IgG, IgM, IgA, IgE antibodies. The positivity rates were 100% for IgG, 50% for IgM, 62% for IgA and 42% for IgE. When the relation between disease period and immunoglobulin classes were evaluated, it was observed that in the 3-6 months period, patients IgM, IgA and IgE levels were; 90%, 72% and 54%, respectively; in the 7-12 months period patients IgM, IgA and IgE levels were 35%, 35% and 21%, respectively, in the > 12 months period patients IgA and IgE levels were 50% and 42%, respectively however, no positive IgM level were detected. In conclusion our data indicated that the specific IgM positivity rate was high (90%) in early stage in fasciolosis, gradually decreased (35%) and became negative in late stages of infection. However, IgA and IgE levels revealed no specific relation to the disease period. Specific IgM determination seems to be useful for the differentiation between acute and chronic period of fasciolosis. Further studies are necessary to prove the diagnostic value of specific IgA and IgE antibodies in setting of fasciolosis.