1. Increased cytokines/chemokines and hyponatremia as a possible cause of clinically mild encephalitis/encephalopathy with a reversible splenial lesion associated with acute focal bacterial nephritis.
- Author
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Okada T, Fujita Y, Imataka G, Takase N, Tada H, Sakuma H, and Takanashi JI
- Subjects
- Bacterial Infections blood, Bacterial Infections cerebrospinal fluid, Bacterial Infections immunology, Chemokines blood, Chemokines cerebrospinal fluid, Chemokines immunology, Child, Preschool, Encephalitis blood, Encephalitis cerebrospinal fluid, Encephalitis immunology, Female, Humans, Hyponatremia blood, Hyponatremia cerebrospinal fluid, Hyponatremia immunology, Male, Nephritis blood, Nephritis cerebrospinal fluid, Nephritis immunology, Bacterial Infections complications, Cytokines blood, Cytokines cerebrospinal fluid, Cytokines immunology, Encephalitis etiology, Hyponatremia complications, Nephritis complications
- Abstract
Objective: Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS), the second most common encephalopathy syndrome in Japan, is most often associated with viral infection. Bacterial MERS has been rarely reported but is mostly associated with acute focal bacterial nephritis (AFBN) for an unknown reason. We examined cytokines and chemokines in four MERS patients with AFBN to determine if they play an important role in the pathogenesis., Methods: We examined the clinical charts and MRI results in four MERS patients with AFBN, and measured 10 cytokines and chemokines in serum and cerebrospinal fluid in the acute phase. These were analyzed using the Mann-Whitney U test, compared with the control group (cases with a non-inflammatory neurological disease). Longitudinal changes in the serum cytokine and chemokine levels were evaluated in two patients., Results: Hyponatremia was observed in all four patients with MERS associated with AFBN (128-134 mEq/L). CSF analysis revealed increased cytokines/chemokines associated with Th1 (CXCL10, TNF-α, IFN-γ), T reg (IL-10), Th17 (IL-6), and neutrophil (IL-8 and CXCL1). In serum, upregulation was observed in those associated with Th1 (CXCL10, TNF-α, IFN-γ), Th17 (IL-6), and inflammasome (IL-1ß). The increased serum cytokines/chemokines in the acute stage normalized within 2 weeks in patients 1 and 2, so examined, in accordance with their clinical improvement., Conclusion: Increased cytokines/chemokines and hyponatremia may be factors that explain why AFBN is likely to cause MERS., (Copyright © 2021 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)
- Published
- 2022
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