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Background La Crosse virus (LACV) is the most common neuroinvasive arboviral infection in children in the United States. However, data regarding predictors of disease severity and neurologic outcome are limited. Additionally, long-term neurologic and neurobehavioral outcomes remain relatively sparse. Methods This was a single-center, retrospective cohort study, followed by recruitment for a cross-sectional analysis of long-term neurobehavioral outcomes, among children aged 0–18 years with proven or probable LACV neuroinvasive disease (LACV-ND) between January 2009 and December 2018. Case ascertainment was assured by International Classification of Diseases , Ninth and Tenth Revision , Clinical Modification codes cross-referenced with laboratory results detecting LACV. Demographics, diagnostics, radiographs, and outcomes were evaluated. Recruitment of patients with prior diagnosis of LACV-ND occurred from January 2020 to March 2020, with assessment performed by validated pediatric questionnaires. Results One-hundred fifty-two children (83 males; median age, 8 years [interquartile range, 5–11.5 years]) were diagnosed with proven (n = 61 [47%]) and probable (n = 91 [60%]) LACV-ND. Sixty-five patients (43%) had severe disease. Altered mental status (AMS) (odds ratio [OR], 6.36 [95% confidence interval {CI}, 2.03–19.95]; P =.0002) and seizures at presentation (OR, 10.31 [95% CI, 3.45–30.86]; P =.0001) were independent predictors of severe disease. Epileptiform discharges on electroencephalogram (EEG) were independently associated with epilepsy diagnosis at follow-up (OR, 13.45 [95% CI, 1.4–128.77]; P =.024). Fifty-four patients were recruited for long-term neurobehavioral follow-up, with frequent abnormal assessments identified (19%–54%) irrespective of disease severity. Conclusions Severe disease was observed frequently among children with LACV-ND. Seizures and AMS at presentation were independent predictors of severe disease. EEG may help determine long-term epilepsy risk. Long-term neurobehavioral issues are frequent and likely underrecognized among children with LACV-ND. [ABSTRACT FROM AUTHOR]

An editorial is presented on Japanese encephalitis disease causing the outbreak being a JEV genotype IV (GIV) virus. Topics include South-East Asia associated with endemic transmission and sporadic cases of encephalitis, mainly in children; and limited distribution raising several questions about ecology, pathology and neuro-invasiveness, as well as its origin.

Background: Japanese encephalitis is an arthropod-borne zoonotic flavivirus infection endemic to tropical and subtropical Asia. A minority of infections leads to a symptomatic course, but affected patients often develop life-threatening encephalitis with severe sequelae. Literature review: Myelitis with flaccid paralysis is a rare complication of Japanese Encephalitis, which—according to our literature search—was reported in 27 cases, some of which were published as case reports and others as case series. Overall, there is a broad clinical spectrum with typically asymmetric manifestation and partly severe motor sequelae and partly mild courses. Lower limb paralysis appears to be more frequent than upper limb paralysis. An encephalitic component is not apparent in all cases Case presentation: We herein add the case of a 29 year-old female who developed encephalitis and myelitis with flaccid paralysis during a long-time stay in Indonesia. Diagnostic workup in Indonesia did not clearly reveal an underlying cause. Upon clinical stabilization, the patient was evacuated to her home country Germany, where further diagnostics confirmed Japanese encephalitis virus as the causative agent. The patient has partly recovered, but still suffers from residual paralysis of the upper limb. Conclusion: Flaccid paralysis is a rare, and likely underdiagnosed complication of Japanese encephalitis, which, to the best of our knowledge, has never been diagnosed outside endemic areas before. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment is one of the primary sequelae affecting the quality of life of patients with Japanese encephalitis (JE). The clinical treatment is mainly focused on life support, lacking of targeted treatment strategy.Methods: A cerebrospinal fluid (CSF) proteomic profiling study was performed including 26 patients with JE in Gansu province of China from June 2017 to October 2018 and 33 other concurrent hospitalized patients who were excluded central nervous system (CNS) organic or CNS infection diseases. The clinical and proteomics data of patients with JE were undergoing combined analysis for the first time.Results: Two subtypes of JE associated with significantly different prognoses were identified. Compared to JE1, the JE2 subtype is associated with lower overall survival rate and a higher risk of cognitive impairment. The percentages of neutrophils (N%), lymphocyte (L%), and monocytes (M%) decreased in JE2 significantly.Conclusions: The differences in proteomic landscape between JE subgroups have specificity for the prognosis of cognitive impairment. The data also provided some potential target proteins for treatment of cognitive impairments caused by JE. Trial registration ChiCTR, ChiCTR2000030499. Registered 1st June 2017, http://www.medresman.org.cn/pub/cn/proj/projectshow.aspx?proj=6333. [ABSTRACT FROM AUTHOR]

Guillain‐Barré syndrome (GBS) is the commonest post‐infectious inflammatory peripheral neuropathy with undiscerned aetiology. The commonly reported antecedent infections implicated in India include Campylobacter jejuni, chikungunya, dengue, and Japanese encephalitis (JE). In this study from south India, we investigated the role of these four agents in triggering GBS. This case‐control study was performed on 150 treatment‐naive patients with GBS and 150 age and sex‐matched controls from the same community. IgM immunoreactivity for C. jejuni, chikungunya, and dengue was detected by enzyme‐linked immunosorbent assay (ELISA) in serum of patients with GBS and control subjects. Immunoreactivity against JE was detected in serum as well as cerebrospinal fluid (CSF) from patients (n = 150) and orthopaedic control (n = 45) subjects. The immunoreactivity against infections was compared between demyelinating and axonal subtypes of GBS. Overall, 119/150 patients with GBS had serological evidence of antecedent infection. Amongst those with evidence of antecedent infection, 24 (16%), 8 (5%), and 9 (6%) patients were exclusively immunoreactive to chikungunya, JE, and C. jejuni, respectively. In the remaining patients (78/119), immunoreactivity to multiple pathogens was noted. Immunoreactivity to C. jejuni infection was found in 32% of GBS patients compared to 2.7% controls (P <.001), whereas to chikungunya virus was reported in 66.7% of patients with GBS compared to 44.7% controls (P =.006). Anti‐dengue immunoreactivity was significantly associated with the demyelinating subtype of GBS. Patients positive for JE IgM (CSF) manifested demyelinating electrophysiology. In this large case‐control study, immunoreactivity against multiple infectious agents was observed in a subset of patients. Chikungunya was the commonest antecedent infection, followed by C. jejuni. [ABSTRACT FROM AUTHOR]

Vaccination against Japanese encephalitis is recommended for long-term travelers to endemic areas; however, the recommendation for pregnant women is controversial. An infant was diagnosed with Japanese encephalitis whose mother moved to an endemic area while pregnant. Preventive strategies are discussed. An infant was diagnosed with Japanese encephalitis whose mother travelled to endemic area while pregnant. As preventive strategies, we suggest vaccination of mother before or during pregnancy before the travel, or application of physical barriers before the child's vaccination. [ABSTRACT FROM AUTHOR]

Introduction: Tick-borne encephalitis (TBE) reflects an increasing burden and can affect public health policy. Vaccination could be the most effective option to reduce the disease burden, this review can support national recommendations for TBE vaccination in Slovenia.Areas Covered: This burden is relatively high in Slovenia and can be estimated by using an incidence-based disability-adjusted life years (DALYs) methodology. Notably, DALYs have been estimated for Slovenia in various studies. The present study summarizes the main differences and conclusions between two studies that dealt with the calculation of DALYs for TBE in Slovenia. The databases of PubMed and Embase were used to get information about publications that dealt with the TBE burden, using an incidence-based DALYs methodology, in Slovenia.Expert Opinion: Permanent sequelae contribute the most to the total burden in DALYs. Increasing vaccination in all ages and age groups can be the most effective and efficient strategy to reduce the burden of TBE and protect the whole population health. [ABSTRACT FROM AUTHOR]

The article discusses the case of a patient diagnosed with Powasan virus encephalitis. Topics discussed include the patient's clinical presentation of fever, headache and progressive encephalopathy, differential diagnosis which include bacterial, fungal and arthropod-borne virus infections, and the results of laboratory tests, computed tomography and magnetic resonance imaging (MRI) of the head. Also discussed are the characteristics of Powassan flavivirus and the treatment of the patient.

We report the case of an eight-year-old boy who presented with an acute encephalitis and was confirmed to have Japanese encephalitis (JE). In addition, we found the vesicular stage of neurocysticercosis (NCC). The co-occurrence of JE and NCC was thought to be synergistic as there is some evidence that in presence of NCC, the neuroinvasiveness and virulence of JE is greater and associated with poor outcome. [ABSTRACT FROM AUTHOR]

The article reports on the declaration by the government in Australia of a Communicable Disease Incident of National Significance in response to its first, locally acquired Japanese encephalitis cases.

Background: Uncontrolled inflammatory response of the central nervous system is a hallmark of severe Japanese encephalitis (JE). Although inflammation is necessary to mount an efficient immune response against virus infections, exacerbated inflammatory response is often detrimental. In this context, cells of the monocytic lineage appear to be important forces driving JE pathogenesis.Main Body: Brain-infiltrating monocytes, macrophages and microglia play a major role in central nervous system (CNS) inflammation during JE. Moreover, the role of inflammatory monocytes in viral neuroinvasion during JE and mechanisms of cell entry into the CNS remains unclear. The identification of cellular and molecular actors in JE inflammatory responses may help to understand the mechanisms behind excessive inflammation and to develop therapeutics to treat JE patients. This review addresses the current knowledge about mechanisms of virus neuroinvasion, neuroinflammation and therapeutics critical for JE outcome.Conclusion: Understanding the regulation of inflammation in JE is challenging. Elucidation of the remaining open questions will help to the development of therapeutic approaches avoiding detrimental inflammatory responses in JE. [ABSTRACT FROM AUTHOR]

Background: Information on tick-borne encephalitis (TBE) in patients already vaccinated against the disease is limited.Objectives: To compare the course and outcome in patients with vaccination breakthrough TBE with findings in patients who developed TBE without previous vaccination.Methods: All adult patients diagnosed with TBE at a single medical centre during a 16-year period and who had received at least two doses of TBE vaccine before the onset of illness qualified for the study. For each patient with breakthrough TBE, two unvaccinated sex- and age-matched patients, diagnosed with TBE in the same year, were included for comparison.Results: Amongst 2332 patients diagnosed with TBE in the period 2000-2015, 39 (1.7%) had been vaccinated against the disease. Their median age was 59 (20-83) years; 22 of 39 (56.4%) were male. In comparison with unvaccinated patients with TBE, those with breakthrough disease more often experienced a monophasic course of illness (P = 0.006), had a higher CSF leucocyte count (P = 0.005), more often had urine retention (P = 0.012), more often needed ICU treatment (P = 0.009), were hospitalized for longer (P = 0.002) and had more severe acute illness (P = 0.004 for simple clinical assessment, P = 0.001 for severity score).Conclusion: In addition to several findings corroborating previous results in patients with vaccination breakthrough TBE, such as older age and the presence of a particular specific serum antibody pattern indicating anamnestic response, findings in this study indicate that the acute illness in patients with breakthrough TBE is more severe than in unvaccinated sex- and age-matched patients who develop the disease. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was the evaluation of frequency and origin of hyponatremia in tick borne encephalitis (TBE) in comparison to non-TBE viral meningitis and bacterial meningitis.Methods: A total of 124 patients aged 18-80 years, with TBE were included to the study. The mild form of TBE was diagnosed in 59 patients, while the severe form was diagnosed in 65 patients. The first control group (VMG) consisted of 72 patients with viral meningitis, but excluded TBE. The second control group (BMG) consisted of 16 patients diagnosed with bacterial meningitis.Results: Hyponatremia was diagnosed in 55 (44.4%) patients with TBE. In 12 (9.7%) patients (mean age 56.6 ± 19.9 years; 9 men, 3 women) syndrome of inappropriate secretion of antidiuretic hormone (SIADH) was diagnosed. In VMG hyponatremia was diagnosed in 7 (9.7%) patients. In the age group <35 years and in the age group of 50-64 years the frequency of hyponatremia and SIADH was higher in TBE than in VMG (p < 0.05). In BMG hyponatremia was diagnosed in 6 (37.5%) patients. No statistically significant differences in frequency of hyponatremia between BMG and TBE groups were observed.Conclusions: (1) Hyponatremia is a common disorder in TBE and is more frequent than in other viral types of meningitis, especially in young patients (< 35 years). (2) The most common cause of hyponatremia in TBE patients is dehydration and fluid supplementation should be a treatment of choice. (3) Overall, 16.9% of the patients with the severe form of TBE develop SIADH syndrome and they required treatment based on fluid restriction and hypertonic saline infusion. [ABSTRACT FROM AUTHOR]

The article explores the outbreak of Japanese encephalitis virus and yellow fever virus, which are both mosquito-borne flaviviruses circulating in disjunct geographic areas with different mosquito vectors. It cites cases of yellow fever in Angola which was processed for high-throughput RNA sequencing, and evidence on the risk of circulation of the flaviviruses in Africa. Also illustrated is the phylogenetic trees of genomic sequences for Japanese encephalitis virus and yellow fever virus.

The article discusses the apraxia of eyelid closure, central nervous system disorder. Topics include an overview of the disorder in which the author explains the nature of the disorder which include the inability of the person to close the eyes and sustain at will and highlights the diseases related to the disorder such as, Creutzfeldt-Jakob disease, supranuclear palsy, and Huntington's disease. Also presented is the case of a 25-year old lady who is diagnosed with the disorder after a coma.

Vector-borne diseases cause a significant burden on healthcare facilities. An increasing number of cases reported with multiple co-infections only add to the ordeal. The presence of co-infection may modify clinical and laboratory parameters significantly making diagnosis and treatment a challenge. Cases of malaria and dengue with other infections such as chikungunya, leptospirosis and hepatitis have been reported previously. We report a case of acute febrile illness with altered sensorium which was eventually diagnosed to have quadruple infection with malaria, dengue, chikungunya and Japanese encephalitis. This may be the first case with four concurrent vector-borne infections, all of which are transmitted by mosquitoes. [ABSTRACT FROM AUTHOR]

Unlabelled: The case of an 11-year-old child with acute myopericarditis associated with central European tick-borne encephalitis is presented. Cardiac involvement was demonstrated by pericardial effusion, elevated serum concentration of troponin-I and cardiac arrhythmia. Co-infections with enteroviruses, Borrelia burgdorferi or the agent of human granulocytic ehrlichiosis were excluded. Recovery was uneventful.Conclusion: Central European tick-borne encephalitis can be complicated by cardiac involvement. [ABSTRACT FROM AUTHOR]

The article focuses on the protection of children against Japanese encephalitis in Bali, Indonesia. Topics discussed include an overview of Japanese encephalitis, its diagnosis, the presence of the disease, its prevalence and transmission, the significance of its vaccination programme, and the community-based mass campaign for the programme.

Two cases of catatonic stupor are described due to presumed encephalitis lethargica. Catatonic and obsessional phenomena in the setting of a depressive psychosis associated with a movement disorder may constitute a post-encephalitic syndrome. [ABSTRACT FROM AUTHOR]

Background: Melioidosis is endemic in Southeast Asia and northern Australia. Infection usually follows percutaneous inoculation or inhalation or ingestion of the causative bacterium, Burkholderia pseudomallei, which is present in soil and surface water in endemic regions. Japanese encephalitis (JE) is a vector-borne viral zoonosis caused by Japanese encephalitis virus (JEV), leading to epidemic encephalitis in Southeast Asia. Both B. pseudomallei and JEV have spread dominantly in the Hainan and Guangdong provinces in China. Here we reported the first case of co-infection of B. pseudomallei and JEV, which was discovered in Huizhou in the Guangdong province in June 2016.Case Presentation: A 52-year-old man was admitted to the hospital with acute febrile illness and headache, diagnosed as respiratory infection, central nervous system (CNS) infection, septicemia, and hepatic dysfunction. Based on B. pseudomallei-positive blood and cerebrospinal fluid (CSF) cultures, the patient was diagnosed with melioidosis and treated aggressively with antibiotics. However, the patient failed to make a full recovery. Further laboratory tests focused on CNS infection were conducted. The co-infection of B. pseudomallei and JEV was confirmed after the positive IgM antibodies of JEV were detected in both CSF and blood. After diagnosis of co-infection with B. pseudomallei and JEV, the patient was provided supportive care in hospital and recovered after approximately 3 weeks.Conclusion: Given the possibility of co-infection of B. pseudomallei and JEV, as well as variable case presentations, it is critical to enhance the awareness, detection, and treatment of co-infection in regard to melioidosis. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study of postencephalitic Parkinson syndrome. Topics discussed include the indications of the parkinsonian syndrome including typical lesions of encephalitis, hemorrhages and areas of degeneration, three major and several minor symptoms including rigidity, loss of automatic and associated movements and changes in secretions and four classification of the parkinsonian syndrome.