Search

Objectives: To investigate the distribution and prevalence of Japanese encephalitis virus (JEV) antibody (as evidence of past infection) in northern Victoria following the 2022 Japanese encephalitis outbreak, seeking to identify groups of people at particular risk of infection; to investigate the distribution and prevalence of antibodies to two related flaviviruses, Murray Valley encephalitis virus (MVEV) and West Nile virus Kunjin subtype (KUNV). Study design: Cross‐sectional serosurvey (part of a national JEV serosurveillance program). Setting: Three northern Victorian local public health units (Ovens Murray, Goulburn Valley, Loddon Mallee), 8 August – 1 December 2022. Participants: People opportunistically recruited at pathology collection centres and by targeted recruitment through community outreach and advertisements. People vaccinated against or who had been diagnosed with Japanese encephalitis were ineligible for participation, as were those born in countries where JEV is endemic. Main outcome measures: Seroprevalence of JEV IgG antibody, overall and by selected factors of interest (occupations, water body exposure, recreational activities and locations, exposure to animals, protective measures). Results: 813 participants were recruited (median age, 59 years [interquartile range, 42–69 years]; 496 female [61%]); 27 were JEV IgG‐seropositive (3.3%; 95% confidence interval [CI], 2.2–4.8%) (median age, 73 years [interquartile range, 63–78 years]; 13 female [48%]); none were IgM‐seropositive. JEV IgG‐seropositive participants were identified at all recruitment locations, including those without identified cases of Japanese encephalitis. The only risk factors associated with JEV IgG‐seropositivity were age (per year: prevalence odds ratio [POR], 1.07; 95% CI, 1.03–1.10) and exposure to feral pigs (POR, 21; 95% CI, 1.7–190). The seroprevalence of antibody to MVEV was 3.0% (95% CI, 1.9–4.5%; 23 of 760 participants), and of KUNV antibody 3.3% (95% CI, 2.1–4.8%; 25 of 761). Conclusions: People living in northern Victoria are vulnerable to future JEV infection, but few risk factors are consistently associated with infection. Additional prevention strategies, including expanding vaccine eligibility, may be required to protect people in this region from Japanese encephalitis. [ABSTRACT FROM AUTHOR]

Objectives: To determine the proportion of people in New South Wales towns at high risk of Japanese encephalitis virus (JEV) infections during the 2022 outbreak; to identify risk factors for JEV infection. Study design: Cross‐sectional serosurvey study of the seroprevalence of JEV‐specific antibodies in NSW. Setting, participants: Convenience sample of people (all ages) from five regional NSW towns deemed to be at high risk of JEV infections after first outbreak of Japanese encephalitis in southeastern Australia in early 2022 (Balranald, Corowa, Dubbo, Griffith, Temora), 21 June – 22 July 2022. Main outcome measures: Proportion of people seropositive for JEV total antibody, assayed by defined epitope‐blocking enzyme‐linked immunosorbent assay; prevalence odds ratios for exposure risk factors and protective behaviours. Results: Eighty of 917 eligible participants (559 girls or women, 61%; 42 Aboriginal and Torres Strait Islander people, 4.6%; median age, 52 years [IQR, 37–62 years]) were seropositive for JEV‐specific total antibody (8.7%); the median age of seropositive people was 61 years (IQR, 48–70 years). The seropositivity proportion was largest for people aged 65 years or more (30 of 192; weighted proportion, 13.7%) and larger for male than female participants (30 of 358, 10.6% v 50 of 559, 7.5%). Five of 42 samples from Aboriginal and Torres Strait Islander participants were seropositive (12%). We found mixed associations with a range of potential risk factors. Conclusion: We found evidence for a substantial number of JEV infections in five regional NSW towns during a single arbovirus season in 2022. Public health responses, including effective surveillance, vaccination against JEV, and mosquito management, are critical for controlling outbreaks. Promoting behaviours that reduce exposure to mosquitoes is a core component of prevention, particularly when the vaccine supply is limited. [ABSTRACT FROM AUTHOR]

Background Para-infectious encephalopathy is an acute inflammatory encephalopathy secondary to a systemic infectious disease, including acute necrotizing encephalopathy (ANE) and mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). This paper reports on 3 cases of SARS-CoV-2 related to para-infectious encephalopathy diagnosed and treated in The Ordos Central Hospital of Inner Mongolia Autonomous Region from December 2022 to February 2023, and reviews relevant literature to summarize the clinical characteristics of the disease. Methods and Results The 3 patients with SARS-CoV-2 related to para-infectious encephalopathy, including 2 cases of SARS-CoV-2 related to ANE and one case of SARS-CoV-2 related to MERS were reported. Three patients developed consciousness disorder 2-4 d after fever, and still had aphasia, mental abnormality, convulsions, etc.. SARS-CoV-2 throat swab was positive. Head MRI showed one abnormal signal of brain stem and bilateral thalamus, one abnormal signal of bilateral thalamus, and one abnormal pressure of corpus callosum. All received hormone shock therapy and (or) intravenous immunoglobulin. One died, and 2 cases were recovered. Conclusions SARS-CoV-2 related to para-infectious encephalopathy including SARS-CoV-2 related to ANE and MERS and other clinical subtypes, the former has rapid progress, severe disease, high disability rate and fatality rate and poor prognosis, while the latter has relatively mild symptoms and better prognosis.

Since 2017, human encephalitis caused by pseudorabies virus (PRV) has been reported in 28 cases in China. The clinical symptoms include fever, headache, seizures, focal neurological loss, disturbance of consciousness, etc.. This disease has the high disability rate and fatality rate. PRV is mainly transmitted through close contact with infected pigs or their excrement, or spread via blood-borne. Patients are mostly practitioners in the live pig industry chain. Early diagnosis and treatment are critical to the prognosis of patients. Therefore, this article reviews the progress on diagnosis and treatment of human encephalitis caused by PRV, in order to improve the clinical diagnosis and treatment of this disease.

Objective: To determine the incidence of decompensated cirrhosis and associated risk factors in people hospitalised with non‐alcoholic fatty liver disease (NAFLD) or non‐alcoholic steatohepatitis (NASH) with or without cirrhosis. Design: Retrospective cohort study; analysis of linked Queensland Hospital Admitted Patient Data Collection, Queensland Registry of Births, Deaths and Marriages, and Queensland Cancer Register data. Setting, participants: Queensland residents aged 20 years or older admitted to Queensland hospitals with NAFLD/NASH during 1 July 2009 – 31 December 2018. Main outcome measures: Progression to decompensated cirrhosis (ascites, hepatic encephalopathy, or oesophageal variceal bleeding). Results: We included data for 8006 patients in our analysis (10 082 admissions), including 4632 women (58%) and 2514 people with diabetes mellitus (31%); median follow‐up time was 4.6 years (interquartile range, 2.7–7.2 years). Three hundred and fifty‐one people (4.4%) experienced decompensated cirrhosis during the follow‐up period. Of the 6900 people without cirrhosis, 4.5% (95% confidence interval [CI], 3.6–5.7%) experienced decompensated cirrhosis within ten years (mean, 0.5% per year; 95% CI, 0.4–0.6% per year); risk of progression was greater for people aged 70 years or older (v 20–39 years: adjusted hazard ratio [aHR], 4.7; 95% CI, 2.0–11.0) and those who had extrahepatic cancers (aHR, 5.0; 95% CI, 3.0–8.2), history of major cardiovascular events (aHR, 1.9; 95% CI, 1.2–3.1), or diabetes mellitus (aHR, 2.8; 95% CI, 2.0–3.9). Of the 1106 people with cirrhosis, 32.4% (95% CI, 27.2–38.3%) experienced decompensated cirrhosis within ten years (mean, 5.5% per year; 95% CI, 4.8–6.3% per year); risk of progression was greater for those with portal hypertension (aHR, 1.8; 95% CI, 1.3–2.7), extrahepatic cancer (aHR, 1.8; 95% CI, 1.1–2.9), or diabetes mellitus (aHR, 1.5; 95% CI, 1.1–2.0). Compared with people who had neither cirrhosis nor diabetes mellitus, the risk of decompensation was greater for people with cirrhosis (aHR, 10.7; 95% CI, 7.6–15.0) or cirrhosis and diabetes mellitus (aHR, 14.4; 95% CI, 10.1–20.6). Conclusions: Given the greater risk of progression to cirrhosis decompensation in people with diabetes mellitus, a disorder common in people with NAFLD/NASH, identifying advanced fibrosis and providing appropriate treatment for averting disease progression is vital. [ABSTRACT FROM AUTHOR]

Not just a disease of children In endemic regions where most people are first exposed to JEV at a young age, Japanese encephalitis is largely a disease of childhood. Keywords: Encephalitis, viral; Arbovirus infections; Vaccination; Central nervous system infections EN Encephalitis, viral Arbovirus infections Vaccination Central nervous system infections 344 347 4 05/03/23 20230501 NES 230501 A structured diagnostic approach is required when assessing for JEV in patients with encephalitis The Japanese encephalitis virus (JEV) has been a long-standing public health concern in Asia, where it is the most common cause of viral encephalitis in many countries. A prospective assessment of the accuracy of commercial IgM ELISAs in diagnosis of Japanese encephalitis virus infections in patients with suspected central nervous system infections in Laos. [Extracted from the article]

Objective To investigate the clinical features of neonates with enterovirus encephalitis, and to prevent the outbreak of enterovirus infection by improving the early identification of this disease. Methods A total of 12 neonates with enterovirus encephalitis who were admitted to our hospital from June 2019 to June 2022 were enrolled and analyzed in terms of clinical features and laboratory examination. The key points of treatment were summarized, and their prognosis was assessed. ResultsAmong the 12 neonates, 7 were preterm infants, with the clinical manifestations of nonspecific sepsis-like symptoms and normal or mildly elevated inflammatory markers. All neonates tested positive for enterovirus nucleic acid in cerebrospinal fluid. All neonates were given standard isolation, intravenous injection of human immunoglobulin, and symptomatic supportive treatment and achieved a good prognosis after treatment. Conclusion Neonates with enterovirus encephalitis often have atypical clinical manifestations and thus require early identification and targeted strategies for the prevention and control of infection.

Japanese encephalitis virus (JEV) is a mosquito-borne flavivirus that causes encephalitis in humans. In 2021, an outbreak of JEV genotype IV occurred in pigs in eastern Australia, leading to 44 cases of human disease. The emergence of this genotype raised questions about the origin and incidence of JEV in Australia. Two studies conducted in New South Wales and Victoria found evidence of past exposure to JEV in a small but significant proportion of people tested. The studies did not identify specific risk factors for exposure to the virus. Accurate serological studies are challenging due to cross-reactivity with other flaviviruses, but the findings of these studies suggest that the 2022 JEV outbreak was more extensive than initially thought. [Extracted from the article]

Background: Influenza-Associated Encephalopathy/Encephalitis (IAE) is characterized by high incidence and poor prognosis. The aim of this study is to describe the clinical features and outcomes of IAE in pediatric patients., Methods: We performed a retrospective review of hospitalized cases of laboratory-confirmed influenza infection between January 2018 and December 2021. Demographic, clinical, imaging, treatment and outcome data were collected. Statistical analysis was performed using SPSS software., Results: Of 446 children hospitalized with influenza, 71 cases were identified with a diagnosis of IAE. The median age was 3 years and 46 (64.8 %) were younger than 5 years. Only one patient was vaccinated for seasonal influenza. 46 (64.8 %) patients had abnormal electroencephalogram examination and 47 (66.2 %) had abnormal brain MRI or CT findings. 68 (95.8 %) patients were treated with oseltamivir/peramivir. 12 (16.9 %) patients suffered mortality. Non-survivors were more likely to have lower Glasgow coma score (median 7), longer duration of fever (median 3 days), with underlying medical conditions (P = 0.006), and complications including sepsis (P = 0.003), shock (P < 0.001), respiratory failure (P = 0.006), acute renal failure (P = 0.001), myocardial damage (P < 0.001), coagulation disorders (P = 0.03), electrolyte disturbance (P = 0.001) and hyperlactacidemia (P = 0.003). Non-survivors had higher percentages of corticosteroids (P = 0.003) and immunoglobulin (P = 0.003) treatments compared to survivors., Conclusions: Children with IAE have a high mortality rate. Lower Glasgow coma score, longer duration of fever, with underlying medical conditions and complications pose a great risk to poor prognosis. Influenza vaccination is recommended to all eligible children., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose Intravenous immunoglobulin (IVIg) is considered as a first-line therapy for autoimmune encephalitis. However, its effectiveness in viral encephalitis has yet to be evaluated. Therefore, we investigated the effectiveness of IVIg therapy for pediatric viral encephalitis. Methods We retrospectively reviewed the records of 35 pediatric patients who were hospitalized with confirmed or suspected viral encephalitis. Twenty patients (57.1%) were treated with IVIg in conjunction with conventional therapy (IVIg-treated group), and 15 patients (42.9%) were treated with conventional therapy (non-IVIg-treated group). We compared the clinical characteristics of the groups at admission and their clinical outcomes. Results Compared to the non-IVIg-treated group, the IVIg-treated group had more critical clinical features at admission, with a lower score on the pediatric Glasgow Coma Scale (mean±standard deviation, 9.1±2.3 vs. 10.8±2.7, P=0.025), longer fever duration (3.5±2.2 days vs. 1.8±1.1 days, P=0.022), and higher incidence of magnetic resonance imaging abnormalities (14/19 [73.7%] vs. 3/15 [20.0%], P=0.002). Nevertheless, the clinical outcomes of the IVIg-treated group were comparable to those of the non-IVIg-treated group in terms of mortality rate (1/20 [5.0%] vs. 0/15 [0%]), neurological deficits at discharge (2/20 [10.0%] vs. 1/15 [6.7%]), and occurrence of epilepsy (5/20 [25.0%] vs. 2/15 [13.3%]). Fourteen (70.0%) and 13 (85.7%) patients in the IVIg-treated and the non-IVIg-treated groups, respectively, achieved complete recovery without any neurological complications. Conclusion IVIg may be considered as a potential immunomodulating agent when treating critical pediatric viral encephalitis to improve neuropsychological outcomes.

Objective To evaluate the value of next⁃generation sequencing (NGS) of cerebrospinal fluid (CSF) in the diagnosis of human herpesvirus encephalitis/meningitis. Methods The clinical features, laboratory and imaging findings of 5 patients with highly suspected human herpesvirus encephalitis/ meningitis from January to September 2018 were retrospectively analyzed, and then the etiological sources were comprehensively analyzed combined with the results of NGS. Results All of the 5 patients had an acute onset, fever, headache and neck ankylosis. The CSF tests revealed a slight increased level of white blood cell count (74-260)×106/L. Among them, a total of 4-5406 nucleic acid sequences of human herpesvirus, including human herpesvirus typeⅠ(n=1), human herpesvirus typeⅢ(n=3) and human herpesvirus typeⅣ(n = 1) were detected by NGS, with the coverage varing from 0.08% to 81.01%. Conclusions NGS of CSF can assist the diagnosis of human herpesvirus encephalitis/meningitis, as well as viruses accurate classification, which is worth popularizing and applying in clinic. DOI：10.3969/j.issn.1672⁃6731.2020.07.014

Objectives: To investigate the immunopathogenic mechanisms of anti-N-methyl-D-aspartate receptor encephalitis (NMDAR-E) by characterizing the changes of immune cells in both peripheral blood (PB) and cerebrospinal fluid (CSF) of patients with NMDAR-E., Methods: Cytology and flow cytometry were used to explore and compare different immunological parameters in PB and CSF of patients with NMDAR-E, viral encephalitis (VE) and healthy volunteers. Moreover, different models were established to assess the possibility of identifying NMDAR-E patients based on PB and CSF parameters., Results: The neutrophil counts and monocyte-to-lymphocyte ratios (MLR) in PB are higher in NMDAR-E patients than in both VEs and controls (P < 0.001, respectively), while the percentages of CD3 + T, CD4 + T lymphocytes, and the leukocytes count in CSF were lower in NMDAR-Es than in VEs (P < 0.01, respectively). The higher percentages of CD8 + T cells in blood and CSF were both correlated with more severe NMDAR-E (P < 0.05, respectively). The poor neurological status group had significantly higher PB leukocytes but lower CSF leukocyte count (P < 0.05). Longitudinal observations in patients with NMDAR-E showed a decreasing trend of leukocyte count, neutrophils count, neutrophil-to-monocyte ratios (NMR), and neutrophil-to-lymphocyte ratios (NLR) with the gradual recovery of neurological function., Conclusions: The expression patterns of T lymphocyte subsets were different in patients with NMDAR-E and viral encephalitis. The changing trends of leukocyte and lymphocyte populations in peripheral blood and cerebrospinal fluid may provide clues for the diagnosis of different types of encephalitides, including NMDARE, and can be used as immunological markers to assess and predict the prognosis., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Increased cerebrospinal fluid (CSF) β2-microglobulin (β2-MG) values are attributed to immune activation, lymphoid cell turnover and release of tissue destruction in the central nervous system (CNS). We investigated plasma and CSF β2-MG levels in adult patients with viral encephalitis/meningitis and their correlations with clinical parameters., Method: CSF samples from 26 patients with viral encephalitis/meningitis were collected. Moreover, 24 CSF samples from patients with non-inflammatory neurological disorders (NIND) as controls were collected. Plasma samples from 22 enrolled patients and 20 healthy individuals were collected. The β2-MG levels were measured by immunoturbidimetry on an automatic biochemical analyzer. Clinical data were extracted from an electronic patient documentation system., Result: CSF levels of β2-MG, adenosine deaminase (ADA), white blood cell (WBC), lactate dehydrogenase (LDH), protein and lactate were significantly increased in patients with viral encephalitis/meningitis respectively (p < 0.001, p < 0.001, p < 0.001, p = 0.001, p < 0.001, p = 0.013). In contrast, no statistically significant difference was found in plasma levels of β2-MG. Furthermore, CSF levels of β2-MG were weakly correlated with WBC (r = 0.426, p = 0.030), lymphocyte percentage (r = 0.599, p = 0.018), ADA (r = 0.545, p = 0.004) and LDH (r = 0.414, p = 0.036), but not with lactate (r = 0.381, p = 0.055), protein (r = 0.179, p = 0.381) and plasma levels of β2-MG (r = -0.156, p = 0.537) in viral encephalitis/meningitis patients., Conclusion: CSF β2-MG may be a potential inflammatory marker for viral encephalitis/meningitis in adult patients diagnosed with viral encephalitis/meningitis., Competing Interests: Declarations of Competing Interest The authors have no competing interests to declare that are relevant to the content of this article., (Copyright © 2024. Published by Elsevier Inc.)

Objectives: one of the neurological side effects of SARS-CoV-2 vaccinations is immune encephalitis. This review aims at summarising previous and current findings on the frequency, clinical presentation, diagnosis, treatment, and outcome of SARS-CoV-2 vaccination-associated encephalitis (SC2VIE)., Methods: narrative review of eligible articles meeting defined search criteria and published between January 2021 and January 2024., Results: A total of 21 patients with SC2VIE reported in 18 articles were included. The AstraZeneca vaccine (ChAdOx1) was the trigger in 10 cases, the Biontech Pfizer vaccine (BNT162b2) in 8 cases, and the Moderna (mRNA1273), CoronaVac, and Sinopharm vaccine (BBIBP-CorV) in one case each. The ages ranged from 21 to 82 years. Twelve patients were female. SC2VIE developed after the first dose in eight patients, after the second in six patients, and in two after the third dose. The latency between vaccination and onset of clinical manifestations ranged from 1 to 56d. Eighteen patients received steroids, one patient intravenous immunoglobulins, one patient plasmapheresis, and two patients rituximab. Complete recovery was achieved in nine patients and incomplete recovery in ten., Conclusions: SC2VIE is not an uncommon complication of SARS-CoV-2 vaccinations. The clinical presentation and treatment of SC2VIE do not differ from those of autoimmune encephalitis of other causes. Since SC2VIE can manifest only as a psychiatric disease, patients with post-SARS-CoV-2 vaccination psychosis should be evaluated for SC2VIA. The outcome of SC2VIE depends largely on the severity of the immune response and comorbidities., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Viral meningitis/encephalitis (ME) is a rare but potentially harmful disease. The prompt identification of the respective virus is important to guide not only treatment but also potential public health countermeasures. However, in about 40% of cases, no virus is identified despite an extensive diagnostic workup. The aim of the present study was to analyze demographic, seasonal, and routine cerebrospinal fluid (CSF) parameters in cases of viral ME and assess their utility for the prediction of the causative virus., Methods: Demographic data, season, and routine CSF parameters (total leucocytes, CSF cell differentiation, age-adjusted CSF/serum albumin ratio, and total immunoglobulin ratios) were retrospectively assessed in cases of viral ME., Results: In total, 156 cases of acute viral ME (74 female, median age 40.0 years) were treated at a tertiary-care hospital in Germany. Specific viral infections were detected in 93 (59.6%) cases. Of these, 14 (9.0%) cases were caused by herpes simplex virus (HSV), 36 (23.1%) by varicella-zoster virus (VZV), 27 (17.3%) by enteroviruses, 9 (5.8%) by West Nile virus (WNV), and 7 (4.5%) by other specific viruses. Additionally, 64 (41.0%) cases of ME of unknown viral etiology were diagnosed. Cases of WNV ME were older, predominantly male, showed a severe disruption of the blood-CSF-barrier, a high proportion of neutrophils in CSF, and an intrathecal total immunoglobulin M synthesis in the first CSF sample. In a multinominal logistic regression analysis, the accuracy of these CSF parameters together with age and seasonality was best for the prediction of WNV (87.5%), followed by unknown viral etiology (66.7%), VZV (61.8%), and enteroviruses (51.9%)., Conclusions: Cases with WNV ME showed a specific pattern of routine CSF parameters and demographic data that allowed for their identification with good accuracy. These findings might help to guide the diagnostic workup in cases with viral ME, in particular allowing the timely identification of cases with ME due to WNV.

Tick-borne encephalitis is a vaccine-preventable disease of concern for public health in large parts of Europe, with EU notification rates increasing since 2018. It is caused by the orthoflavivirus tick-borne encephalitis virus (TBEV) and a diagnosis of infection is mainly based on serology due to its short viremic phase, often before symptom onset. The interpretation of TBEV serology is hampered by a history of orthoflavivirus vaccination and by previous infections with related orthoflaviviruses. Here, we sought to improve TBEV sero-diagnostics using an antigen combination of in-house expressed NS1 and EDIII in a multiplex, low-specimen-volume set-up for the detection of immune responses to TBEV and other clinically important orthoflaviviruses (i.e., West Nile virus, dengue virus, Japanese encephalitis virus, Usutu virus and Zika virus). We show that the combined use of NS1 and EDIII results in both a specific and sensitive test for the detection of TBEV IgG for patient diagnostics, vaccination responses and in seroprevalence studies. This novel approach potentially allows for a low volume-based, simultaneous analysis of IgG responses to a range of orthoflaviviruses with overlapping geographic circulations and clinical manifestations.

Tick-borne encephalitis was limited to northeast portions of Italy. We report in Lombardy, a populous region in the northwest, a chamois displaying clinical signs of tickborne encephalitis virus that had multiple virus-positive ticks attached, as well as a symptomatic man. Further, we show serologic evidence of viral circulation in the area.

Objective To evaluate the role of three-dimensional arterial spin labeling (3D-ASL) in the diagnosis of viral encephalitis. Methods MRI [T1WI, T2WI, diffusion-weighted imaging (DWI) and 3D-ASL] was performed in 41 patients with clinically diagnosed viral encephalitis, including 28 cases in acute phase and subacute phase with duration < 10 d and 13 cases in late subacute phase and chronic phase with duration ≥ 10 d. The positive outcomes of each MRI sequence for each patient were accounted and compared. The cerebral blood flow (CBF) and apparent diffusion coefficient (ADC) images were extracted from 3D-ASL imaging and regions of interest (ROIs) were selected. CBF and ADC values between ipsilateral side and contralateral side, between normal brain regions of ipsilateral side and contralateral side were compared respectively. Results Among 41 cases, 28 (68.29% ) showed abnormalities: T1WI hypointense signal in 3 cases, T2WI hyperintense signal in 8 cases, DWI hyperintense signal in 14 patients, 3D-ASL hyperperfusion in 27 cases and hypoperfusion in one case. The positive rates for 3D-ASL [68.29% (28/41)] were significantly higher than that of T1WI [7.32% (3/41); χ2 = 32.416, P = 0.000], T2WI [19.51% (8/41); χ2 = 19.807, P = 0.000] and DWI [34.15% (14/41); χ2 = 9.567, P = 0.004] respectively. CBF value of ipsilateral side in acute phase and subacute phase (< 10 d) was significantly higher than that of contralateral side [(83.61 ± 7.19) ml/(min·100 g) vs. (63.32 ± 4.83) ml/(min·100 g); t = 2.690, P = 0.012], while there was no significant difference in ADC value (P > 0.05). There was no significant difference for both CBF and ADC values in late subacute phase and chronic phase (≥ 10 d) between ipsilateral side and contralateral side (P > 0.05, for all). There was no significant difference for both CBF and ADC values between normal brain regions of ipsilateral side and contralateral side (P > 0.05, for all). Conclusions The main manifestation of viral encephalitis in 3D-ASL imaging was hyperperfusion in the early stage. 3D-ASL is superior to conventional MRI sequences in detection of encephalitis lesion and may contribute to the diagnosis of early viral encephalitis in clinical practice. DOI: 10.3969/j.issn.1672-6731.2018.03.006

Purpose: Intravenous immunoglobulin (IVIg) is considered as a first-line therapy for autoimmune encephalitis. However, its effectiveness in viral encephalitis has yet to be evaluated. Therefore, we investigated the effectiveness of IVIg therapy for pediatric viral encephalitis. Methods: We retrospectively reviewed the records of 35 pediatric patients who were hospitalized with confirmed or suspected viral encephalitis. Twenty patients (57.1%) were treated with IVIg in conjunction with conventional therapy (IVIg-treated group), and 15 patients (42.9%) were treated with conventional therapy (non-IVIg-treated group). We compared the clinical characteristics of the groups at admission and their clinical outcomes. Results: Compared to the non-IVIg-treated group, the IVIg-treated group had more critical clinical features at admission, with a lower score on the pediatric Glasgow Coma Scale (mean±standard deviation, 9.1±2.3 vs. 10.8±2.7, P=0.025), longer fever duration (3.5±2.2 days vs. 1.8±1.1 days, P=0.022), and higher incidence of magnetic resonance imaging abnormalities (14/19 [73.7%] vs. 3/15 [20.0%], P=0.002). Nevertheless, the clinical outcomes of the IVIg-treated group were comparable to those of the non-IVIg-treated group in terms of mortality rate (1/20 [5.0%] vs. 0/15 [0%]), neurological deficits at discharge (2/20 [10.0%] vs. 1/15 [6.7%]), and occurrence of epilepsy (5/20 [25.0%] vs. 2/15 [13.3%]). Fourteen (70.0%) and 13 (85.7%) patients in the IVIg-treated and the non-IVIg-treated groups, respectively, achieved complete recovery without any neurological complications. Conclusion: IVIg may be considered as a potential immunomodulating agent when treating critical pediatric viral encephalitis to improve neuropsychological outcomes. [ABSTRACT FROM AUTHOR]

Cytomegalovirus (CMV) is one of the opportunistic microorganisms with the highest prevalence in immunocompromised patients. Reactivation has decreased after the introduction of highly active antiretroviral therapy (HAART). Encephalitis has been reported in the coinfection as one of the most frequent presentations. We present the case of a young adult patient with HIV infection and rapid neurological deterioration due to classic clinical symptoms and signs of the Wernicke-Korsakoff syndrome, with no risk factors for thiamine deficiency, with images by nuclear magnetic resonance typical of the syndrome, and identification of cytomegalovirus in cerebrospinal fluid. The specific treatment for CMV managed to control the symptoms with neurological sequelae in progression towards improvement. This is one of the few cases reported in the literature of Wernicke syndrome secondary to cytomegalovirus encephalitis.

This represents the first detections of MVEV in south-east Australia in the 2022-2023 mosquito season, the first surveillance detections in Victoria since 2011, and the first confirmed human case in Victoria since 1974. Keywords: Arbovirus infections; Virology; Zoonoses; Encephalitis, viral; Public health; Surveillance EN Arbovirus infections Virology Zoonoses Encephalitis, viral Public health Surveillance 40 41 2 06/30/23 20230701 NES 230701 Competing interests No relevant disclosures. [Extracted from the article]

Japanese encephalitis virus (JEV) belongs to the Flaviviridae family and is a representative mosquito-borne flavivirus responsible for acute encephalitis and meningitis in humans. Despite the availability of vaccines, JEV remains a major public health threat with the potential to spread globally. According to the World Health Organization (WHO), there are an estimated 69,000 cases of JE each year, and this figure is probably an underestimate. The majority of JE victims are children in endemic areas, and almost half of the surviving patients have motor or cognitive sequelae. Thus, the absence of a clinically approved drug for the treatment of JE defines an urgent medical need. Recently, several promising and potential drug candidates were reported through drug repurposing studies, high-throughput drug library screening, and de novo design. This review focuses on the historical aspects of JEV, the biology of JEV replication, targets for therapeutic strategies, a target product profile, and drug development initiatives.

Background: Adenovirus is a major pathogen causing febrile illness among children. It may also cause acute encephalitis/encephalopathy. This study aimed to elucidate the clinical features of adenovirus-associated encephalitis/encephalopathy (AdVE) among children in Japan., Methods: A nationwide survey of children with AdVE was conducted. An initial survey was distributed among pediatricians to obtain information about children with AdVE treated between January 2014 and March 2019. A second survey was used to obtain the clinical information of children with AdVE from hospitals that responded to the initial survey and those identified from a literature search of the reported cases. We collected demographic data and information about symptoms of infection, neurological symptoms, laboratory parameters, treatment, and outcomes. Outcomes were determined using the Pediatric Cerebral Performance Category Score., Results: Clinical information was available for 23 children with a median age of 39 months. Two had preexisting neurological disorders and six had a history of febrile seizures. The outcome was good in 15 patients and poor in eight patients. Serum lactate dehydrogenase, glucose, and ammonia levels were higher among children with a poor outcome compared to those with a good outcome. Clinically mild encephalitis/encephalopathy with a reversible splenial lesion was the most common type (n = 8), followed by acute encephalopathy with biphasic seizures and late reduced diffusion (n = 7)., Conclusion: A prior history of febrile seizures was frequent in children with AdVE. Several different subtypes of acute encephalopathy were seen in children with AdVE, and the outcome was poor in those with acute encephalopathy with biphasic seizures and late reduced diffusion and hemorrhagic shock and encephalopathy syndrome. Elevated lactate dehydrogenase, glucose, and ammonia levels on admission were found to correlate with a poor outcome., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)

Japanese encephalitis virus is a mosquito-borne member of the Flaviviridae family. JEV is the leading cause of viral encephalitis in Asia and is characterized by encephalitis, high lethality, and neurological sequelae in survivors. The virus also causes severe disease in swine, which are an amplifying host in the transmission cycle, and in horses. US agricultural authorities have recently recognized the threat to the swine industry and initiated preparedness activities. Other mosquito-borne viruses exotic to the Western Hemisphere have been introduced and established in recent years, including West Nile, Zika, and chikungunya viruses, and JEV has recently invaded continental Australia for the first time. These events amply illustrate the potential threat of JEV to US health security. Susceptible indigenous mosquito vectors, birds, feral and domestic pigs, and possibly bats, constitute the receptive ecological ingredients for the spread of JEV in the US. Fortunately, unlike the other virus invaders mentioned above, an inactivated whole virus JE vaccine (IXIARO ® ) has been approved by the US Food and Drug Administration for human use in advance of a public health emergency, but there is no veterinary vaccine. This paper describes the risks and potential consequences of the introduction of JEV into the US, the need to integrate planning for such an event in public health policy, and the requirement for additional countermeasures, including antiviral drugs and an improved single dose vaccine that elicits durable immunity in both humans and livestock.

Autosomal recessive tyrosine kinase 2 (TYK2) deficiency is characterized by susceptibility to mycobacterial and viral infections. Here, we report a 4-year-old female with severe respiratory viral infections, EBV-driven Burkitt-like lymphoma, and infection with the neurotropic Jamestown Canyon virus. A novel, homozygous c.745C > T (p.R249*) variant was found in TYK2. The deleterious effects of the TYK2 lesion were confirmed by immunoblotting; by evaluating functional responses to IFN-α/β, IL-10, and IL-23; and by assessing its scaffolding effect on the cell surface expression of cytokine receptor subunits. The effects of the mutation could not be pharmacologically circumvented in vitro, suggesting that alternative modalities, such as hematopoietic stem cell transplantation or gene therapy, may be needed. We characterize the first patient from Canada with a novel homozygous mutation in TYK2., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Meningitis and encephalitis are medical emergencies. Patients need prompt evaluation and immediate empiric therapy to reduce the likelihood of fatal outcomes and chronic neurological sequelae. Conjugate bacterial vaccines have significantly reduced the incidence of bacterial meningitis, especially in children. As the results of changes in patterns of bacterial drug sensitivity, ceftriaxone is now part of the recommended empiric treatment for bacterial meningitis and should be administered as early as possible. Neuroimaging delays the treatment of meningitis and is not needed in most cases. Adjunctive corticosteroid therapy is of benefit for many patients with meningitis and should be initiated in most adults before antibiotic therapy. Molecular testing can assist the specific diagnosis of encephalitis and should be based on the exposure history and geographic risk factors relevant to the patient, but non-infectious causes of encephalitis are also common. Empiric therapy for encephalitis should be directed at the most frequently identified infectious pathogen, herpes simplex virus type 1 (ie, intravenous aciclovir). Vaccines can protect against the major pathogens of childhood infections (measles, mumps, rubella, polio, varicella viruses), influenza viruses, and exotic pathogens that cause meningitis and encephalitis (rabies, Japanese encephalitis, dengue, yellow fever, tick-borne encephalitis viruses, Mycobacterium tuberculosis). [ABSTRACT FROM AUTHOR]