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Hoang HE, Robinson-Papp J, Mu L, Thakur KT, Gofshteyn JS, Kim C, Ssonko V, Dugue R, Harrigan E, Glassberg B, Harmon M, Navis A, Hwang MJ, Gao K, Yan H, Jette N, Yeshokumar AK. Determining an infectious or autoimmune etiology in encephalitis. Ann Clin Transl Neurol 2022; 9:1125-1135. [PMID: 35713518 PMCID: PMC9380144 DOI: 10.1002/acn3.51608] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/09/2022] [Accepted: 06/01/2022] [Indexed: 01/21/2023] Open
Abstract
Objectives Early presentation and workup for acute infectious (IE) and autoimmune encephalitis (AE) are similar. This study aims to identify routine laboratory markers at presentation that are associated with IE or AE. Methods This was a multi‐center retrospective study at three tertiary care hospitals in New York City analyzing demographic and clinical data from patients diagnosed with definitive encephalitis based on a confirmed pathogen and/or autoantibody and established criteria for clinical syndromes. Results Three hundred and thirty‐three individuals with confirmed acute meningoencephalitis were included. An infectious‐nonbacterial (NB) pathogen was identified in 151/333 (45.40%), bacterial pathogen in 95/333 (28.50%), and autoantibody in 87/333 (26.10%). NB encephalitis was differentiated from AE by the presence of fever (NB 62.25%, AE 24.10%; p < 0.001), higher CSF white blood cell (WBC) (median 78 cells/μL, 8.00 cells/μL; p < 0.001), higher CSF protein (76.50 mg/dL, 40.90 mg/dL; p < 0.001), lower CSF glucose (58.00 mg/dL, 69.00 mg/dL; p < 0.001), lower serum WBC (7.80 cells/μL, 9.72 cells/μL; p < 0.050), higher erythrocyte sedimentation rate (19.50 mm/HR, 13.00 mm/HR; p < 0.05), higher C‐reactive protein (6.40 mg/L, 1.25 mg/L; p = 0.005), and lack of antinuclear antibody titers (>1:40; NB 11.54%, AE 32.73%; p < 0.001). CSF‐to‐serum WBC ratio was significantly higher in NB compared to AE (NB 11.3, AE 0.99; p < 0.001). From these findings, the association of presenting with fever, CSF WBC ≥50 cells/μL, and CSF protein ≥75 mg/dL was explored in ruling‐out AE. When all three criteria are present, an AE was found to be highly unlikely (sensitivity 92%, specificity 75%, negative predictive value 95%, and positive predictive value 64%). Interpretations Specific paraclinical data at initial presentation may risk stratify which patients have an IE versus AE.
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Affiliation(s)
- Hai Ethan Hoang
- Weill Cornell Medical Center and New York Presbyterian Hospital, New York, New York, USA
| | | | - Lan Mu
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Kiran T Thakur
- Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York, USA
| | | | - Carla Kim
- Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York, USA
| | - Vivian Ssonko
- Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York, USA
| | - Rachelle Dugue
- Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York, USA
| | - Eileen Harrigan
- Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York, USA
| | - Brittany Glassberg
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Michael Harmon
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Allison Navis
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Mu Ji Hwang
- Weill Cornell Medical Center and New York Presbyterian Hospital, New York, New York, USA
| | - Kerry Gao
- Weill Cornell Medical Center and New York Presbyterian Hospital, New York, New York, USA
| | - Helena Yan
- Weill Cornell Medical Center and New York Presbyterian Hospital, New York, New York, USA
| | - Nathalie Jette
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
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Chen Z, Zhang Y, Cui L, Huang H, Chen W, Su Y. Presence of Anti-Thyroid Antibodies Correlate to Worse Outcome of Anti-NMDAR Encephalitis. Front Immunol 2021; 12:725950. [PMID: 34566983 PMCID: PMC8456002 DOI: 10.3389/fimmu.2021.725950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/25/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the characteristics and prognosis of anti-NMDAR encephalitis with the prevalence of anti-thyroid antibodies (ATAbs). Methods The clinical data of anti-NMDAR encephalitis patients admitted to Xuanwu Hospital from January 2012 to August 2018 was prospectively analyzed, and the patients were followed up for 24 months. Results A total of 120 patients were enrolled, of which 34.2% (41/120) were positive for ATAbs. The antibodies were more frequent in patients with severe disease compared to the non-severe group (51.4% vs. 25.6%, P=0.008). In addition, prevalence of ATAbs correlated with a higher incidence of disturbed consciousness, autonomic dysfunction, central hypoventilation and mechanical ventilation. The ATAbs-positive patients were also more likely to receive intravenous gamma immunoglobulin and immunosuppressor compared to the ATAbs-negative cases (P=0.006; P=0.035). Although the presence of ATAbs was associated with longer hospital stays and worse prognosis at 6 months (P=0.006; P=0.038), it had no impact on long-term patient prognosis. Positive status of anti-thyroglobulin antibody was an independent risk factor for worse prognosis at 6 months [odds ratio (OR)= 3.907, 95% CI: 1.178-12.958, P=0.026]. Conclusion ATAbs are prevalent in patients with anti-NMDAR encephalitis, especially in severe cases, and correlate with poor prognosis and impaired short-term neurological recovery.
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Affiliation(s)
- Zhongyun Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Institute of Sleep and Consciousness Disorders, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Lili Cui
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Huijin Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Weibi Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yingying Su
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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