1
|
Tiwari P, Ali SA, Puri B, Kumar A, Datusalia AK. Tinospora cordifolia Miers enhances the immune response in mice immunized with JEV-vaccine: A network pharmacology and experimental approach. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 119:154976. [PMID: 37573808 DOI: 10.1016/j.phymed.2023.154976] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/09/2023] [Accepted: 07/15/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Tinospora cordifolia Miers. (TC) (Giloya/Guduchi) is a native Indian herb, reported for its wide array of medicinal activities including immunomodulatory activity. However, the exact pharmacological mechanism of TC as an immunomodulatory agent remains unclear. Central to this, to the best of our knowledge, no study has explored the immunoadjuvant potential of TC in response to the Japanese encephalitis (JE) vaccines. PURPOSE The study aims to explore the immunoadjuvant potential of TC ethanolic extract in response to the JE vaccine and illustrates its potential mechanism of immunomodulation using an integrated approach of network pharmacology and in-vivo experimental study. STUDY DESIGN AND METHODS Initially, the extract was prepared and the components of TC were identified through high-resolution liquid chromatography mass spectrometry (HR-LC/MS). The compounds were then screened for network pharmacology analysis. Next, the drug and disease targets were identified and the network was constructed using Cytoscape 3.7.2 to obtain different signalling pathways of TC in JEV. We then evaluated the immunoadjuvant potential of TC ethanolic extract in mice immunized with inactivated JE vaccine (SA-14-14-2 strain). BALB/c mice were supplemented with TC extract (30 and 100 mg/kg, i.g.), daily for 56 days, marked with immunization on 28th day of the study, by JE vaccine. Blood was collected for flow cytometry and haematological analysis (total and differential cell counts). The surface expression of immune-cell markers (CD3+, CD4+, CD19+, CD11c+, CD40+) were evaluated on day 0 (pre-immunization), day 14 and 28 post-immunization. Additionally, inflammatory cytokines (IFN-γ+/IL-17A+) were evaluated post-14 and 28 days of immunization. RESULTS The HR-LC/MS analysis identified the presence of glycosides, terpenoids, steroids and alkaloids in the TC extract. Through network analysis, 09 components and 166 targets were obtained, including pathways that involve toll-like receptor signalling, pattern-recognition receptor signalling, cytokine receptor and cytokine mediated signalling, etc. The in-vivo results showed that preconditioning with TC ethanolic extract significantly elevated the haematological variables (leucocyte count) as well as the surface expression of CD markers (B and T cell subsets) on day 0 (pre-immunization), day 14 and 28 post-immunization. Furthermore, preconditioning of TC demonstrated a dose-dependant augmentation of immune cells (CD3+, CD4+, CD19+, CD11c+) and inflammatory cytokines (IFN-γ+/IL-17A+) on day 14 and 28 post-immunization when compared to vaccine alone group. CONCLUSION Results showed that preconditioning with TC extract before immunization might play a potential role in enhancing the cell-mediated as well as humoral immunity. Altogether, the combinatorial approach of network pharmacology and in-vivo animal experimentation demonstrated the immunoadjuvant potential of TC in response to JEV vaccine.
Collapse
Affiliation(s)
- Priyanka Tiwari
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research-(NIPER)-Raebareli, Lucknow 226002, India
| | - Syed Afroz Ali
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research-(NIPER)-Raebareli, Lucknow 226002, India
| | - Bhupendra Puri
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research-(NIPER)-Raebareli, Lucknow 226002, India
| | - Anoop Kumar
- Department of Pharmacology, Delhi Pharmaceutical Sciences and Research University, New Delhi 110017, India
| | - Ashok Kumar Datusalia
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research-(NIPER)-Raebareli, Lucknow 226002, India; Department of Regulatory Toxicology, National Institute of Pharmaceutical Education and Research-(NIPER)-Raebareli, Lucknow 226002, India.
| |
Collapse
|
2
|
Suma R, Netravathi M, Gururaj G, Thomas PT, Singh B, Solomon T, Desai A, Vasanthapuram R, Banandur PS. Profile of Acute Encephalitis Syndrome Patients from South India. J Glob Infect Dis 2023; 15:156-165. [PMID: 38292694 PMCID: PMC10824229 DOI: 10.4103/jgid.jgid_19_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/18/2023] [Accepted: 08/23/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Encephalitis is a major public health problem worldwide that causes huge emotional and economic loss to humanity. Encephalitis, being a serious illness, affects people of all ages. The aim is to describe the sociodemographic, clinical, etiological, and neuroimaging profile among 101 acute encephalitis syndrome (AES) patients visiting a tertiary neuro-specialty care hospital in India. Methods Record review of medical records of all patients attending neurology emergency and outpatient services at NIMHANS Hospital, diagnosed with AES in 2019, was conducted. Data were collected using standardized data collection forms for all cases in the study. Descriptive analyses (mean and standard deviation for continuous variables and proportions for categorical variables) were conducted. The Chi-square test/Fisher's exact test was used for the comparison of independent groups for categorical variables, and t-test for comparing means for continuous variables. Results About 42.6% of AES patients had viral etiology, while in 57.4%, etiology was not ascertained. Common presenting symptoms were fever (96%), altered sensorium (64.4%), seizures (70.3%), headache (42.6%), and vomiting (27.7%). Herpes simplex was the most common (21.8%) identified viral encephalitis, followed by chikungunya (5%), arboviruses (chikungunya and dengue) (4%), Japanese encephalitis (4%), rabies (3%), dengue (1%), and varicella virus (1%). About 40% of AES patients showed cerebrospinal fluid pleocytosis (44%), increased protein (39.6%), abnormal computed tomography brain (44.6%), and magnetic resonance imaging abnormalities (41.6%). Conclusion The study highlights the need to ascertain etiology and importance of evidence-based management of AES patients. A better understanding of opportunities and limitations in the management and implementation of standard laboratory and diagnostic algorithms can favor better diagnosis and management of AES.
Collapse
Affiliation(s)
- Rache Suma
- Department of Epidemiology NIMHANS, Bengaluru, Karnataka, India
| | - M. Netravathi
- Department of Neurology NIMHANS, Bengaluru, Karnataka, India
| | | | | | - Bhagteshwar Singh
- Clinical Research Fellow, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Tom Solomon
- Health Protection Research Unit in Emerging and Zoonotic Infections, National Institute of Health Research, University of Liverpool, Liverpool, UK
- The Walton Centre, Liverpool, UK
| | - Anita Desai
- Department of Neurovirology NIMHANS, Bengaluru, Karnataka, India
| | | | | |
Collapse
|
3
|
Money KM, Chauhan L, Piquet AL, Tyler KL, Pastula DM. An Overview of Japanese Encephalitis. Neurohospitalist 2023; 13:328-330. [PMID: 37441216 PMCID: PMC10334049 DOI: 10.1177/19418744231164810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Affiliation(s)
- Kelli M. Money
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Lakshmi Chauhan
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Amanda L. Piquet
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Kenneth L. Tyler
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, School of Medicine, University of Colorado, Aurora, CO, USA
- Department of Immunology-Microbiology, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Daniel M. Pastula
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, School of Medicine, University of Colorado, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| |
Collapse
|
4
|
Wang X, He A, Zhang C, Wang Y, An J, Zhang Y, Hu W. Japanese encephalitis transmission trends in Gansu, China: A time series predictive model based on spatial dispersion. One Health 2023; 16:100554. [PMID: 37363262 PMCID: PMC10288096 DOI: 10.1016/j.onehlt.2023.100554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 06/28/2023] Open
Abstract
Objective This study serves to ascertain trends of space and time for Japanese encephalitis (JE) transmission at the township-level and develop an innovative time series predictive model to predict the geographical spread of JE in Gansu Province, China. Methods We collected weekly data on JE from 2005 to 2019 at the township-level. Kriging interpolation maps were used to visualize the trend of the epidemic spread of JE, and linear regression models were used to calculate the monthly changes in minimum longitude and maximum latitude of emerging towns with JE to assess the speed of the epidemic's spread to the northwest. Additionally, we utilized a time series Seasonal Autoregressive Integrated Moving Average (SARIMA) model to dynamically predict the ongoing weekly number of JE emerging townships. Results The Kriging difference map revealed a significant trend of JE spread towards the northwest. Our regression model indicated that the rate of decrease in minimum longitude was approximately 0.64 km per month, while the rate of increase in maximum latitude was approximately 1.00 km per month. Furthermore, the SARIMA pattern (2,0,0)(2,0,1)52 exhibited a better goodness-of-fit for predicting JE transmission, with an overall agreement of 93.27% to 94.23%. Conclusion Our study highlights the expansion of JE cases towards the northwest of Gansu, indicating the need for ongoing surveillance and control efforts. The use of the SARIMA model provides a valuable tool for predicting the trend of JE spatial dispersion, thereby improving early warning systems. Our findings suggest that the number of emerging townships can be used to predict the trend of JE spatial dispersion, providing crucial insights for future research on JE incidence.
Collapse
Affiliation(s)
- Xuxia Wang
- Gansu Center for Disease Control and Prevention, Lanzhou, Gansu, China
| | - Aiwei He
- Gansu Center for Disease Control and Prevention, Lanzhou, Gansu, China
| | - Chunfang Zhang
- Gansu Center for Disease Control and Prevention, Lanzhou, Gansu, China
| | - Yongsheng Wang
- Evidence-Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Jing An
- Gansu Center for Disease Control and Prevention, Lanzhou, Gansu, China
| | - Yu Zhang
- Gansu Center for Disease Control and Prevention, Lanzhou, Gansu, China
- Chinese Center for Disease Control and Prevention, Changping, Beijing, China
| | - Wenbiao Hu
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| |
Collapse
|
5
|
Frank JC, Song BH, Lee YM. Mice as an Animal Model for Japanese Encephalitis Virus Research: Mouse Susceptibility, Infection Route, and Viral Pathogenesis. Pathogens 2023; 12:pathogens12050715. [PMID: 37242385 DOI: 10.3390/pathogens12050715] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Japanese encephalitis virus (JEV), a zoonotic flavivirus, is principally transmitted by hematophagous mosquitoes, continually between susceptible animals and incidentally from those animals to humans. For almost a century since its discovery, JEV was geographically confined to the Asia-Pacific region with recurrent sizable outbreaks involving wildlife, livestock, and people. However, over the past decade, it has been detected for the first time in Europe (Italy) and Africa (Angola) but has yet to cause any recognizable outbreaks in humans. JEV infection leads to a broad spectrum of clinical outcomes, ranging from asymptomatic conditions to self-limiting febrile illnesses to life-threatening neurological complications, particularly Japanese encephalitis (JE). No clinically proven antiviral drugs are available to treat the development and progression of JE. There are, however, several live and killed vaccines that have been commercialized to prevent the infection and transmission of JEV, yet this virus remains the main cause of acute encephalitis syndrome with high morbidity and mortality among children in the endemic regions. Therefore, significant research efforts have been directed toward understanding the neuropathogenesis of JE to facilitate the development of effective treatments for the disease. Thus far, multiple laboratory animal models have been established for the study of JEV infection. In this review, we focus on mice, the most extensively used animal model for JEV research, and summarize the major findings on mouse susceptibility, infection route, and viral pathogenesis reported in the past and present, and discuss some unanswered key questions for future studies.
Collapse
Affiliation(s)
- Jordan C Frank
- Department of Animal, Dairy, and Veterinary Sciences, College of Agriculture and Applied Sciences, Utah State University, Logan, UT 84322, USA
| | - Byung-Hak Song
- Department of Animal, Dairy, and Veterinary Sciences, College of Agriculture and Applied Sciences, Utah State University, Logan, UT 84322, USA
| | - Young-Min Lee
- Department of Animal, Dairy, and Veterinary Sciences, College of Agriculture and Applied Sciences, Utah State University, Logan, UT 84322, USA
| |
Collapse
|
6
|
Kamath SD, Jha B, Ahmed T, Sarkar N. A Profile Study of Japanese Encephalitis in an Industrial Hospital in Eastern India. Cureus 2023; 15:e38455. [PMID: 37273339 PMCID: PMC10238288 DOI: 10.7759/cureus.38455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Introduction Japanese encephalitis (JE), caused by a Flavivirus, is one of the common causes of mosquito-borne encephalitis the world over including India. The disease is endemic in many states of India, including Jharkhand. Mortality ranges from 30 to 40% in different studies and a large number of patients survive with permanent neuropsychiatric sequelae. Aim The study aimed to evaluate the clinical spectrum, laboratory (including radiological) features and outcomes of cases of JE admitted in our hospital. Methods and materials This is a retrospective observational study consisting of confirmed cases of JE admitted to the medical wards and critical care unit of Tata Main Hospital (TMH) from January to December 2022. The case records of patients were retrieved from Hospital Management System (HMS) and analysed for demographic characteristics, clinical presentations and treatment details along with outcome measures, which included length of stay (LOS), complications, and mortality. Observation Of the 14 confirmed cases, six (43.9%) were males and eight (57.1%) were females. The average age of male and female patients was 41.8 ± 23.1 and 35.1 ± 20.5 years respectively. A total of 35.7% of the patients were in the age group of 21 to 30 years. The clinical manifestations in the decreasing frequency were altered sensorium in 11 (78.6%) patients, headache in six (42.8%) patients, generalised convulsions in four (28.6%) cases, vomiting in three (21.4%) cases and weakness in all limbs and of the right half of the body in one (7.1%) case each. Objective neurological findings noted were neck stiffness (3, 21.4%), cog-wheel rigidity (3, 21.4%), tremors (2, 14.3%), delirium (2,14.3%), quadriparesis, facio-brachial dystonia and hemiparesis (1, 7.14%) patient each. Neutrophilic leucocytosis was observed in five (35.7%) patients and mild thrombocytopenia in two (14.3%) patients. The average C-reactive protein (CRP) level was 7.3 ± 6.6 mg/dL. Three (21.4%) patients had mild transaminitis. Cerebrospinal fluid analysis was abnormal in all patients with varying degrees of elevated protein and cell count, while adenosine deaminase (ADA) levels and sugar were normal in all patients. Magnetic resonance imaging (MRI) brain revealed bilateral thalamic T2 FLAIR (fluid-attenuated inversion recovery) hyperintensities in 11 patients (78.6%). The average length of hospital stay was 9.6 ± 4.7 days. Ten patients (71.4%) needed treatment in the critical care unit. Complications seen were acute respiratory distress syndrome (2, 14.3%), sepsis with multiorgan failure (2, 14.3%) and ventilator-associated pneumonia (1, 7.1%). The case fatality rate was one (7.1%). Six patients (42.9%) had residual neuropsychiatric sequelae. Conclusion JE continues to be a major health-related problem. Most cases are concentrated during the post-monsoon period, coinciding with a higher vector density. Patients from rural backgrounds were seen to be more susceptible. JE may present with varying severities of acute encephalitic syndrome. As there is no specific treatment, timely diagnosis is important to reduce the morbidity and mortality associated with this disease. Clinicians must be aware of the wide spectrum of presentation of this disease. A high degree of suspicion along with thorough clinical examination and appropriate investigations are needed to diagnose this condition early and prevent complications.
Collapse
Affiliation(s)
| | - Bijaya Jha
- General Medicine, Tata Main Hospital, Jamshedpur, IND
| | - Tauheed Ahmed
- Internal Medicine, Tata Main Hospital, Jamshedpur, IND
| | | |
Collapse
|
7
|
Li D, Zhang X, Shi T, Jin N, Zhao X, Meng L, Liu Y, Zheng H, Zhao X, Li J, Shen X, Ren X. A comparison of clinical manifestations of Japanese encephalitis between children and adults in Gansu Province, Northwest China (2005-2020). Acta Trop 2022; 231:106449. [PMID: 35395230 DOI: 10.1016/j.actatropica.2022.106449] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/20/2022]
Abstract
Japanese encephalitis (JE), a mosquito-borne zoonotic disease, has emerged as a major public health concern around the world. Previous research has shown that JE has serious sequelae, and the recent shift in the population from children to adults presents a significant challenge for JE treatment and prevention. Therefore, we examined the differences in clinical manifestations (clinical symptoms, clinical signs, complications, and clinical typing) of JE between children and adults over the 15 years in Gansu Province to provide a theoretical basis for better response to JE treatment. Clinical typing was found to be statistically significant in the child versus adult groups and the groups with or without vaccination. Only the dysfunction of consciousness differed statistically between children with and without vaccination, whereas neurological symptoms such as vomiting (jet vomiting), irritability, drowsiness, convulsions, and hyperspasmia differed statistically between children and adults, and the rest of the symptoms did not differ statistically. Only pupil size changes were statistically different in clinical signs between the children with and without vaccination, while blood pressure changes, change in pupil size, positive meningeal stimulation signs, and positive pathological reflexes (increased muscle tone and Babinski's sign) were statistically different between adults and children. Bronchopneumonia was the most common complication, especially in adults. Therefore, the authors believe that children and adults differ in some clinical manifestations and propose that efforts should be directed toward developing individualized treatment plans for different age groups and employing more effective supportive treatment for various populations. In addition, we suggest expanding the coverage of the JE vaccine and increasing overall vaccination rates and adopting multiple measures in conjunction with JE prevention and control.
Collapse
Affiliation(s)
- Donghua Li
- School of Public Health, Lanzhou University, Chengguan District, Lanzhou, Gansu 730000, China
| | - Xiaoshu Zhang
- Gansu Provincial Center for Disease Control and Prevention, Chengguan District, Lanzhou, Gansu 733000, China
| | - Tianshan Shi
- School of Public Health, Lanzhou University, Chengguan District, Lanzhou, Gansu 730000, China
| | - Na Jin
- Gansu Provincial Center for Disease Control and Prevention, Chengguan District, Lanzhou, Gansu 733000, China
| | - Xiangkai Zhao
- School of Public Health, Lanzhou University, Chengguan District, Lanzhou, Gansu 730000, China
| | - Lei Meng
- Gansu Provincial Center for Disease Control and Prevention, Chengguan District, Lanzhou, Gansu 733000, China
| | - Yanchen Liu
- School of Public Health, Lanzhou University, Chengguan District, Lanzhou, Gansu 730000, China
| | - Hongmiao Zheng
- School of Public Health, Lanzhou University, Chengguan District, Lanzhou, Gansu 730000, China
| | - Xin Zhao
- School of Public Health, Lanzhou University, Chengguan District, Lanzhou, Gansu 730000, China
| | - Juansheng Li
- School of Public Health, Lanzhou University, Chengguan District, Lanzhou, Gansu 730000, China
| | - Xiping Shen
- School of Public Health, Lanzhou University, Chengguan District, Lanzhou, Gansu 730000, China
| | - Xiaowei Ren
- School of Public Health, Lanzhou University, Chengguan District, Lanzhou, Gansu 730000, China.
| |
Collapse
|
8
|
Estimates of Japanese Encephalitis mortality and morbidity: A systematic review and modeling analysis. PLoS Negl Trop Dis 2022; 16:e0010361. [PMID: 35613183 PMCID: PMC9173604 DOI: 10.1371/journal.pntd.0010361] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 06/07/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background Japanese Encephalitis (JE) is known for its high case fatality ratio (CFR) and long-term neurological sequelae. Over the years, efforts in JE treatment and control might change the JE fatality risk. However, previous estimates were from 10 years ago, using data from cases in the 10 years before this. Estimating JE disease severity is challenging because data come from countries with different JE surveillance systems, diagnostic methods, and study designs. Without precise and timely JE disease severity estimates, there is continued uncertainty about the JE disease burden and the effect of JE vaccination. Methodology We performed a systematic review to collate age-stratified JE fatality and morbidity data. We used a stepwise model selection with BIC as the selection criteria to identify JE CFR drivers. We used stacked regression, to predict country-specific JE CFR from 1961 to 2030. JE morbidity estimates were grouped from similar study designs to estimate the proportion of JE survivors with long-term neurological sequelae. Principal findings We included 82 and 50 peer-reviewed journal articles published as of March 06 2021 for JE fatality and morbidity with 22 articles in both analyses. Results suggested overall JE CFR estimates of 26% (95% CI 22, 30) in 1961–1979, 20% (95% CI 17, 24) in 1980–1999, 14% (95% CI 11, 17) in 2000–2018, and 14% (95% CI 11, 17) in 2019–2030. Holding other variables constant, we found that JE fatality risk decreased over time (OR: 0.965; 95% CI: 0.947–0.983). Younger JE cases had a slightly higher JE fatality risk (OR: 1.012; 95% CI: 1.003–1.021). The odds of JE fatality in countries with JE vaccination is 0.802 (90% CI: 0.653–0.994; 95% CI: 0.62–1.033) times lower than the odds in countries without JE vaccination. Ten percentage increase in the percentage of rural population to the total population was associated with 15.35% (95% CI: 7.71, 22.57) decrease in JE fatality odds. Ten percentage increase in population growth rate is associated with 3.71% (90% CI: 0.23, 7.18; 95% CI: -0.4, 8.15) increase in JE fatality odds. Adjusting for the effect of year, rural population percent, age of JE cases, and population growth rate, we estimated that there was a higher odds of JE fatality in India compared to China. (OR: 5.46, 95% CI: 3.61–8.31). Using the prediction model we found that, in 2000–2018, Brunei, Pakistan, and Timor-Leste were predicted to have the highest JE CFR of 20%. Bangladesh, Guam, Pakistan, Philippines, and Vietnam had projected JE CFR over 20% for after 2018, whereas the projected JE CFRs were below 10% in China, Indonesia, Cambodia, Myanmar, Malaysia, and Thailand. For disability, we estimated that 36% (min-max 0–85) JE patients recovered fully at hospital discharge. One year after hospital discharge, 46% (min-max 0%-97%) JE survivors were estimated to live normally but 49% (min-max 3% - 86%)till had neurological sequelae. Conclusion JE CFR estimates were lower than 20% after 2000. Our study provides an updated estimation of CFR and proportion of JE cases with long-term neurological sequelae that could help to refine cost-benefit assessment for JE control and elimination programs. Japanese Encephalitis (JE) is known for its high case fatality ratio (CFR) and long-term neurological sequelae. Although JE fatality and morbidity risk might change as the characteristics of the population change with the strengthened surveillance scales, expanded immunization coverage, and healthcare improvements, there have not been any updates in the estimates for JE mortality and morbidity estimates for 10 years. In this paper, we made updated estimates of the JE CFR and the proportion of JE survivors with long-term neurological sequelae by performing a systematic review and developing statistical and machine learning models. We estimated JE CFR decreased over time, with estimates of 26% (95% CI 22, 30) in 1961–1979, 20% (95% CI 17, 24) in 1980–1999, 14% (95% CI 11, 17) in 2000–2018, and 14% (95% CI 11, 17) in 2019–2030. countries without JE vaccination, younger JE cases, higher population growth rate, and lower rural population percentage were associated with higher JE CFR. We estimated that 36% (min-max 0–85) JE patients recovered fully at hospital discharge. One year after hospital discharge, 46% (min-max 0%-97%) JE survivors were estimated to live normally but 49% (min-max 3% - 86%) JE patients still had neurological sequelae. The insights gained will be important in evaluating and updating current JE disease burden among all endemic areas and effectively channeling resources to most needed areas.
Collapse
|
9
|
Li X, Li J, Wu G, Wang M, Jing Z. Detection of Japanese Encephalitis by Metagenomic Next-Generation Sequencing of Cerebrospinal Fluid: A Case Report and Literature Review. Front Cell Neurosci 2022; 16:856512. [PMID: 35250491 PMCID: PMC8892252 DOI: 10.3389/fncel.2022.856512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/25/2022] [Indexed: 12/28/2022] Open
Abstract
Japanese encephalitis (JE) is an acute viral central nervous system disease, although less than 1% of patients infected with Japanese encephalitis virus (JEV) result in JE, which has an extremely poor prognosis. The Routine detection methods for JEV are time-consuming or limited by hospital conditions, therefore, need the quicker and sensitive techniques to detect JEV. Here, we reported a 14-year-old female who was admitted to our hospital with a severe fever, progressively headache and unconsciousness. Based on the clinical presentation, Preliminary diagnosis on admission indicated central nervous system infection of suspected viral meningoencephalitis or autoimmune encephalitis. The patient's symptoms were unrelieved after being treated with empiric antiviral therapy. Magnetic resonance imaging (MRI) showed that the lesions were located in the bilateral thalamus, head of caudate nucleus, and right lenticular nucleus, so we had to consider the possibility of Flaviviruses infection. We sent the cerebrospinal fluid (CSF) for metagenomic next-generation sequencing (mNGS) immediately, subsequent result suggested the infection caused by JEV. Two days later the results of the serum agglutination test confirmed that virus immunoglobulin M antibody positive. After a week treatment with intravenous immunoglobulin (IVIG), meanwhile, the lumbar puncture was used to check the pressure and various indicators of the CSF again to evaluate the treatment effect, An decrease in the number of WBC indicates, protein and unique RNA reads that the previous experimental treatment was effective, accompany by temperature and consciousness of the patient was normalized. Two weeks after admission, the patient was transferred to the rehabilitation hospital, MR showed the lesions had disappeared completely after 2 months of follow-up. We believed that mNGS may be an effective method for rapid identification of JE.
Collapse
Affiliation(s)
- Xin Li
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Jing Li
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Guode Wu
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Manxia Wang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
- *Correspondence: Manxia Wang
| | - Zhang Jing
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
| |
Collapse
|
10
|
Aryal R, Shrestha S, Homagain S, Chhetri S, Shrestha K, Kharel S, Karn R, Rajbhandari R, Gajurel BP, Ojha R. Clinical spectrum and management of dystonia in patients with Japanese encephalitis: A systematic review. Brain Behav 2022; 12:e2496. [PMID: 35025122 PMCID: PMC8865161 DOI: 10.1002/brb3.2496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/25/2021] [Accepted: 01/02/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Japanese encephalitis (JE) is a potentially fatal viral infection with a wide range of manifestations and can also present with a variety of movement disorders (MD) including dystonia. Dystonic features in JE are uncommon. Here, we have tried to summarize the clinical features and management of dystonia among JE patients with a comprehensive literature search. METHODS Various databases, including PubMed, Embase, and Google Scholar, were searched against the predefined criteria using suitable keywords combination and boolean operations. Relevant information from observational and case studies was extracted according to the author, dystonic features, radiological changes in the brain scans, treatment options, and outcome wherever provided. RESULT We identified 19 studies with a total of 1547 JE patients, the diagnosis of which was confirmed by IgM detection in serum and/or cerebrospinal fluid in the majority of the patients (88.62%). 234 (15.13%) of JE patients had dystonia with several types of focal dystonia being present in 131 (55.98%) either alone or in combination. Neuroimaging showed predominant involvement of thalami, basal ganglia, and brainstem. Oral medications including anticholinergics, GABA agonists, and benzodiazepines followed by botulinum toxin were the most common treatment modalities. CONCLUSION Dystonia can be a disabling consequence of JE, and various available medical therapies can significantly improve the quality of life. Owing to insufficient studies on the assessment of dystonia associated with JE, longitudinal studies with a larger number of patients are warranted to further clarify the clinical course, treatment, and outcome of dystonia.
Collapse
Affiliation(s)
- Roshan Aryal
- Department of Medicine, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, 44600, Nepal
| | - Suraj Shrestha
- Department of Medicine, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, 44600, Nepal
| | - Sushan Homagain
- Department of Medicine, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, 44600, Nepal
| | - Sunit Chhetri
- Department of Medicine, B.P. Koirala Institute of Health Sciences, Dharan, 56700, Nepal
| | - Kshitiz Shrestha
- Department of Medicine, B.P. Koirala Institute of Health Sciences, Dharan, 56700, Nepal
| | - Sanjeev Kharel
- Department of Medicine, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, 44600, Nepal
| | - Ragesh Karn
- Department of Neurology, Tribhuvan University Institute of Medicine, Kathmandu, 44600, Nepal
| | - Reema Rajbhandari
- Department of Neurology, Tribhuvan University Institute of Medicine, Kathmandu, 44600, Nepal
| | - Bikram Prasad Gajurel
- Department of Neurology, Tribhuvan University Institute of Medicine, Kathmandu, 44600, Nepal
| | - Rajeev Ojha
- Department of Neurology, Tribhuvan University Institute of Medicine, Kathmandu, 44600, Nepal
| |
Collapse
|
11
|
Caldwell M, Boruah AP, Thakur KT. Acute neurologic emerging flaviviruses. Ther Adv Infect Dis 2022; 9:20499361221102664. [PMID: 35719177 PMCID: PMC9198421 DOI: 10.1177/20499361221102664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/30/2022] [Indexed: 11/24/2022] Open
Abstract
The COVID-19 pandemic has shed light on the challenges we face as a global society in preventing and containing emerging and re-emerging pathogens. Multiple intersecting factors, including environmental changes, host immunological factors, and pathogen dynamics, are intimately connected to the emergence and re-emergence of communicable diseases. There is a large and expanding list of communicable diseases that can cause neurological damage, either through direct or indirect routes. Novel pathogens of neurotropic potential have been identified through advanced diagnostic techniques, including metagenomic next-generation sequencing, but there are also known pathogens which have expanded their geographic distribution to infect non-immune individuals. Factors including population growth, climate change, the increase in animal and human interface, and an increase in international travel and trade are contributing to the expansion of emerging and re-emerging pathogens. Challenges exist around antimicrobial misuse giving rise to antimicrobial-resistant infectious neurotropic organisms and increased susceptibility to infection related to the expanded use of immunomodulatory treatments. In this article, we will review key concepts around emerging and re-emerging pathogens and discuss factors associated with neurotropism and neuroinvasion. We highlight several neurotropic pathogens of interest, including West Nile virus (WNV), Zika Virus, Japanese Encephalitis Virus (JEV), and Tick-Borne Encephalitis Virus (TBEV). We emphasize neuroinfectious diseases which impact the central nervous system (CNS) and focus on flaviviruses, a group of vector-borne pathogens that have expanded globally in recent years and have proven capable of widespread outbreak.
Collapse
Affiliation(s)
- Marissa Caldwell
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Abhilasha P Boruah
- Department of Neurology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital (CUIMC/NYP), New York, NY, USA
| | - Kiran T Thakur
- Division of Critical Care and Hospitalist Neurology, Department of Neurology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital (CUIMC/NYP), 177 Fort Washington Avenue, Milstein Hospital, 8GS-300, New York, NY 10032, USA
| |
Collapse
|
12
|
Long-Term Neurological Sequelae and Disease Burden of Japanese Encephalitis in Gansu Province, China. Ann Glob Health 2021; 87:103. [PMID: 34722167 PMCID: PMC8533657 DOI: 10.5334/aogh.3343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background and objects: The study aimed to evaluate the long-term neurological sequelae and the disease burden of JE in Gansu, China. Methods: JE patients were included as study population from 2005–2011 in Gansu, and a follow-up survey was conducted in 2007–2014. Pair-matched healthy individuals were selected as controls. All subjects underwent a neurological examination and intelligence quotient (IQ) and memory quotient (MQ) assessments. Then, the disability-adjusted life years (DALYs), and direct and indirect medical expenses were systematic assessed. Results: Forty-four point seven percent of the JE patients had objective neurological deficits, compared with 2.4% of controls. Subnormal intelligence was found in 21.2% of JE subjects, compared with 1.2% control who exhibited a mildly reduced IQ. Abnormal MQ scores were noted in 56.3% JE subjects, compared with only 12.7% controls. Prevalence of each sequelae caused by JE were significantly higher in adults than in younger subjects. Furthermore, median DALY lost due to JE was 9.2 per subject. Median economic cost of JE was approximately $2776.6 per subject and significantly higher in adults than in younger subjects. Findings and Conclusions: JE patients suffered from severe neurological sequelae and high disease burden, resulting in a significant downstream burden for both the patients (especially adults) and the healthcare system.
Collapse
|
13
|
Aggarwal A, Adukia S, Bhatt M. Video Anthology of Movement Disorders Due to Infections in South Asia. Mov Disord Clin Pract 2021; 8:843-858. [PMID: 34405094 DOI: 10.1002/mdc3.13275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/23/2021] [Accepted: 06/16/2021] [Indexed: 12/13/2022] Open
Abstract
South Asia, encompassing many populous countries including India, Pakistan, and Bangladesh, is home to a wide variety of infectious diseases several of which are disproportionately prevalent, endemic or distinctive to the region. These result in considerable morbidity and mortality, which can be greatly reduced through public-health measures, timely diagnosis and treatment. Some of these infectious diseases have neurological manifestations including movement disorders either due to the pathogen being neuroinvasive or via an immune-mediated response. For diseases such as Japanese encephalitis, movement disorders are the primary manifestation while for others, they can be a presenting feature. Thus, recognizing these movement disorders is often crucial to the diagnosis of the particular infection, and/or to exclude infection as a cause and arrive at the correct alternate diagnosis. Once diagnosed, the infection-related movement disorders are treated by targeting the infectious agent, or symptomatically. In this article, we describe and illustrate a variety of movement disorders that are seen in patients infected by viruses, bacteria and parasites in South Asia. This would be of value to neurologists practicing in the region and, with the increasing ease in movement of people and pathogens, those practicing elsewhere.
Collapse
Affiliation(s)
- Annu Aggarwal
- Movement Disorder Clinic, Department of Neurosciences Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute Mumbai India
| | - Sachin Adukia
- Movement Disorder Clinic, Department of Neurosciences Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute Mumbai India
| | - Mohit Bhatt
- Movement Disorder Clinic, Department of Neurosciences Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute Mumbai India
| |
Collapse
|
14
|
Dutta A, Nag SS, Dutta M, Basu S. Long-Term Morbidity and Functional Outcome of Japanese Encephalitis in Children: A Prospective Cohort Study. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2306-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
15
|
Chow C, Dehority W. Long-Term Outcomes in Children Surviving Tropical Arboviral Encephalitis: A Systematic Review. J Trop Pediatr 2021; 67:6295672. [PMID: 34109400 DOI: 10.1093/tropej/fmab028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Survivors of childhood encephalitis often suffer from physical and neurocognitive sequelae, particularly in tropical, resource-limited areas with a large burden of arboviral, neurotropic pathogens and limited resources with which to address chronic morbidities. Research into overall and pathogen-specific outcomes following childhood encephalitis may help identify risk factors for poor outcomes, quantify the burden of sequelae, assist with resource allocation and help focus rehabilitative efforts. However, such research is limited. To this end, we systematically reviewed the literature on this topic to identify gaps in knowledge worthy of future investigation. METHODS A search of PubMed, Web of Knowledge and the Cochrane databases was performed 10 January through 20 February 2020, using 17 search terms for sequelae and 14 for tropical, arboviral pathogens. Eligible reports demonstrated post-discharge follow-up of ≥3 months and assessment of clinical outcome in a child with an arboviral encephalitis ≤18 years of age at diagnosis. RESULTS Of 1513 articles, 35 were eligible, comprising 693 children. Japanese encephalitis accounted for 18 articles and 93.2% of all subjects (646 total). Sequelae were documented in ∼60% of subjects overall and in those with Japanese encephalitis. For non-Japanese encephalitis virus encephalitides (47 children), sequelae were found in 78.1%. No studies utilized comprehensive neurocognitive testing or assessed the efficacy of rehabilitative efforts. Only nine studies reported data from ≥1 follow-up visit. CONCLUSION Investigation into long-term outcomes following tropical childhood encephalitis is limited, particularly for neurocognitive sequelae, serial assessments over time and the effect of rehabilitative measures. LAY SUMMARY Encephalitis, an infection of the brain, is frequently caused by arboviruses (viruses spread via the bite of infected arthropods, such as mosquitoes) in tropical locales. Following infection, surviving children may be plagued with severe physical and cognitive deficits. Unfortunately, research into the type of deficits, their frequency and their responsiveness to rehabilitative efforts is lacking. We identified and reviewed 35 studies describing outcomes in children recovering from tropical, arboviral encephalitis at least 3 months following hospital discharge. Poor outcomes were common and found in up to 60% of children. Long-term and serial follow-up visits were rare, as was the use of comprehensive neurocognitive testing. No studies assessed the efficacy of rehabilitative measures. Further study into these areas is recommended.
Collapse
Affiliation(s)
- Christal Chow
- Division of Infectious Diseases, Department of Pediatrics, The University of New Mexico School of Medicine, Albuquerque, NM 87131-0001, USA
| | - Walter Dehority
- Division of Critical Care, Department of Pediatrics, The University of New Mexico School of Medicine, Albuquerque, NM 87131-0001, USA
| |
Collapse
|
16
|
MRI Spectrum of Japanese Encephalitis in Northeast India: A Cross-Sectional Study. J Neurosci Rural Pract 2021; 12:281-289. [PMID: 33935446 PMCID: PMC8079177 DOI: 10.1055/s-0041-1722820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective
Japanese encephalitis (JE) is an arthropod-borne flavivirus infection having high mortality and morbidity. This study was performed to evaluate the conventional magnetic resonance imaging (MRI) findings in JE and to find out any difference between pediatric and adult JE.
Materials and Methods
This retrospective study was performed on serologically positive 54 JE patients presented to a tertiary care hospital with acute encephalitic symptoms between April 2016 and October 2019. Relevant neurological examination, cerebrospinal fluid analysis, and MRI scan of the brain were performed.
Results
Fifty-four JE patients (
n
= 31 males and
n
= 23 females) having 32 pediatric and 22 adult JE were included in the study sample. Group 1 JE (
n
= 16) patients had encephalitic symptoms with duration less than 15 days up to the day of MRI scan and group 2 JE (
n
= 38) had symptoms more than 15 days. Group 1 JE had mean apparent diffusion coefficient (ADC) value of 0.563 ± 0.109 (standard deviation [SD]) × 10
–3
mm
2
/sec and group 2 JE had 1.095 ± 0.206 (SD) × 10
–3
mm
2
/sec. The mean ADC value of pediatric JE was 0.907 ± 0.336 (SD) × 10
–3
mm
2
/sec and adult JE was 0.982 ± 0.253 (SD) × 10
–3
mm
2
/sec.
Conclusion
The majority of the JE patient shows abnormal signal alterations in bilateral thalami and substantia nigra. Diffusion-weighted imaging with ADC mapping helps in evaluating the stage of the JE. No statistical significance of the various conventional MRI findings was found between the pediatric JE and adult JE.
Collapse
|
17
|
Sathyanathan BP, Ravichandran A, Ranganathan R. ASL perfusion in atypical Japanese encephalitis. Indian J Radiol Imaging 2021; 30:536-539. [PMID: 33737791 PMCID: PMC7954167 DOI: 10.4103/ijri.ijri_268_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/16/2020] [Accepted: 09/02/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Aishwarya Ravichandran
- Barnard Insitute of Radiology, Madras Medical College, Chennai, Tamil Nadu, India. E-mail:
| | - Ravi Ranganathan
- Barnard Insitute of Radiology, Madras Medical College, Chennai, Tamil Nadu, India. E-mail:
| |
Collapse
|
18
|
Xu Q, Huang L, Xing J, Zhang J, Li H, Liu L, Hu C, Liao M, Yue J, Qi W. Japanese encephalitis virus manipulates lysosomes membrane for RNA replication and utilizes autophagy components for intracellular growth. Vet Microbiol 2021; 255:109025. [PMID: 33725516 DOI: 10.1016/j.vetmic.2021.109025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/26/2021] [Indexed: 12/13/2022]
Abstract
Japanese encephalitis virus is absolutely dependent on their host cells and has evolved various strategies to manipulate the cellular secretory pathways for viral replication. However, how cellular secretory pathways are hijacked, and the origin of the viral vesicles remains elusive during JEV replication. Here we show how JEV manipulates multiple components of the cellular secretory pathway, including autophagic machinery, to generate a superior environment for genome replication. We utilized double-strand RNA antibodies to label JEV RNA complex seeking the viral replication compartments and found that JEV genome replication takes place in lysosomes (LAMP1), not in autophagosomes (LC3). Subsequently, in situ hybridization results showed that viral RNAs (vRNAs) of JEV strongly colocalized with LAMP1. What surprised us was that JEV vRNAs markedly colocalized with LC3, indicating that autophagy plays an active role in JEV replication. Interestingly, we found that JEV utilized autophagic components for intracellular growth in an autophagy-dependent manner and the fusion of autophagosome-lysosome plays a positive role in JEV post-RNA replication processes. Collectively, our findings demonstrate that JEV can manipulate cellular secretory pathway to form genome replication organelles and exploit autophagy components for intracellular growth, providing new insights into the life cycle of JEV and uncovering an attractive target for antiviral drugs.
Collapse
Affiliation(s)
- Qiang Xu
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China; Key Laboratory of Zoonosis, Ministry of Agriculture and Rural Affairs, Guangzhou, 510642, China; National and Regional Joint Engineering Laboratory for Medicament of Zoonosis Prevention and Control, Guangzhou, 510642, China; Key Laboratory of Zoonoses Prevention and Control of Guangdong Province, Guangzhou, 510642, China
| | - Lihong Huang
- Department of Biomedical Sciences, City University of Hong Kong, 999077, Hong Kong, China
| | - Jinchao Xing
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China; National and Regional Joint Engineering Laboratory for Medicament of Zoonosis Prevention and Control, Guangzhou, 510642, China; Key Laboratory of Zoonoses Prevention and Control of Guangdong Province, Guangzhou, 510642, China
| | - Jiahao Zhang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China; National and Regional Joint Engineering Laboratory for Medicament of Zoonosis Prevention and Control, Guangzhou, 510642, China; Key Laboratory of Zoonoses Prevention and Control of Guangdong Province, Guangzhou, 510642, China
| | - Huanan Li
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China; Key Laboratory of Zoonosis, Ministry of Agriculture and Rural Affairs, Guangzhou, 510642, China; Key Laboratory of Zoonoses Prevention and Control of Guangdong Province, Guangzhou, 510642, China
| | - Lele Liu
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China; Key Laboratory of Zoonosis, Ministry of Agriculture and Rural Affairs, Guangzhou, 510642, China; National and Regional Joint Engineering Laboratory for Medicament of Zoonosis Prevention and Control, Guangzhou, 510642, China
| | - Chen Hu
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China; Key Laboratory of Zoonoses Prevention and Control of Guangdong Province, Guangzhou, 510642, China
| | - Ming Liao
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China; Guangdong Laboratory for Lingnan Modern Agriculture, Guangzhou, 510642, China; Key Laboratory of Zoonosis, Ministry of Agriculture and Rural Affairs, Guangzhou, 510642, China; National and Regional Joint Engineering Laboratory for Medicament of Zoonosis Prevention and Control, Guangzhou, 510642, China; Key Laboratory of Zoonoses Prevention and Control of Guangdong Province, Guangzhou, 510642, China
| | - Jianbo Yue
- Department of Biomedical Sciences, City University of Hong Kong, 999077, Hong Kong, China.
| | - Wenbao Qi
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China; Guangdong Laboratory for Lingnan Modern Agriculture, Guangzhou, 510642, China; Key Laboratory of Zoonosis, Ministry of Agriculture and Rural Affairs, Guangzhou, 510642, China; National and Regional Joint Engineering Laboratory for Medicament of Zoonosis Prevention and Control, Guangzhou, 510642, China; Key Laboratory of Zoonoses Prevention and Control of Guangdong Province, Guangzhou, 510642, China.
| |
Collapse
|
19
|
Adults with severe Japanese encephalitis: a retrospective analysis of 9 cases in Linyi, China. Neurol Sci 2020; 42:2811-2817. [PMID: 33169192 PMCID: PMC7652048 DOI: 10.1007/s10072-020-04867-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/27/2020] [Indexed: 01/17/2023]
Abstract
Objective Japanese encephalitis (JE) is a critical problem of public health worldwide; however, there is limited data about the clinical features and indicators of outcome in adults with severe Japanese encephalitis. Methods The clinical manifestations and laboratory study on brain neuroimaging of patients with severe JE were statistically analyzed retrospectively. All patients were followed up for 6 months after discharge. The patients were grouped into good outcome and poor outcome according to the results of the follow-up. Results This retrospective study consists of 9 adults with severe JE, including 5 cases with poor outcome, defined as the modified Rankin Scale (mRS) scores of greater than or equal to 4 points, and remained ventilator dependent. Typical clinical manifestations of JE include fever (100%), altered consciousness (100%), headache (66.7%), flaccid weakness (66.7%), and status epilepticus (44.4%). Serological examination revealed that a higher percentage of neutrophils and a lower percentage of lymphocytes at admission may be associated with a poor outcome. Abnormal neuroimaging of the thalamus (85.7%), hippocampal (71.4%), midbrain (28.6%), and basal ganglia (14.3%) was found. 42.9% of patients left severe irreversible disability, and the most prominent were mental symptoms (71.4%) and memory or understanding disorder (57.1%). Conclusion Our data suggest that respiratory failure is one of the important causes of early death. Serologic examination, coma, and status epilepticus may indicate a poor outcome for severe JE. Additionally, the hippocampus is the second most common lesion in the adults with severe JE. A large-scale clinical trial is required to further confirm these conclusions. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-020-04867-8.
Collapse
|
20
|
Abstract
Background: Movement disorders are often a prominent part of the phenotype of many neurologic rare diseases. In order to promote awareness and diagnosis of these rare diseases, the International Parkinson’s and Movement Disorders Society Rare Movement Disorders Study Group provides updates on rare movement disorders. Methods: In this narrative review, we discuss the differential diagnosis of the rare disorders that can cause chorea. Results: Although the most common causes of chorea are hereditary, it is critical to identify acquired or symptomatic choreas since these are potentially treatable conditions. Disorders of metabolism and mitochondrial cytopathies can also be associated with chorea. Discussion: The present review discusses clues to the diagnosis of chorea of various etiologies. Authors propose algorithms to help the clinician in the diagnosis of these rare disorders.
Collapse
|
21
|
Feng Q, Chen Q, Bi X, Yu S, Wang J, Sun X, Ren C, Liu H, Guan L. Severe Japanese encephalitis with multiple intracranial hemorrhages: A case report. Medicine (Baltimore) 2019; 98:e17453. [PMID: 31593101 PMCID: PMC6799848 DOI: 10.1097/md.0000000000017453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Intracranial hemorrhage occurs infrequently in Japanese encephalitis (JE), and even less frequently with hemorrhage occurring twice. In this report, we describe the clinical features and outcomes of a patient with confirmed JE combined with hemorrhage twice. PATIENT CONCERNS The patient, a 71-year-old Asian woman, was admitted to the hospital with symptoms of hemiplegia following fever and diarrhea. Soon her condition worsened and a decreased level of consciousness, respiratory failure, and paralysis of extremities occurred.The brain diffusion-weighted imaging sequence showed suspicious abnormal signals in bilateral thalami. Japanese encephalitis virus immunoglobulin M antibody was detected in her serum and cerebrospinal fluid samples, so the patient was diagnosed with JE. During treatment, her condition became aggravated and the brain computed tomography (CT) scan showed multiple lobar hemorrhages. One month later, the multiple lobar hemorrhages occurred again, as observed by a brain CT scan. DIAGNOSIS JE with multiple intracranial hemorrhages. INTERVENTIONS The patient was treated comprehensively, including surgery, lowering her intracranial pressure and ventilator-assisted breathing. OUTCOMES One month later, the patient underwent another surgical procedure for intracranial hemorrhage and suffered a serious neurological disorder. LESSONS Severe intracranial hemorrhage may occur in elderly patients with JE, especially in those with poor vascular condition. Therefore, when treating such patients, great caution, as well as early detection and prevention, should be taken in case of the occurrence of severe intracranial hemorrhage.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Lina Guan
- Neurosurgical Intensive Care Unit, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| |
Collapse
|
22
|
Arahata Y, Fujii K, Nishimura T, Uchida T, Kitazawa K, Honda A. Longitudinal magnetic resonance imaging changes in Japanese encephalitis. Brain Dev 2019; 41:731-734. [PMID: 31003834 DOI: 10.1016/j.braindev.2019.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/03/2019] [Accepted: 04/09/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Japanese encephalitis is a flavivirus that can cause pandemic encephalitis, and is prevalent in Southeast Asia and Australia. Brain images of patients with Japanese encephalitis are characterized by thalamic lesions, distinct from those seen in viral encephalopathies caused by the herpes simplex virus and West Nile virus. AIM Herein, we describe for the first time a time-dependent magnetic resonance imaging pattern in Japanese encephalitis in a 10-month-old Japanese boy. CASE The patient was a previously healthy 10-month-old Japanese boy, who exhibited acute-onset flaccid tetraplegia and loss of tendon reflexes. RESULTS Brain MRI showed characteristic thalamic changes on diffusion weighted images from spotty to uniform and from the left to the right side, associated with low apparent diffusion coefficient maps. These images suggest that the Japanese encephalitis virus may first affect the unilateral thalamus, possibly expanding to the other side, with characteristic patterns changing from spotty to uniform in a manner consistent with the presentation of cytotoxic edema. CONCLUSION This report first showed longitudinal magnetic resonance changes in Japanese encephalitis, which may help in accurate diagnosis and in discrimination from other etiologies.
Collapse
Affiliation(s)
- Yukie Arahata
- Department of Pediatrics, Asahi General Hospital, Chiba, Japan
| | - Katsunori Fujii
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan.
| | | | - Tomoko Uchida
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
| | | | - Akihito Honda
- Department of Pediatrics, Asahi General Hospital, Chiba, Japan
| |
Collapse
|
23
|
Clinical analysis of psychiatric symptoms of Japanese encephalitis during the convalescent Period: A single center study in Chongqing, China. Brain Dev 2019; 41:614-617. [PMID: 30902357 DOI: 10.1016/j.braindev.2019.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study aimed to analyze clinical and imaging features of children with severe Japanese encephalitis (JE), and to analyze causes and solutions for psychiatric symptoms of JE during the convalescent period. METHODS We analyzed clinical information for 78 children with severe JE at the Department of Neurology, Department of Infection, and Department of Rehabilitation in our hospital during 2014-2016. Seventy-eight cases of severe JE were divided into patients with psychiatric symptoms and no psychiatric symptoms groups. We focused on analysis of the patients with psychiatric symptoms group. RESULTS The incidence of psychiatric symptoms during the convalescent period was 46.15% (36/78). Antipsychotic drugs can effectively control psychiatric symptoms and shorten duration of symptoms. Seventy-one patients underwent reexamination with a head MRI. Of these, 8 cases (8/36 = 22.22%) in patients with psychiatric symptoms group showed new lesions in the basal ganglia, insula, and hippocampus. During the 12-month follow-up, two cases showed reappearance of psychiatric symptoms that had been relieved previously. CONCLUSION This study found that severe JE cases revealed a considerable proportion with psychiatric symptoms during the convalescent period.
Collapse
|
24
|
Tadokoro K, Ohta Y, Sato K, Maeki T, Sasaki R, Takahashi Y, Shang J, Takemoto M, Hishikawa N, Yamashita T, Lim CK, Tajima S, Abe K. A Japanese Encephalitis Patient Presenting with Parkinsonism with Corresponding Laterality of Magnetic Resonance and Dopamine Transporter Imaging Findings. Intern Med 2018. [PMID: 29526949 PMCID: PMC6120820 DOI: 10.2169/internalmedicine.0337-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Japanese encephalitis (JE) survivors often present with nigrostriatal aftereffects with parkinsonian features. A 67-year-old woman with JE showed right-dominant clinical parkinsonism and left-dominant substantia nigra lesions after magnetic resonance imaging (MRI). Dopamine transporter (DAT) imaging using 123I-labeled 2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl)-nortropane (123I-FP-CIT) revealed a corresponding left-dominant decrease. The present case is the first to reveal a clear match of laterality between clinical parkinsonism, MRI-based substantia nigra lesions, and impaired DAT in presynaptic dopaminergic neurons in JE.
Collapse
Affiliation(s)
- Koh Tadokoro
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Yasuyuki Ohta
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Kota Sato
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Takahiro Maeki
- Laboratory of Arboviruses, Department of Virology 1, National Institute of Infectious Diseases, Japan
| | - Ryo Sasaki
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Yoshiaki Takahashi
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Jingwei Shang
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Mami Takemoto
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Nozomi Hishikawa
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Toru Yamashita
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Chang Kweng Lim
- Laboratory of Arboviruses, Department of Virology 1, National Institute of Infectious Diseases, Japan
| | - Shigeru Tajima
- Laboratory of Arboviruses, Department of Virology 1, National Institute of Infectious Diseases, Japan
| | - Koji Abe
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| |
Collapse
|
25
|
Wong AMC, Yeh CH, Lin JJ, Liu HL, Chou IJ, Lin KL, Wang HS. Arterial spin-labeling perfusion imaging of childhood encephalitis: correlation with seizure and clinical outcome. Neuroradiology 2018; 60:961-970. [PMID: 30046856 DOI: 10.1007/s00234-018-2062-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/17/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE In childhood encephalitis, perfusion abnormalities have been infrequently reported to associate with clinical status. We investigated whether perfusion abnormalities correlated with seizure and clinical outcome in encephalitis. METHODS We retrospectively analyzed the MR studies of 77 pediatric patients with encephalitis. Pseudo-continuous arterial spin-labeling (ASL) imaging was performed on a 3-T scanner. The patients were divided into five groups according to ASL perfusion imaging pattern: normal perfusion (NP), focal hypoperfusion (Lf), extreme global hypoperfusion (LE), focal hyperperfusion (Hf), and extreme global hyperperfusion (HE). Clinical outcome at 3 weeks was dichotomized to unfavorable or favorable outcome according to the Glasgow outcome scale. Multivariate logistic regression was conducted to predict unfavorable outcome and presence of seizure separately, based on explanatory variables including age, sex, and ASL pattern. RESULTS Twenty-seven (35%) patients were designated as in group Hf, five (7%) in group Lf, 11 (14%) in group LE, none in group HE, and 34 (44%) in group NP. Multivariate logistic regression analysis showed that ASL pattern was significantly associated with unfavorable outcome (P = 0.005) and with presence of seizure (P = 0.005). For ASL pattern, group LE was 17.31 times as likely to have an unfavorable outcome as group NP (odds ratio confidence interval [CI] 3.084, 97.105; P = 0.001). Group Hf was 6.383 times as likely to have seizure as group NP (CI 1.765, 23.083; P = 0.005). CONCLUSIONS In childhood encephalitis, patients with extreme global hypoperfusion had poor neurological outcome and those with focal hypoperfusion were more likely to have seizure.
Collapse
Affiliation(s)
- Alex Mun-Ching Wong
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung/Linkou, and Chang Gung University, 5 Fu-Hsing Street, Taoyuan, 333, Taiwan.
| | - Chih-Hua Yeh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung/Linkou, and Chang Gung University, 5 Fu-Hsing Street, Taoyuan, 333, Taiwan
| | - Jainn-Jim Lin
- Division of Pediatric Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ho-Ling Liu
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - I-Jun Chou
- Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung University, Linkou, Taiwan
| | - Kuang-Lin Lin
- Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung University, Linkou, Taiwan
| | - Huei-Shyong Wang
- Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung University, Linkou, Taiwan
| |
Collapse
|
26
|
Vanjare HA, Mannam P, Mishra AK, Karuppusami R, Carey RAB, Abraham AM, Rose W, Iyyadurai R, Mani S. Brain Imaging in Cases with Positive Serology for Dengue with Neurologic Symptoms: A Clinicoradiologic Correlation. AJNR Am J Neuroradiol 2018; 39:699-703. [PMID: 29439121 DOI: 10.3174/ajnr.a5544] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/29/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Dengue is a common arboviral disease, which uncommonly involves the brain. There has been a recent surge in dengue cases and dengue-related deaths in tropical countries. The aim of this study was to describe brain imaging findings in patients with dengue infection having neurologic symptoms. MATERIALS AND METHODS Thirty-five patients with positive serology for dengue with CNS symptoms undergoing imaging of the brain were included in the study. Clinical, laboratory, and imaging parameters were assessed and correlated to poor outcome. RESULTS A Glasgow Coma Scale score of ≤12 at presentation, clinical classification of severe-type dengue, and the presence of acute renal failure were associated with poor outcome. Imaging parameters associated with poor outcome were involvement of the thalami and cerebellar peduncles and the presence of diffusion restriction and hemorrhagic foci in the brain parenchyma. CONCLUSIONS Although not specific, dengue infection has imaging findings that can be used to narrow down the differential list and help in prognostication.
Collapse
Affiliation(s)
- H A Vanjare
- From the Departments of Radiology (H.A.V., P.M., S.M.)
| | - P Mannam
- From the Departments of Radiology (H.A.V., P.M., S.M.)
| | | | | | | | | | - W Rose
- Pediatrics (W.R.), Christian Medical College and Hospital, Tamil Nadu, India
| | | | - S Mani
- From the Departments of Radiology (H.A.V., P.M., S.M.)
| |
Collapse
|
27
|
Kumar R, Patil RD. Cryptic etiopathological conditions of equine nervous system with special emphasis on viral diseases. Vet World 2017; 10:1427-1438. [PMID: 29391683 PMCID: PMC5771167 DOI: 10.14202/vetworld.2017.1427-1438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/30/2017] [Indexed: 01/04/2023] Open
Abstract
The importance of horse (Equus caballus) to equine practitioners and researchers cannot be ignored. An unevenly distributed population of equids harbors numerous diseases, which can affect horses of any age and breed. Among these, the affections of nervous system are potent reason for death and euthanasia in equids. Many episodes associated with the emergence of equine encephalitic conditions have also pose a threat to human population as well, which signifies their pathogenic zoonotic potential. Intensification of most of the arboviruses is associated with sophisticated interaction between vectors and hosts, which supports their transmission. The alphaviruses, bunyaviruses, and flaviviruses are the major implicated groups of viruses involved with equines/humans epizootic/epidemic. In recent years, many outbreaks of deadly zoonotic diseases such as Nipah virus, Hendra virus, and Japanese encephalitis in many parts of the globe addresses their alarming significance. The equine encephalitic viruses differ in their global distribution, transmission and main vector species involved, as discussed in this article. The current review summarizes the status, pathogenesis, pathology, and impact of equine neuro-invasive conditions of viral origin. A greater understanding of these aspects might be able to provide development of advances in neuro-protective strategies in equine population.
Collapse
Affiliation(s)
- Rakesh Kumar
- Department of Veterinary Pathology, Dr. G.C. Negi College of Veterinary and Animal Sciences, CSK Himachal Pradesh Agricultural University, Palampur - 176 062, Himachal Pradesh, India
| | - Rajendra D Patil
- Department of Veterinary Pathology, Dr. G.C. Negi College of Veterinary and Animal Sciences, CSK Himachal Pradesh Agricultural University, Palampur - 176 062, Himachal Pradesh, India
| |
Collapse
|
28
|
Koeller KK, Shih RY. Viral and Prion Infections of the Central Nervous System: Radiologic-Pathologic Correlation: From the Radiologic Pathology Archives. Radiographics 2017; 37:199-233. [PMID: 28076019 DOI: 10.1148/rg.2017160149] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Viral infections of the central nervous system (CNS) range in clinical severity, with the most severe proving fatal within a matter of days. Some of the more than 100 different viruses known to affect the brain and spinal cord are neurotropic with a predilection for producing CNS infection. The host response to viral infection of the CNS is responsible for the pathophysiology and imaging findings seen in affected patients. Viral CNS infections can take the form of meningitis, encephalitis, encephalomyelitis, or, when involving the spinal cord and nerve roots, encephalomyeloradiculitis. In 1982, an infectious particle termed a prion that lacked nucleic acid and therefore was not a virus was reported to produce the fatal neurodegenerative disease Creutzfeldt-Jakob disease and related disorders. These prion diseases produce characteristic neuroimaging findings that are distinct from those seen in most viral infections. The clinical and imaging findings associated with viral CNS infection are often nonspecific, with microbiologic analysis of cerebrospinal fluid the most useful single test allowing for diagnosis of a specific viral infection. This review details the spectrum of viral CNS infections and uses case material from the archives of the American Institute for Radiologic Pathology, with a focus on the specific clinical characteristics and magnetic resonance imaging features seen in these infections. Where possible, the imaging features that allow distinction of these infections from other CNS inflammatory conditions are highlighted.
Collapse
Affiliation(s)
- Kelly K Koeller
- From the Department of Neuroradiology, American Institute for Radiologic Pathology, Silver Spring, Md (K.K.K., R.Y.S.); Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (K.K.K.); Uniformed Services University of the Health Sciences, Bethesda, Md (R.Y.S.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (R.Y.S.)
| | - Robert Y Shih
- From the Department of Neuroradiology, American Institute for Radiologic Pathology, Silver Spring, Md (K.K.K., R.Y.S.); Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (K.K.K.); Uniformed Services University of the Health Sciences, Bethesda, Md (R.Y.S.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (R.Y.S.)
| |
Collapse
|
29
|
Sunwoo JS, Lee ST, Jung KH, Park KI, Moon J, Jung KY, Kim M, Lee SK, Chu K. Clinical Characteristics of Severe Japanese Encephalitis: A Case Series from South Korea. Am J Trop Med Hyg 2017; 97:369-375. [PMID: 28829730 DOI: 10.4269/ajtmh.17-0054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Japanese encephalitis (JE) virus is a major cause of devastating viral encephalitis, especially in Asia. Although a successful vaccination program led to its near-elimination over three decades in South Korea, the incidence of JE has increased since 2010. The present study investigated the clinical manifestations, laboratory findings, and factors affecting neurological outcomes of reemerging JE. We retrospectively reviewed medical records of laboratory-confirmed JE patients who presented with acute encephalitis syndrome at three tertiary hospitals between 2010 and 2015. A total of 17 patients with JE were identified. Their median age was 51 years, and 10 (58.5%) were men. The most common symptoms and signs were fever (94.1%), altered consciousness (94.1%), and headache (80.2%). Hyporeflexia (47.1%), seizures (35.2%), abnormal brainstem reflex (23.5%), and flaccid weakness (17.6%) were also noted. Brain imaging revealed thalamic lesions in all patients, with the hippocampus, midbrain, basal ganglia, and cerebral cortex affected to varying degrees. Sixteen patients (94.1%) required management in the intensive care unit with mechanical ventilation due to neurological deterioration. At the time of discharge, 11 (64.7%) had poor recovery, defined as Glasgow coma scale scores of less than 8, and remained ventilator dependent. Comparison between the two outcome groups indicated that midbrain involvement (P = 0.028) and rapid deterioration (P = 0.005) were associated with severe neurological sequelae. Given that JE is a vaccine-preventable disease, vaccination for adults should be considered in response to the reemergence of JE.
Collapse
Affiliation(s)
- Jun-Sang Sunwoo
- Department of Neurology, Soonchunhyang University School of Medicine, Seoul, South Korea
| | - Soon-Tae Lee
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
| | - Keun-Hwa Jung
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Jangsup Moon
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
| | - Ki-Young Jung
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
| | - Manho Kim
- Protein Metabolism Medical Research Center, Seoul National University College of Medicine, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
| | - Sang Kun Lee
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| |
Collapse
|
30
|
Infection-mediated autoimmune movement disorders. Parkinsonism Relat Disord 2017; 46 Suppl 1:S83-S86. [PMID: 28756176 DOI: 10.1016/j.parkreldis.2017.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 11/21/2022]
Abstract
Infectious diseases remain the most common cause of neurological disability in the world. A number of movement disorders can develop in adults and children in response to infections. These can occur in isolation or as part of a broader neurological illness, with movement abnormalities consequent to an encephalopathy or a broader brain dysfunction. While most infection-related movement disorders are direct consequences of an active infectious process affecting cerebral structures implied in the motor network, at times a delayed immune-mediated process in response to a previous infectious is responsible for the neurological dysfunction. This immunological response can occur as a consequence of a number of pathogens, and develop at variable times after the initial infection. The most common infection-mediated autoimmune movement disorders are chorea, which is especially common in children, and other hyperkinetic disorders, but Parkinsonism and other hypokinetic movement disorders may also occur.
Collapse
|
31
|
Wong AM, Lin JJ, Toh CH, Bilaniuk LT, Zimmerman RA, Chang YC, Lin KL, Wang HS. Childhood encephalitis: relationship between diffusion abnormalities and clinical outcome. Neuroradiology 2014; 57:55-62. [DOI: 10.1007/s00234-014-1449-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 09/29/2014] [Indexed: 12/01/2022]
|
32
|
Jhunjhunwala K, Netravathi M, Pal PK. Movement disorders of probable infectious origin. Ann Indian Acad Neurol 2014; 17:292-7. [PMID: 25221398 PMCID: PMC4162015 DOI: 10.4103/0972-2327.138503] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/14/2014] [Accepted: 03/01/2014] [Indexed: 12/11/2022] Open
Abstract
Background: Movement disorders (MDs) associated with infections remains an important debilitating disorder in the Asian countries. Objectives: The objective of the following study is to report the clinical and imaging profile of a large cohort of patients with MDs probably associated with infection. Materials and Methods: This was a chart review of 35 patients (F:M-15:20) presenting with MD in the Neurology services of National Institute of Mental Health and Neurosciences, India. The demographic profile, type of infection, time from infection to MD, phenomenology of MD and magnetic resonance imaging (MRI) findings were reviewed. Results: The mean age at presentation was 22.6 ± 13.3 years, (5-60), age of onset of MD was 15.7 ± 15 years, and duration of symptoms was 6.9 ± 8.1 years (42 days to 32 years). The mean latency of onset of MD after the infection was 5.9 ± 4.2 weeks. The phenomenology of MD were: (1) Pure dystonia-28.6%, (2) dystonia with choreoathetosis-22.9%, (3) Parkinsonism-14.6%, (4) pure tremor, hemiballismus, myoclonus and chorea-2.9% each, and (5) mixed MD-22.9%. Most often the MD was generalized (60%), followed by right upper limb (31.4%) and left upper limb (8.6%). A viral encephalitic type of neuroinfection was the most common infection (85.7%), which was associated with MD. Abnormalities of brain MRI, seen in 79.2%, included signal changes in (1) thalamus-52.0%, (2) putamen and subcortical white matter-16% each, (3) pons-12%, (4) striatopallidum, striatum and grey matter-8% each, and (5) caudate, cerebellum, lentiform nucleus, midbrain and subthalamic nucleus-4.0% each. Conclusions: MDs associated with infection were the most often post-encephalitic. Dystonia was the most common MD, and thalamus was the most common anatomical site involved.
Collapse
Affiliation(s)
- Ketan Jhunjhunwala
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - M Netravathi
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| |
Collapse
|
33
|
Saini J, Gupta RK, Jain KK. Intracranial infections: key neuroimaging findings. Semin Roentgenol 2014; 49:86-98. [PMID: 24342678 DOI: 10.1053/j.ro.2013.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Rakesh K Gupta
- Department of Radiology and Imaging, Fortis Memorial Research Institute, Gurgaon, Haryana, India.
| | - Krishan K Jain
- Department of Radiology and Imaging, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| |
Collapse
|
34
|
Japanese encephalitis in a French traveler to Nepal. J Neurovirol 2014; 20:99-102. [PMID: 24408307 DOI: 10.1007/s13365-013-0226-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 11/28/2013] [Accepted: 12/05/2013] [Indexed: 10/25/2022]
Abstract
Japanese encephalitis is frequent in Asia, with a severe prognosis, but rare in travelers. Culex mosquitoes transmit Japanese encephalitis virus. Risk factors are destination, duration of stay, summer and fall seasons, outdoor activities, and type of accommodation. We report the case of a French traveler to Nepal with neutralization-based serological confirmed Japanese encephalitis. He presented classical clinical (viral syndrome before an encephalitis status with behavioral disorder, global hypotonia, mutism, movement disorders, seizure, and coma), radiological (lesions of thalami, cortico-spinal tracts, and brainstem) and biological features (lymphocytic meningitis). Nowadays, the presence of Japanese encephalitis virus in Nepal, including mountain areas, is established but Japanese encephalitis remains rare in travelers returning from this area and neurologist physicians need to become familiar with this. We recommend vaccination for travelers spending a long period of time in Nepal and having at-risk outdoor activities.
Collapse
|
35
|
Li XD, Li XF, Ye HQ, Deng CL, Ye Q, Shan C, Shang BD, Xu LL, Li SH, Cao SB, Yuan ZM, Shi PY, Qin CF, Zhang B. Recovery of a chemically synthesized Japanese encephalitis virus reveals two critical adaptive mutations in NS2B and NS4A. J Gen Virol 2013; 95:806-815. [PMID: 24362961 DOI: 10.1099/vir.0.061838-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A full-length genome infectious clone is a powerful tool for functional assays in virology. In this study, using a chemical synthesized complete genome of Japanese encephalitis virus (JEV) strain SA14 (GenBank accession no. U14163), we constructed a full-length genomic cDNA clone of JEV. The recovered virus from the cDNA clone replicated poorly in baby hamster kidney (BHK-21) cells and in suckling mice brain. Following serial passage in BHK-21 cells, adaptive mutations within the NS2B and NS4A proteins were recovered in the passaged viruses leading to viruses with a large-plaque phenotype. Mutagenesis analysis, using a genome-length RNA and a replicon of JEV, demonstrated that the adaptive mutations restored replication to different degrees, and the restoration efficiencies were in the order: NS2B-T102M<NS4A-R79K<NS2B-T102M+NS4A-R79K. An in vivo virulence assay in mice showed that the recombinant virus containing double mutations showed similar virulence to the WT SA14 (GenBank accession no. M55506). This study reports the first chemically synthesized JEV. A reverse genetics assay demonstrated that substitutions of NS2B-T102M and NS4A-R79K altered JEV replication.
Collapse
Affiliation(s)
- Xiao-Dan Li
- University of Chinese Academy of Sciences, Beijing 100049, PR China.,Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, PR China
| | - Xiao-Feng Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China
| | - Han-Qing Ye
- Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, PR China
| | - Cheng-Lin Deng
- Key Laboratory of Agricultural and Environmental Microbiology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, PR China.,Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, PR China
| | - Qing Ye
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China
| | - Chao Shan
- University of Chinese Academy of Sciences, Beijing 100049, PR China.,Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, PR China
| | - Bao-Di Shang
- University of Chinese Academy of Sciences, Beijing 100049, PR China.,Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, PR China
| | - Lin-Lin Xu
- University of Chinese Academy of Sciences, Beijing 100049, PR China.,Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, PR China
| | - Shi-Hua Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China
| | - Sheng-Bo Cao
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, Hubei 430070, PR China
| | - Zhi-Ming Yuan
- Key Laboratory of Agricultural and Environmental Microbiology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, PR China.,Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, PR China
| | - Pei-Yong Shi
- Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA
| | - Cheng-Feng Qin
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, PR China
| | - Bo Zhang
- Key Laboratory of Agricultural and Environmental Microbiology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, PR China.,Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, PR China
| |
Collapse
|
36
|
Secondary cervical dystonic tremor after Japanese encephalitis. Neurol Sci 2013; 35:491-3. [PMID: 24249222 DOI: 10.1007/s10072-013-1579-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 11/08/2013] [Indexed: 10/26/2022]
|