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Wang G, Zhong L, Wang M, Zhou J, Liu S, Miao W, Li L, Liu Y, Guo S, Li H, Wang X, Xie L, Xie M, Fu S, Xuan T, Li F, Yang T, Shao L, Shi M, Li X, Li X, Gao L, Zhai S, Ding J, Wang T, Liu D, Ma G, Wu J, Wan D, Guo J, Zhang X, Wu J, Wang Y, Jin A, Ma L, Yang H, He X, Ma X, Liu H, Ma B, Yang N, Hou X, Xu T, Qin CF, Wang H, Xie P, Wang Z. Peripheral nerve injury associated with JEV infection in high endemic regions, 2016-2020: a multicenter retrospective study in China. Emerg Microbes Infect 2024; 13:2337677. [PMID: 38578315 PMCID: PMC11036900 DOI: 10.1080/22221751.2024.2337677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
Previously, we reported a cohort of Japanese encephalitis (JE) patients with Guillain-Barré syndrome. However, the evidence linking Japanese encephalitis virus (JEV) infection and peripheral nerve injury (PNI) remains limited, especially the epidemiology, clinical presentation, diagnosis, treatment, and outcome significantly differ from traditional JE. We performed a retrospective and multicenter study of 1626 patients with JE recorded in the surveillance system of the Chinese Center for Disease Control and Prevention, spanning the years 2016-2020. Cases were classified into type 1 and type 2 JE based on whether the JE was combined with PNI or not. A comparative analysis was conducted on demographic characteristics, clinical manifestations, imaging findings, electromyography data, laboratory results, and treatment outcomes. Among 1626 laboratory confirmed JE patients, 230 (14%) were type 2 mainly located along the Yellow River in northwest China. In addition to fever, headache, and disturbance of consciousness, type 2 patients experienced acute flaccid paralysis of the limbs, as well as severe respiratory muscle paralysis. These patients presented a greater mean length of stay in hospital (children, 22 years [range, 1-34]; adults, 25 years [range, 0-183]) and intensive care unit (children, 16 years [range, 1-30]; adults, 17 years [range, 0-102]). The mortality rate was higher in type 2 patients (36/230 [16%]) compared to type 1 (67/1396 [5%]). The clinical classification of the diagnosis of JE may play a crucial role in developing a rational treatment strategy, thereby mitigating the severity of the disease and potentially reducing disability and mortality rates among patients.
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Affiliation(s)
- Guowei Wang
- The First Clinical Medical School, Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Lianmei Zhong
- Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Manxia Wang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, People’s Republic of China
| | - Juan Zhou
- Guangzhou Women and Children’s Medical Center, Guangzhou, People’s Republic of China
| | - Shuting Liu
- Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Wang Miao
- Neuro-Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Leilei Li
- West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Yonghong Liu
- Department of Neurology, Xijing Hospital, The Air Force Medical University, Xi’an, People’s Republic of China
| | - Shougang Guo
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Haining Li
- Neurology Center, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Xiaoming Wang
- The Affiliated Hospital of North Sichuan Medical College, Nanchong, People’s Republic of China
| | - Liuqing Xie
- Meishan People’s Hospital, Meishan, People’s Republic of China
| | - Min Xie
- Chengdu Seventh People’s Hospital, Chengdu, People’s Republic of China
| | - Shihong Fu
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Tingting Xuan
- The First Clinical Medical School, Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Fan Li
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Tingting Yang
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
- Diagnosis and Treatment Engineering Technology Research Center of Nervous System Diseases of Ningxia, Yinchuan, People’s Republic of China
| | - Lufei Shao
- Neurology Center, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Mingfang Shi
- Department of Pediatrics, Yibin Hospital, Children's Hospital of Chongqing Medical University, Yibin, People’s Republic of China
| | - Xiaocong Li
- The First Clinical Medical School, Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Xiaoling Li
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, People’s Republic of China
| | - Li Gao
- Baoji Central Hospital, Baoji, People’s Republic of China
| | - Shaopeng Zhai
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, People’s Republic of China
| | - Jia Ding
- The First People’s Hospital of Tianshui, Tianshui, People’s Republic of China
| | - Tianhong Wang
- The First Hospital of Lanzhou University, Lanzhou, People’s Republic of China
| | - Dayong Liu
- The Affiliated Hospital of Gansu Medical College, Pingliang, People’s Republic of China
| | - Guosheng Ma
- Gansu Provincial People’s Hospital, Lanzhou, People’s Republic of China
| | - Jiang Wu
- The First People’s Hospital of Longnan, Longnan, People’s Republic of China
| | - Dongjun Wan
- The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou, People’s Republic of China
| | - Junlin Guo
- Qingyang People's Hospital, Qingyang, People’s Republic of China
| | - Xinbo Zhang
- Department of Neurology, Xijing Hospital, The Air Force Medical University, Xi’an, People’s Republic of China
| | - Jinxia Wu
- Department of Pediatrics, Yibin Hospital, Children's Hospital of Chongqing Medical University, Yibin, People’s Republic of China
| | - Yinxu Wang
- The Affiliated Hospital of North Sichuan Medical College, Nanchong, People’s Republic of China
| | - Ansong Jin
- The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Lei Ma
- Emergency Center, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Huan Yang
- Emergency Center, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Xuexian He
- Cerebrospinal Fluid Laboratory, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Xiaona Ma
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
- Diagnosis and Treatment Engineering Technology Research Center of Nervous System Diseases of Ningxia, Yinchuan, People’s Republic of China
| | - Huijuan Liu
- Department of Infectious Diseases, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Boya Ma
- Neurology Center, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Ningai Yang
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
- Diagnosis and Treatment Engineering Technology Research Center of Nervous System Diseases of Ningxia, Yinchuan, People’s Republic of China
| | - Xiaolin Hou
- Neurology Center, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Ting Xu
- General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Cheng-feng Qin
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People’s Republic of China
| | - Huanyu Wang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Peng Xie
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, Chongqing, People’s Republic of China
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Zhenhai Wang
- Neurology Center, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
- Diagnosis and Treatment Engineering Technology Research Center of Nervous System Diseases of Ningxia, Yinchuan, People’s Republic of China
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Wang Y, Guo J, Yang F, Dong R, Song D, Huang P, Wen L, Xiang G, Wang S, Teng J, Miao W. Predictive effect of the decline in CD4 + T cell levels in blood on infection in patients with severe hemorrhagic stroke and mechanism. Front Neurol 2023; 14:1118282. [PMID: 37360336 PMCID: PMC10288285 DOI: 10.3389/fneur.2023.1118282] [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] [Received: 01/16/2023] [Accepted: 05/03/2023] [Indexed: 06/28/2023] Open
Abstract
Objective The purpose of this research was to evaluate the influence of immunity on infection in patients with severe hemorrhagic stroke and explore the mechanism underlying this connection. Methods Clinical data obtained from 126 patients with severe hemorrhagic stroke were retrospectively analyzed, and the factors affecting infection were screened by multivariable logistic regression models. Nomograms, calibration curves, the Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis were used to examine the effectiveness of the models in evaluating infection. The mechanism underlying the reduction in CD4+ T-cell levels in blood was explored by analysis of lymphocyte subsets and cytokines in cerebrospinal fluid (CSF) and blood. Results The results showed that CD4+ T-cell levels of <300/μL was an independent risk factor for early infection. The models for multivariable logistic regression involving the CD4+ T-cell levels and other influencing factors had good applicability and effectiveness in evaluating early infection. CD4+ T-cell levels decreased in blood but increased in CSF. Similarly, interleukin (IL)-6 and IL-8 levels in CSF had a significant increase, generating a substantial concentration gradient between the CSF and the blood. Conclusion Reduced blood CD4+ T-cell counts among patients who had severe hemorrhagic stroke increased the risk of early infection. CSF IL-6 and IL-8 may be involved in inducing the migration of CD4+ T cells into the CSF and decreasing blood CD4+ T-cell levels.
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Affiliation(s)
- Yating Wang
- Neuro-Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Junshuang Guo
- Neuro-Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Department of Immunology, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - Fan Yang
- Neuro-Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ruirui Dong
- Neuro-Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Dandan Song
- Neuro-Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Peipei Huang
- Neuro-Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lijun Wen
- Neuro-Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Guoliang Xiang
- Neuro-Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Shuiyu Wang
- Neuro-Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Junfang Teng
- Neuro-Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wang Miao
- Neuro-Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Cole E, Boast A, Yiu EM, Kornberg AJ, Jadhav T, Mignone C, Abo YN, Britton PN, Osowicki J, Macdonald-Laurs E. Geographic Expansion of Japanese Encephalitis Virus to Australia: Neuroinflammatory Sequelae and Consideration of Immunomodulation. Pediatr Infect Dis J 2023; 42:e173-e176. [PMID: 36795573 DOI: 10.1097/inf.0000000000003861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
We report a child from Southern Australia (New South Wales) who presented during a La Niña event with encephalopathy and acute flaccid paralysis. Magnetic resonance imaging suggested Japanese encephalitis (JE). Steroids and intravenous immunoglobulin did not improve symptoms. Therapeutic plasma exchange (TPE) resulted in rapid improvement and tracheostomy decannulation. Our case illustrates the complex pathophysiology of JE, its' geographic expansion into Southern Australia and potential use of TPE for neuroinflammatory sequelae.
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Affiliation(s)
| | - Alison Boast
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Eppie M Yiu
- From the Department of Neurology
- Murdoch Children's Research Institute, Melbourne Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | | | | | | | - Yara-Natalie Abo
- Murdoch Children's Research Institute, Melbourne Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Microbiology, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Philip N Britton
- Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Joshua Osowicki
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Emma Macdonald-Laurs
- From the Department of Neurology
- Murdoch Children's Research Institute, Melbourne Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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Betterle C, Furmaniak J, Sabbadin C, Scaroni C, Presotto F. Type 3 autoimmune polyglandular syndrome (APS-3) or type 3 multiple autoimmune syndrome (MAS-3): an expanding galaxy. J Endocrinol Invest 2023; 46:643-665. [PMID: 36609775 DOI: 10.1007/s40618-022-01994-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/13/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND The number of recognised distinct autoimmune diseases (AIDs) has progressively increased over the years with more than 100 being reported today. The natural history of AIDs is characterized by progression from latent and subclinical to clinical stages and is associated with the presence of the specific circulating autoantibodies. Once presented, AIDs are generally chronic conditions. AIDs have the tendency to cluster and co-occur in a single patient. Autoimmune thyroid diseases (AITD) are the most prevalent of AIDs in the world population, and about one-third of the AITD patients also present with a non-thyroid AID during their life-span. Furthermore, patient with non-thyroid AIDs often presents with a form of AITD as a concurrent condition. Many of the clusters of AIDs are well characterized as distinctive syndromes, while some are infrequent and only described in case reports. PURPOSE In this review, we describe the wide spectrum of the combinations and the intricate relationships between AITD and the other AIDs, excluding Addison's disease. These combinations are collectively termed type 3 Autoimmune Polyglandular Syndrome (APS-3), also called type 3 Multiple Autoimmune Syndrome (MAS-3), and represent the most frequent APS in the world populations. CONCLUSIONS Numerous associations of AITD with various AIDs could be viewed as if the other AIDs were gravitating like satellites around AITD located in the center of a progressively expanding galaxy of autoimmunity.
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Affiliation(s)
- C Betterle
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy.
- Chair of Clinical Immunology and Allergy, Department of Medical and Surgical Sciences, University of Padua Medical School, Via Ospedale Civile 105, 35128, Padua, Italy.
| | | | - C Sabbadin
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - C Scaroni
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - F Presotto
- Unit of Internal Medicine, Ospedale Dell'Angelo, Mestre-Venice, Italy
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Guo J, Wang Y, Zhang M, Zheng H, Zang Q, Huang P, Wen L, Song D, Yang F, Dong R, Miao W. Human parvovirus B19 infection in hospitalized patients suspected of infection with pathogenic microorganism. Front Cell Infect Microbiol 2022; 12:1083839. [PMID: 36619750 PMCID: PMC9812433 DOI: 10.3389/fcimb.2022.1083839] [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] [Received: 10/29/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background Human parvovirus B19 (HPV B19) is a single-stranded DNA virus. The detection rate of HPV B19 in the blood of healthy blood donors using PCR technology was reported to be 6.323/100000. However, that among hospitalized patients suspected of being infected with a pathogenic microorganism is unknown. Methods A retrospective analysis was conducted on 2,182 high-throughput NGS results for 1,484 inpatients admitted to the First Affiliated Hospital of Zhengzhou University from January 2020 to October 2021 who were suspected of being infected with a pathogenic microorganism, as well as on clinical data of some HPV B19-positive patients. Results Human parvovirus B19 was detected in 39 samples from 33 patients. The positivity rate was 2.22% among patients and 1.78% among samples. HPV B19 was detected in 20 cerebrospinal fluid samples, 13 blood samples, 3 alveolar lavage fluid samples, 2 tissue samples, and 1 throat swab. Based on clinical symptoms and NGS results, 16 patients were diagnosed with HPV B19 infection. The number of HPV B19 sequences in these patients was greater than 6, and the patients showed common symptoms such as fever (14 cases), anemia (11 cases), and severe nervous system symptoms such as meningoencephalitis (9 cases) and Guillain-Barré syndrome with peripheral motor and sensory nerve axon damage (4 cases). All 16 patients had experienced events likely to lead to decreased immunity (11 had a history of trauma/surgery/major disease, 4 had a history of precursor infection, and 3 had used immunosuppressants) and 7 had a history of blood transfusion during hospitalization. After treatment with antiviral drugs (12 cases) and intravenous human immunoglobulin (3 cases), of the 16 patients, 14 patients improved. Conclusion The HPV B19 infection rate in hospitalized patients suspected of microbial infection was 2.22%. Most patients with HPV B19 infection had a history of low immunity and blood transfusion. HPV B19 could be detected in various bodily fluids and tissues (especially cerebrospinal fluid) using NGS. Patients with severe HPV B19 infection may have nervous system damage such as Guillain-Barré syndrome and meningoencephalitis. Early diagnosis using NGS and treatment with antiviral drugs and immunoglobulin can improve prognosis.
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Affiliation(s)
- Junshuang Guo
- Neuro-Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China,Department of Immunology, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - Yating Wang
- Neuro-Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Mian Zhang
- General intensive care unit of Zhengzhou Seventh People’s Hospital, Zhengzhou, Henan, China
| | - Hongxiang Zheng
- General intensive care unit of Zhengzhou Seventh People’s Hospital, Zhengzhou, Henan, China
| | - Qiuling Zang
- Neuro-Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Peipei Huang
- Neuro-Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lijun Wen
- Neuro-Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Dandan Song
- Neuro-Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Fan Yang
- Neuro-Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ruirui Dong
- Neuro-Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wang Miao
- Neuro-Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China,*Correspondence: Wang Miao,
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Liu S, Wang J, Yang J, Wen Y. The underlying mechanism of Guillain-Barré syndrome in a young patient suffered from Japanese encephalitis virus infection: a case report. Virol J 2022; 19:139. [PMID: 36050705 PMCID: PMC9434870 DOI: 10.1186/s12985-022-01870-7] [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: 05/24/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background The presentation of Guillain–Barré syndrome (GBS) caused by Japanese encephalitis virus (JEV) is uncommon, although clusters of GBS cases were observed in China in 2018. The underlying mechanism is unclear, particularly in individuals vaccinated against Japanese encephalitis in childhood. Case presentation We report a patient with acute flaccid paralysis involving four extremities and respiratory muscles, while magnetic resonance imaging of the brain and spine were standard. Electrophysiological examination displayed slowed motor nerve conduction speed and reduced evoked velocity amplitude. GBS was finally considered which was related to JEV infection verified by positive anti-JEV immunoglobulin M antibody and positive immunoglobulin G antibody in the serum. Unfortunately, the patient refused intravenous immunoglobulin and declined the use of mechanical ventilation again. He voluntarily withdrew from the hospital and died on the 36th day after the onset of illness. We also performed a review of previously reported related cases and discussed the underlying mechanism. Conclusion JEV infection-associated GBS is unusual. We should pay attention to the atypical manifestations of JEV infection and explore possible pathogenesis in particular individuals.
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Affiliation(s)
- Sheng Liu
- Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, China
| | - Jinyong Wang
- Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, China
| | - Jun Yang
- Neurology Department, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.
| | - Ying Wen
- Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, China.
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