Abstract
This study is aimed at investigating the lymphocyte subsets of cerebrospinal fluid (CSF) to provide possible differential diagnostic values and better understand the pathophysiological mechanism underlying autoimmune encephalitis (AE) and infectious lymphocytic encephalitis. A series of CD markers, including CD3/4/8/20 representing different types and developmental stages of lymphocytes, were used to count the corresponding subpopulations of CSF from clinical and laboratory confirmed cases of anti-N-methyl-D-aspartate receptor AE (NMDAR-AE), herpes simplex virus encephalitis (HSVE), and tuberculous meningitis (TBM). The percentages of lymphocytes observed and the CD4 : CD8 ratios were compared between the three groups. There were no significant differences of the percentage of total lymphocytes, CD3 cells, and CD4 cells of CSF among each group. However, there were strongly statistical differences of the CD4 : CD8 ratio in CSF of each group with 0.6 : 1 in NMDAR-AE, 0.9 : 1 in HSVE, and 3.2 : 1 in TBM. The percentage of CD20 B lymphocytes in NMDAR-AE was statistically higher than that of other groups. The distinct percentages of lymphocyte subpopulations of CSF appeared to be characteristic and could potentially serve as diagnostic indicators. Further verification and research will be necessary to clarify the significance and nature of CD4 : CD8 ratios and B lymphocytes in CSF between AE and the infectious lymphocytic encephalitis.
Highlights
Autoimmune encephalitis (AE) is a group of newly recognized encephalitis syndromes associated with the autoantibodies to the antigen of neurons [1]
Before the antibody is successfully detected, it is to be misdiagnosed as other diseases with the similar clinical manifestations or cerebrospinal fluid (CSF) characteristics, such as herpes simplex virus encephalitis (HSVE), tuberculous meningitis (TBM), syphilis meningitis (SM), and Creutzfeldt-Jakob disease occasionally
There were no significant differences of the percentage of total lymphocytes and CD3 cells of CSF among each group (P = 0:784 and P = 0:535, respectively); the total WBC count in the NMDAR-AE group is lower than that of the HSVE and TBM groups
Summary
Autoimmune encephalitis (AE) is a group of newly recognized encephalitis syndromes associated with the autoantibodies to the antigen of neurons [1]. A confirmatory diagnosis of AE relies on the detection of autoantibodies; the antibody tests can be negative in the early onset stage of AE [3]. The pathophysiological mechanisms of NMDAR-AE are still incompletely understood [4]. Before the antibody is successfully detected, it is to be misdiagnosed as other diseases with the similar clinical manifestations or cerebrospinal fluid (CSF) characteristics, such as herpes simplex virus encephalitis (HSVE), tuberculous meningitis (TBM), syphilis meningitis (SM), and Creutzfeldt-Jakob disease occasionally. It had been evidenced that early diagnosis and treatment will predict a better prognosis for this treatable serious disorder of NMDAR-AE [5]. It is necessary to find newly differential diagnostic methods on these disorders
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