Viral etiologies in adult patients with encephalitis in Poland: A prospective single center study.

Marta Popiel,Tomasz Dzieciątkowski,Marek Radkowski,Iwona Bukowska-Ośko,Karol Perlejewski,Agnieszka Pawełczyk,Tomasz Laskus,Agnieszka Bednarska,Maria Fic,Marcin Paciorek,Monika Jabłonowska,Hanna Czeszko-Paprocka,Dariusz Lipowski,Andrzej Horban,Kamila Caraballo Cortes,Tobias Derfuss

doi:10.1371/journal.pone.0178481

Marta Popiel, Tomasz Dzieciątkowski + Show 14 more

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https://doi.org/10.1371/journal.pone.0178481

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Journal: PloS one	Publication Date: Jun 1, 2017
Citations: 15	License type: CC BY 4.0

Affiliation: Medical University of Warsaw

Abstract

Encephalitis is a severe neurological syndrome associated with high morbidity and mortality as well as long-term neurological sequelae. Despite being an important public health problem, very few extensive population-based studies were conducted so far in the world and none in Central Europe. Altogether 114 consecutive patients meeting the initial criteria for encephalitis were enrolled at the Warsaw Hospital for Infectious Diseases between June 2012 and July 2015. Eighteen patients were secondarily excluded from the analysis due to incomplete data or noinfectious cause. Potential pathogen sequences were searched for by molecular methods in the cerebrospinal fluid (CSF) and specific antibodies were detected in CSF and sera. An infectious agent was identified in 41 patients (42.7%). The most frequently diagnosed infections were Human herpesvirus 1 (HHV-1) (22 cases, 24%) followed by Enterovirus (6 cases, 6.3%), Varicella zoster virus (VZV) (5 cases, 5.2%), Tick-borne encephalitis virus (TBEV) (6 cases, 6.3%) and Cytomegalovirus (CMV) (2 cases, 2.1%). There were no cases of human adenovirus, Human herpesvirus 6 (HHV-6) or West Nile virus (WNV) infection identified. In 55 cases (57.3%) the cause of encephalitis remained unknown. Compared to patients in whom the diagnosis was determined the latter group contained more women, was less likely to manifest fever and had lower CSF pleocytosis (p < 0.05) In summary, we identified HHV-1 followed by Enterovirus, VZV and TBEV as the most common causes of encephalitis among adult patients in Poland. In a large proportion of patients the cause of encephalitis remained unknown.

Highlights

Encephalitis is a severe neurological syndrome associated with high morbidity and mortality as well as long-term neurological sequelae and imposes a severe burden on the health care systems [1]
Novel developments related to the increased travel and mobility were the spread of Japanese encephalitis virus (JEV) into India, Nepal and Australia and several outbreaks of Chikungunya virus infection in the Indian Ocean islands and India [13]
114 patients meeting the initial criteria of encephalitis were enrolled between June 2012 and July 2015

Summary

Introduction

Encephalitis is a severe neurological syndrome associated with high morbidity and mortality as well as long-term neurological sequelae and imposes a severe burden on the health care systems [1]. The most common causative agents of encephalitis are Human herpes virus type 1 (HHV-1); followed by varicella zoster virus (VZV) [1,3,4,5,7,8,9], while other herpesviruses like Epstein-Barr virus (EBV), cytomegalovirus (CMV) and human herpesvirus 6 (HHV-6) are less common and largely limited to immunocompromised patients [4,5] Another important cause of encephalitis are arthropod-borne viruses (arboviruses) from the Flaviviridae family: West Nile virus (WNV) and Tick-borne encephalitis virus (TBEV) [10]. Nothwithstanding significant progress in diagnostics, in a large proportion of cases (40%-80%) the etiology remains unknown [5,15]

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