Cases Of Viral Encephalitis Research Articles

(Re-)Emergence of Oropouche Virus (OROV) Infections: Systematic Review and Meta-Analysis of Observational Studies.

Oropouche Virus (OROV; genus of Orthobunyavirus) is the causal agent of Oropouche Fever (OF). Due to the lack of specific signs and symptoms and the limited availability of diagnostic tests, the actual epidemiology of OROV infections and OF has been extensively disputed. In this systematic review with meta-analysis, a literature search was carried out in PubMed, Scopus, EMBASE, and MedRxiv in order to retrieve relevant articles on the documented occurrence of OROV infections. Pooled detection rates were then calculated for anti-OROV antibodies and virus detection (i.e., viral RNA detected by viral cultures and/or real-time polymerase chain reaction [RT-qPCR]). Where available, detection rates for other arboviruses (i.e., Dengue [DENV], Chikungunya [CHKV], and Zika Virus [ZIKV]) were calculated and compared to those for OROV. A total of 47 studies from South America and the Caribbean were retrieved. In individuals affected by febrile illness during OROV outbreaks, a documented prevalence of 0.45% (95% confidence interval [95%CI] 0.16 to 1.12) for virus isolation, 12.21% (95%CI 4.96 to 27.09) for seroprevalence (including both IgM and IgG class antibodies), and 12.45% (95%CI 3.28 to 37.39) for the detection of OROV-targeting IgM class antibodies were eventually documented. In the general population, seroprevalence was estimated to be 24.45% (95%CI 7.83 to 55.21) for IgG class antibodies. The OROV detection rate from the cerebrospinal fluids of suspected cases of viral encephalitis was estimated to be 2.40% (95%CI 1.17 to 5.03). The occurrence of OROV infections was consistently lower than that of DENV, CHKV, and ZIKV during outbreaks (Risk Ratio [RR] 24.82, 95%CI 21.12 to 29.16; RR 2.207, 95%CI 1.427 to 3.412; and RR 7.900, 95%CI 5.386 to 11.578, respectively) and in the general population (RR 23.614, 95%CI 20.584 to 27.129; RR 3.103, 95%CI 2.056 to 4.685; and RR 49.500, 95%CI 12.256 to 199.921, respectively). In conclusion, our study stresses the possibly high underestimation of OROV prevalence in the general population of South America, the potential global threat represented by this arbovirus infection, and the potential preventive role of a comprehensive "One Health approach".

Epidemiological characteristic of viral encephalitis in children and adolescents in Henan Province, 2012-2023

Objective: To understand the epidemiological characteristics and spatiotemporal distribution of viral encephalitis in children and adolescents in Henan Province from 2012 to 2023. Methods: The information about viral encephalitis cases from October 1, 2012 to July 26, 2023 were collected from Zhengzhou Children's Hospital (National Children's Regional Medical Center),Henan Provincial Children's Hospital for the analyses on temporal distribution the cases, the severe illness rate, age distribution, pathogen type and imaging findings of the cases. Results: A total of 6 276 cases of viral encephalitis were included in this study after excluding cases with incomplete information. The cases mainly originated from Zhengzhou (38.96%), followed by Zhoukou (9.93%), Xuchang (8.68%), Zhumadian (7.90%) and Pingdingshan (7.39%). The cases in boys accounted for 62.13% and the cases in girls accounted for 37.87%. Most cases (72.45%) occurred in age group 7-13 years. The overall rate of severe illness cases was 4.51% from 2012 to 2023. There were significant differences in severe illness cases among different areas and years (χ2=5.33,P=0.021; χ2=48.14,P<0.001). Enteroviruses were mainly detected (31.57%), in which Coxsackie virus was predominant (58.37%). Imaging findings showed that cerebral hemisphere damage was most common in children and adolescents with viral encephalitis (54.93%). Conclusions: From 2012 to 2023, more cases of viral encephalitis occurred in boys in Henan. Children and adolescents aged 7-13 years were the main affected group. The prevention of enteroviruses infection, especially Coxsackie virus, needs to be strengthened. Special attention should be paid to the prevention of cerebral hemisphere damage after viral encephalitis diagnosis.

Epstein-Barr virus (EBV) DNAemia in saliva of viral encephalitis and nasopharyngeal carcinoma patients.

Epstein-Barr virus (EBV) is a lymphotropic virus that causes diseases ranging from a flu-like illness called infectious mononucleosis to nasopharyngeal carcinoma, Burkitt's lymphoma, and central nervous system (CNS) infection. Detection of EBV DNA is usually done using whole blood samples taken from the patients. We undertook the detection of EBV in blood, cerebrospinal fluid (CSF), and saliva by real-time quantitative PCR in two patients, one with a history of nasopharyngeal carcinoma, and the other having a case of viral encephalitis. EBV was detected only in saliva, whole blood in both patients, and CSF in the second case tested negative. This case series illustrates the importance of testing for EBV DNAemia in saliva by real-time polymerase chain reaction (PCR) to rule in a diagnosis of EBV.

Incongruence between confirmed and suspected clinical cases of Japanese encephalitis virus infection.

Japanese encephalitis (JE) is a notifiable infectious disease in China. Information on every case of JE is reported to the superior health administration department. However, reported cases include both laboratory-confirmed and clinically diagnosed cases. This study aimed to differentiate between clinical and laboratory-confirmed cases of Japanese encephalitis virus (JEV) infection, and improve the accuracy of reported JE cases by analyzing the acute-phase serum and cerebrospinal fluid of all reported JE cases in the Sichuan province from 2012 to 2022. All acute-phase serum and/or cerebrospinal fluid samples of the reported JE cases were screened for IgM(ImmunoglobulinM)to JEV using the enzyme-linked immunosorbent assay (ELISA), and the detection of the viral genes of JEV and 9 other pathogens including enterovirus (EV), using reverse transcription PCR was attempted. Epidemiological analyses of JE and non-JE cases based on sex, age, onset time, and geographical distribution were also performed. From 2012 to 2022, 1558 JE cases were reported in the Sichuan province. The results of serological (JEV-specific IgM) and genetic testing for JEV showed that 81% (1262/1558) of the reported cases were confirmed as JEV infection cases (laboratory-confirmed cases). Among the 296 cases of non-JEV infection, 6 viruses were detected in the cerebrospinal fluid in 62 cases, including EV and the Epstein-Barr virus (EBV), constituting 21% (62/296) of all non-JE cases. Among the 62 non-JEV infection cases with confirmed pathogens, infections with EV and EBV included 17 cases each, herpes simplex virus (HSV-1/2) included 14 cases, varicella- zoster virus included 6 cases, mumps virus included 2 cases, and human herpes viruses-6 included 1 case. Additionally, there were five cases involving mixed infections (two cases of EV/EBV, one case of HSV-1/HSV-2, one case of EBV/HSV-1, and one case of EV/herpes viruses-6). The remaining 234 cases were classified as unknown viral encephalitis cases. Our analysis indicated that those aged 0-15 y were the majority of the patients among the 1558 reported JE cases. However, the incidence of laboratory-confirmed JE cases in the >40 y age group has increased in recent years. The temporal distribution of laboratory-confirmed cases of JE revealed that the majority of cases occurred from May to September each year, with the highest incidence in August. The results of this study indicate that there is a certain discrepancy between clinically diagnosed and laboratory-confirmed cases of JE. Each reported case should be based on laboratory detection results, which is of great importance in improving the accuracy of case diagnosis and reducing misreporting. Our results are not only important for addressing JE endemic to the Sichuan province, but also provide a valuable reference for the laboratory detection of various notifiable infectious diseases in China and other regions outside China.

The reemerging and outbreak of genotypes 4 and 5 of Japanese encephalitis virus.

The Japanese encephalitis virus (JEV) is classified into five distinct genotypes, with genotypes 1 and 3 historically showing higher activity. These genotypes are the primary agents of viral encephalitis in the Asian continent. Genotypes 4 and 5 have remained silent in low-latitude tropical regions since their discovery. From 2009, the hidden genotype 5 suddenly emerged simultaneously in mosquitoes from the Tibetan region of China and those from South Korea in East Asia. The detection of genotype 5 of JEV in these mosquitoes was associated with cases of viral encephalitis in the local population. Similarly, in 2022, the long-silent genotype 4 of JEV emerged in Australia, resulting in a local outbreak of viral encephalitis that primarily affected adults and caused fatalities. The emergence and outbreaks of genotypes 4 and 5 of JEV present new challenges for the prevention and control of Japanese encephalitis (JE). This study not only analyzes the recent emergence of these new genotypes but also discusses their implications in the development of JE vaccines and laboratory tests for newly emerging JEV infections.

RORB, an Alzheimer’s disease susceptibility gene, is associated with viral encephalitis, an Alzheimer’s disease risk factor

BackgroundViral encephalitis increases later-life risk of Alzheimer’s disease (AD) by a factor of 31. MethodsTo further evaluate this finding, we examined the relationship of West Nile virus (WNV) to Alzheimer’s disease in 50 US states. In addition, we performed a genome wide association study (GWAS) of viral encephalitis cases in UK Biobank (UKBB) to see if encephalitis genes might be related to AD. ResultsWNV was significantly associated with deaths from Alzheimer’s disease in 50 US states (r = 0.806, p < 0.001). One gene, RORB-AS1, was most significantly related on GWAS to viral encephalitis. RORB-AS1 (RORB Antisense RNA 1) is an RNA gene. Diseases associated with RORB-AS1 include childhood epilepsy and idiopathic generalized epilepsy. The closely related RORB (Related Orphan Receptor B) is a marker of selectively AD vulnerable excitatory neurons in the entorhinal cortex; these neurons are depleted and susceptible to neurofibrillary inclusions during AD progression. RORB variants significantly decreased the risk of AD, independent of the significant effects of epilepsy, age, and years of education. The total effect size of variant RORB on AD prevalence is small, 0.19%, probably the reason RORB has not turned up on genome wide association studies of AD. But the decrease in effect size on AD, no variant versus varian is larger 0.20–0.16%. To produce the 31-fold increase in AD risk associated with viral encephalitis, non-variant RORB may need to interact with encephalitis virus. LimitationsA weakness in our correlative analysis is possible confounding by the ecological fallacy (or ecological inference fallacy), a logical fallacy in the interpretation of statistical data where inferences about the nature of individuals are derived from inference for the group to which those individuals belong. In this case, inferences about individuals are being drawn from the characteristics of U.S. states where they reside, rather than from the individuals themselves. A weakness in our GWAS is that UK Biobank had only 18 cases of viral encephalitis and none of these had AD. Conclusiondata presented here confirm the association of viral encephalitis with AD and suggest that WNV infection is a significant AD risk factor. In addition, GWAS suggests that the gene RORB, an AD vulnerability factor, is significantly related to viral encephalitis. Future prospects: A human WNV vaccine could reduce Alzheimer’s disease morbidity and mortality.

Etiological aspects of viral encephalitis explored using PCR-based cerebrospinal fluid analysis, considering patients’ HIV status

This study examined 124 patients suffering from acute viral encephalitis who were admitted to the Center for the Development of Professional Skills of Medical Personnel between 2014 and 2019. The research focused on the outcomes of cerebrospinal fluid PCR diagnostics in viral encephalitis cases, taking into account patients' HIV status. Findings revealed that PCR testing offers a more reliable diagnosis and, when lab resources permit, should be employed for CSF analysis to more accurately identify the etiological agent responsible for SVE. It is advised to repeat real-time PCR diagnostics of CSF in cases where the cause of SVE remains undetermined to improve detection rates of SVE's causative factors and enhance targeted therapy effectiveness, shifting from empirical and symptomatic to etiotropic approaches.

Bilateral Optic Neuritis After Administration of Inactivated COVID-19 Vaccine: A Case Report

Background: Since the beginning of the COVID-19 pandemic, various efforts have been taken to alleviate the spread of the severe acute respiratory syndrome coronavirus 2 (SARS CoV2). Studies have shown effective prevention and protection through vaccination. However, there have also been reports of neurologic diseases after vaccination. Case Presentation: The first case in the Philippines belonged to a 25-year-old female who initially sought a consult for the increased sleeping time associated with retrograde amnesia immediately after receiving her second dose of inactivated SARS-CoV-2 vaccine. She was then managed as a case of viral encephalitis. However, two weeks later, the patient developed a bilateral decline in visual acuity. Diagnostics included visual perimetry, routine EEG, contrast enhanced cranial MRI, and visual evoked potentials. The patient was then managed as a case of bilateral optic neuritis and was started on pulse methylprednisolone for 3 days with noted gradual but incomplete reversal of the condition. Conclusion: Autoimmune neurologic events after COVID-19 vaccination are treatable, and the benefits of the vaccination outweigh its risk.

Autoimmune Encephalitis-A Diagnostic Challenge for the Neurologist

Objective Autoimmune encephalitis, is a clinically challenging entity with varied neurological presentations. As autoimmune serology is negative in over 50% cases, our objective was to prioritise the use of electroencephalography supported by MRI Brain or PET–CT imaging to make a definitive diagnosis of autoimmune encephalitis. Background Autoimmune encephalitis is the consequence of an antibody mediated neuronal damage caused by cell surface antigens. However, antibody assays can be negative in early stages of the disease. Hence, we suggest the use of electroencephalogram along with MRI brain imaging or PET-CT scans to avoid diagnostic delays. Design/Methods During a span of four years [2018–2022] a retrospective review of the case records of 50 patients of autoimmune encephalitis and 50 patients of non-autoimmune encephalitis were compared. Besides clinical examination, serum and cerebrospinal fluid viral and autoimmune antibody assay, electroencephalogram, Magnetic Resonance and FDG-PET- CT scans were used to confirm the diagnosis. Results 60% patients were seronegative and 40 % were seropositive in the autoimmune group while 90% were seropositive and 10% seronegative in the non-autoimmune encephalitis group. Electroencephalography was abnormal in all cases of autoimmune encephalitis 100% [50/50] and in 80% [40/50] cases of viral encephalitis. In autoimmune encephalitis, MRI Brain revealed evidence of limbic encephalitis in 80% cases and FDG PET-CT scans were abnormal in the remaining 20%. In non-autoimmune encephalitis, MRI Brain was abnormal in 60% cases and FDG PET-CT was abnormal in 10%. Conclusions In seronegative autoimmune encephalitis, electroencephalographic abnormalities supported by MRI Brain imaging and PET-CT scans enabled early diagnosis in 100% cases [p value &lt;0.001]. While in non-autoimmune encephalitis serology with electroencephalography, MRI Brain and PET-CT scans were diagnostic in 80% cases [p value &lt;0.001]. However, as the sample size is small further studies are needed to confirm these findings.

Development and Validation of a Risk Score to Differentiate Viral and Autoimmune Encephalitis in Adults.

Encephalitis represents a challenging condition to diagnose and treat. To assist physicians in considering autoimmune encephalitis (AE) sooner, we developed and validated a risk score. The study was conducted as a retrospective cohort of patients with a diagnosis of definite viral encephalitis (VE) and AE from​​ February 2005 to December 2019. Clinically relevant and statistically significant features between cases of AE and VE were explored in a bivariate logistic regression model and results were used to identify variables for inclusion in the risk score. A multivariable logistic model was used to generate risk score values and predict risk for AE. Results were externally validated. A total of 1310 patients were screened. Of the 279 enrolled, 36 patients met criteria for definite AE and 88 criteria for definite VE. Patients with AE compared with VE were more likely to have a subacute to chronic presentation (odds ratio [OR] = 22.36; 95% confidence interval [CI], 2.05-243.7), Charlson comorbidity index <2 (OR = 6.62; 95% CI, 1.05-41.4), psychiatric and/or memory complaints (OR = 203.0; 95% CI, 7.57-5445), and absence of robust inflammation in the cerebrospinal fluid defined as <50 white blood cells/µL and protein <50 mg/dL (OR = 0.06; 95% CI, .005-0.50). Using these 4 variables, patients were classified into 3 risk categories for AE: low (0-1), intermediate (2-3), and high (4). Results were externally validated and the performance of the score achieved an area under the curve of 0.918 (95% CI, .871-.966). This risk score allows clinicians to estimate the probability of AE in patients presenting with encephalitis and may assist with earlier diagnosis and treatment.

Diagnostic Value of the Electroencephalogram and Cerebrospinal Fluid in Viral Encephalitis.

Electroencephalogram (EEG) and cerebrospinal fluid (CSF) are widely used in the clinical diagnosis of viral encephalitis (VE), but their value in the diagnosis of VE and the detection rate of abnormal indicators need to be further supported by more clinical data. In this study, routine laboratory testing, biochemical examinations of cerebrospinal fluid (CSF) and EEG characteristics were performed in patients with VE to guide the diagnosis and treatment of VE in clinical settings. A total of 330 patients with VE were enrolled in the Department of Neurology of the Third Affiliated Hospital of Zunyi Medical University from January 1, 2015 to January 30, 2020. EEG, routine testing and assessment of biochemical indicators of CSF were performed within 10 days after admission, and the results were analyzed by paired χ 2 test to compare the diagnostic value of EEG and CSF for VE. In 330 cases of VE, 283 cases (85.76%) had abnormal EEG, and 189 cases (57.27%) had abnormal CSF indicators. The incidence of EEG abnormalities was higher than that of CSF indicators, and the difference was statistically significant ( P <0.05). Both the EEG and CSF analysis are valuable indicators in the diagnosis of VE patients. Compared with the CSF examination, the EEG examination had a better diagnostic efficacy for the diagnosis of VE. In addition, a normal EEG or a normal CSF level cannot exclude VE, and it is still necessary to develop new diagnostic indicators to cover all viral encephalitides.

Multiparameter magnetic resonance imaging in the diagnosis of herpes encephalitis in children

Introduction. This study is determined with the high prevalence of encephalitis in children, as well as the severe course and the possible disability. Herpes encephalitis occurs in almost half of cases of viral encephalitis in children. It is known that changes on the brain magnetic resonance imaging (MRI) in the acute stage of the disease are detected more often than on brain computed tomography (CT), but the clarification of this brain MRI changes is needed.Objectives of the study. To assess the features of brain multiparametric MRI changes in herpes encephalitis in children.Materials and methods. Two groups of children were examined, the first group included 25 children aged 6,0±4,8 years with laboratory-confirmed acute EH, the second group (control) — 23 children without signs of central nervous system damage at the comparable gender and age. Structural changes were assessed using MRI of the brain in T1-WI, T2-WI, Flair, T1-WI modes post contrast, DWI, DTI and MR spectroscopy.Results. In 40% of cases revealed panencephalitis, 36% — leukoencephalitis, 24% — polioencephalitis. Most often, the process involved the cerebral hemispheres — 72%, the brain stem — 44%, the thalamus — 40% and basal nuclei — 36%. In 52% of cases changes in DWI were found, in 20% of cases the lesions accumulated contrast agent. There was a statistically significant decrease of FA both in the focus and in the intact area in children with EH compared with the control group.Conclusion. The application of multiparametric MRI using DWI, DTI, and MR spectroscopy methods are statistically significant for the detection and assessment of focal brain lesions in children with herpes encephalitis.

Scrub typhus meningoencephalitis in children

Background: Scrub typhus is being reported from different parts of India. Meningitis or meningoencephalitis among various neurological complication seen in scrub typhus is not uncommon. Delay in diagnosis may cause higher mortality without prompt treatment. The aim of the study was to describe the various manifestations of scrub typhus meningoencephalitis and their outcome from eastern part of India. Subjects and Methods: A prospective observational study of scrub meningoencephalitis was carried out at Kalinga Institute of Medical Sciences, between October 2018 and August 2020. The diagnosis was made based on the compatible clinical features, positive Scrub Ig M by ELISA and cerebrospinal fluid lymphocytosis (&gt;5 cell/cmm), after excluding other causes of meningoencephalitis. Results: Twenty-seven (12.38%) cases of scrub meningoencephalitis were included in the study with male (66.6%) predominance. All had presented with fever of mean duration of 8.5 days of illness. Altered sensorium and seizure was observed in 70.5% and 62.9% of our patients along with two patients who had sixth cranial nerve palsy. Eschar was found in 25.9% of our children. The mean CSF cell count, protein and glucose were 25 cells/cmm,84.2 mg/dL and 62.9 mg/dL respectively with lymphocytosis in all cases. There was no mortality in this study. Conclusion: Meningoencephalitis is an important complication of scrub typhus in children. Unlike most viral encephalitis cases, it has a definite treatment with good outcome, if treated early.

Adefovir dipivoxil efficiently inhibits the proliferation of pseudorabies virus in vitro and in vivo

Since 2011, highly pathogenic pseudorabies virus (PRV) variants that emerged on many farms in China have posed major economic burdens to the animal industry and have even recently caused several human cases of viral encephalitis. Currently, there are no approved effective drugs to treat PRV associated diseases in humans or pigs. Thus, it is important to develop a new effective drug for the treatment of PRV infection. To this end, we established a novel rapid method to screen drugs against PRV from 1818 kinds of small molecular drugs approved by the FDA. Using this method, we identified 21 kinds of them that can strongly suppress the proliferation of PRV. Mitoxantrone, puromycin dihydrochloride, mitoxantrone hydrochloride and adefovir dipivoxil effectively inhibited PRV in vitro. Of them, only adefovir dipivoxil could potently protect mice against lethal PRV infection. Our work identifies several kinds of potential therapeutics against PRV and may offer important guidance for controlling PRV epidemics and treating associated diseases in humans and animals.

A diagnostic dilemma: Laparoscopic approach in treating ovarian teratoma-associated anti-N-methyl-D-aspartate receptor encephalitis

A 24-year-old nulligravida who presented with seizures and behavioral changes with prodrome of flu-like symptoms was initially treated as a case of viral encephalitis. Neurologic diagnostic tests including electroencephalogram, cerebrospinal fluid analysis (CSF), and cranial magnetic resonance imaging were done and inconclusive. Patient's seizure attacks persisted and her neurologic status was deteriorating despite giving appropriate anti-epileptic medications, hence an autoimmune disease was highly considered. The CSF was positive for N-methyl-D-aspartate receptor antibodies. This prompted a search for an associated teratoma and revealed a diagnostic dilemma between presence of an ovarian new growth versus a normal enlarged ovary. Laparoscopy which is both diagnostic and therapeutic was utilized. This report highlights prompt recognition of a rare case and prevented its progression to a potentially fatal condition as resection of the tumor dramatically relieved the symptoms. The significance of minimally invasive surgery in managing this case, effect in fertility, and possible association with pelvic inflammatory disease are also discussed.

A Case of Acute Viral Encephalitis: Important Aspects and Related Literature Review of Sri Lankan Studies

Encephalitis in otherwise healthy and normal children causes many untimely deaths, giving rise to unexpected complications for physicians, forensic pathologists, and parents alike. Instead of resorting to extensive diagnostic options, aetiology can be identified in only around half of such cases. The case under discussion is a diagnosed case of viral encephalitis and the author attempts to discuss the multiple aspects surrounding the case. The victim was a previously healthy 9-year-old girl who presented with a three-day history of fever, vomiting, and altered consciousness with an episode of convulsion. No causative organism was identified while she was being treated. The histology revealed typical features of viral encephalitis along with other complications. The parental negligence could have been a contributory factor for her demise. Despite high fever with altered consciousness and convulsion, it had taken two days to diagnose her for having encephalitis upon admission. The forensic pathologist was inquired about the cause of her illness many times by the grieving parents. The parental grief was extensive in this case and the establishment of centres to deal with such encounters is suggested.

Intracranial hemorrhage with COVID 19 patient; case report

Coronavirus disease is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the majority of patients with COVID-19 typically have characteristic respiratory prese-ntations, a large number of patients were presented with multi-system affection included central nervous system. The neurotropic features of SARS-CoV-2 account for the damaging effects of this virus on the central nervous system. This was initially evidenced by reports from Beijing Ditan Hospital of the first case of viral encephalitis due to COVID 19. A growing number of case reports and series have been published describing the clinical characteristics of patients with ischemic strokes and COVID-19. These emerging reports, including large vessel occlusion, brain infarcts, venous thro-mboembolism and raised inflammatory markers. We reported a case of an intracranial hemorrhage (ICH) in our hospital in diabetic hypertensive patients infected with confirmed COVID 19.

Acute Viral Encephalitis Neuroimaging Spectrum

Acute viral encephalitis involves inflammation of the brain caused by multiple different viruses, with CT of the head and MR imaging of the brain involved in the initial diagnostic work-up. Although viral encephalitis may have nonspecific findings on neuroimaging, some imaging patterns have been identified in viral subtypes on MR imaging. The most common cause of encephalitis is herpes simplex virus, with the typical imaging features demonstrating unilateral medial temporal lobe signal abnormalities. Bilateral temporal lobe, cerebellum, and brain stem signal abnormalities are seen in herpes simplex virus 2, with associated edema, necrosis, and hemorrhage. Signal abnormalities are commonly seen in the bilateral basal ganglia, thalami, and mesial temporal lobes in West Nile virus encephalitis. HIV encephalitis is associated with symmetric signal abnormality in the periventricular and deep white matter, which can be differentiated from progressive multifocal leukoencephalopathy by asymmetric U-fiber involvement. The purpose of this article is to present imaging findings associated with typical and atypical cases of viral encephalitis to guide diagnosis, promote early intervention, and improve clinical outcomes.Learning Objective: Identify unique radiologic findings associated with different types of viral encephalitis to guide diagnosis and improve clinical outcomes.

Infectability of human BrainSphere neurons suggests neurotropism of SARS-CoV-2

Reports from Wuhan suggest that 36% of COVID-19 patients show neurological symptoms, and cases of viral encephalitis have been reported, suggesting that the virus is neurotropic under unknown circumstances. This is well established for other coronaviruses. In order to understand why some patients develop such symptoms and others do not, we address herein the infectability of the central nervous system (CNS). Reports that the ACE2 receptor – critical for virus entry into lung cells – is found in different neurons support this expectation. We employed a human induced pluripotent stem cell (iPSC)- derived BrainSphere model, which we used earlier for Zika, Dengue, HIV and John Cunningham virus infection studies. We detected the expression of the ACE2 receptor, but not TMPRSS2, in the model. Incubating the BrainSpheres for 6 hours with SARS-CoV-2 at a multiplicity of infection (MOI) of 0.1 led to infection of a fraction of neural cells with replication of the virus evident at 72 hpi. Virus particles were found in the neuronal cell body extending into apparent neurite structures. PCR measurements corroborated the replication of the virus, suggesting at least a tenfold increase in virus copies per total RNA. Leveraging state-of-the-art 3D organotypic cell culture, which has been shown to allow both virus infection and modeling of (developmental) neurotoxicity but is at the same time simple enough to be transferred and used in a BSL-3 environment, we demonstrate, for the first time, the potential critically important neurotropism of SARS-CoV-2.

Clinical, laboratory and immune aspects of Zika virus-associated encephalitis in children

ObjectiveTo evaluate the clinical, laboratory, and immune characteristics of Zika virus (ZIKV)-associated encephalitis in pediatric patients after the epidemic in Huila, southern Colombia. MethodsA pediatric neuro-surveillance hospital study was conducted in a referral health center in southern Colombia, from October 2016 to October 2017. Cases of encephalitis were confirmed by nucleic acid amplification tests and serological methods in cerebrospinal fluid (CSF), plasma, and/or urine. Levels of six cytokines were evaluated by flow cytometry. Patients underwent daily clinical and laboratory follow-up. ResultsTwenty children with probable encephalitis were included for further studies and 16 of them were confirmed. Four cases of bacterial meningoencephalitis (Streptococcus pneumoniae, group B Streptococcus, Staphylococcus epidermidis, and Escherichia coli) and 12 cases of viral encephalitis were identified, six of them associated with ZIKV infection. Other viral encephalitis cases were caused by herpes viruses (n=3), enterovirus (n=2), and dengue virus type 2 (DENV-2; n=1) infections. ZIKV-associated encephalitis symptoms subsided faster than those of patients with encephalitis caused by other agents. CSF analysis revealed lymphocytic pleocytosis. Compared to healthy controls, children with ZIKV-associated encephalitis presented modest plasma interleukin (IL)-10 but not IL-2, IL-4, IL-6, interferon gamma (IFN-γ), or tumor necrosis factor alpha (TNF-α). Cytokine expression was differentially regulated, as dramatically elevated IL-6, IL-10, and IFN-γ levels were observed in CSF but not in paired plasma samples in one of the patients with ZIKV detectable in CSF. ConclusionsThis study provides evidence that ZIKV is responsible for pediatric encephalitis in endemic areas, and the local presence of the virus may induce cephalic but not systemic expression of cytokines.