Cases Of Viral Encephalitis Research Articles

A case of central nervous system infection due to a novel Sandfly Fever Virus (SFV) variant: Sandfly Fever Turkey Virus (SFTV)

We present a case of viral encephalitis due to Sandfly Fever Turkey Virus (SFTV), a novel phlebovirus genetically related to but distinct from Sandfly Fever Sicilian Virus (SFSV), recently identified in a 63-year-old female, via consensus PCR and sequencing. SFTV was initially characterized in 2010 in samples from outbreaks of febrile diseases occurred during 2007–2008 and to the best of our knowledge, this is the first report of an SFTV-related central nervous system (CNS) infection.

Fatal Human Case of Western Equine Encephalitis, Uruguay

Fatal Human Case of Western Equine Encephalitis, Uruguay

EVALUATION OF THE UNITED KINGDOM NATIONAL EXTERNAL QUALITY ASSESSMENT SERVICE 2008 (UK NEQAS 2008) GUIDELINES FOR THE DIAGNOSIS OF SUBARACHNOID HEMORRHAGE USING SPECTROPHOTOMETRIC XANTHOCHROMIA: A RETROSPECTIVE STUDY

Objective: Evaluation of the UK NEQAS 2008 guidelines for the interpretation of spectrophotometric xanthochromia. Method: A search of the laboratory database for all the xanthochromia test results between May 1st 2008 and May 1st 2009 was performed. Medical charts were reviewed for patients of Hôpital de l’Enfant-Jésus (HEJ) that had at least one detectable pigment (bilirubin, oxyhemoglobin, or methemoglobin). Xanthochromia results obtained with 4 different criteria (Chalmers original, Modified Chalmers, Duiser and UK NEQAS 2008) were compared. Results: We reviewed 41 medical charts (2 patients with duplicate lumbar punctures (LP) for a total of 43 LP). For these 41 patients there were 11 positive xanthochromia results, 5 of which were in concordance with a final diagnosis of subarachnoid hemorrhage (SAH). The diagnosis of the 6 other positive xanthochromia results were as follow: meningeal spread of a lymphoma, cerebral amyloid angiopathy, exertional headache, viral encephalitis with a possibility of petechiaes on the cerebral CT and second LP. Interpretation (negative/positive) of 40/43 LP was identical for the 4 methods. 2 LP were positive with Duiser and UK NEQAS 2008 but negative with Chalmers approaches (final diagnosis: SAH and cerebral amyloid angiopathy). 1 LP was positive only by the Duiser method (viral encephalitis). Conclusions: UK NEQAS 2008 guidelines identified all SAH but are sensitive to traumatic and pathologic meningeal lesions. Except for a case of viral encephalitis with a suspicion of cerebral petechiaes on CT, UK NEQAS 2008 gave xanthochromia results similar to the one in use at HEJ (Duiser). Chalmers original and Modified Chalmers methods missed one of the five SAH.

Management of acute viral encephalitis in Brazil

The appropriate management of acute viral encephalitis is a challenge. Clinical picture includes general symptoms and a wide range of neurological signs. Etiological diagnosis cannot be performed only by clinical means and depends on neuroimaging studies and cerebrospinal fluid molecular analyses. It is recommended since some of these viruses are treatable and that the prognoses of these infections depend on the prompt administration of antiviral and/or immunomodulatory drugs. The management of acute viral encephalitis in Brazil has some peculiarities. First, the etiological distribution of the viral encephalitis may differ from what is found in other countries. Some viruses, such as dengue virus, are more common in Brazil than in developed countries while others, like West Nile virus, are not found here. Second, there are some regions in Brazil where neuroimaging and laboratorial methods are not available, and a clinical-based decision is the only therapeutic approach. As most of the guidelines in the literature are based on complimentary methods, it is relevant to establish an alternative approach compatible with the Brazilian health system reality. The goal of this study was to review the recent advances in the field of the acute viral encephalitis, to discuss the diagnosis and the treatment of the main etiologies of acute viral encephalitis found in Brazil, and to propose a viable guideline for the evaluation of the suspected acute viral encephalitis cases in the emergence room in Brazil.

Clinical observation of ganciclovir treatment for the young child viral encephalitis

Objective To observe effect of ganciclovir on the treatment of the young child viral encephalitis. Methods 68 cases of viral encephalitis were randomly divided into treatment group(45 cases) and the control group (23 cases), the two groups of children with clinical manifestations and treatment effects were observed. Results Headache, vomiting, convulsions symptoms and the resumption of the time was obviously shorter in treatment group than that of the control group, fever symptoms persisted despite the shortened time, but the difference was not statis- tically significant. Conclusion Ganciclovir in children with viral encephalitis have significant effect. Key words: Encephalitis, viral; Ganciclovir; Child

Flavivirus DNA Vaccines—Good Science, Uncertain Future

The flaviviruses are the most medically significant vectorborne viral pathogens in the world. Yellow fever virus and the 4 dengue virus serotypes are leading causes of viral hemorrhagic fever and shock, and Japanese encephalitis virus, West Nile virus, and tickborne encephalitis virus produce tens of thousands of cases of viral encephalitis annually [1, 2]. Although considerable resources are directed toward prevention and control efforts, many extant strategiesavoidance of exposure to vectors, vector control, and vaccination-are ineffective or have uncertain or low benefits relative to

Chandipura virus: A major cause of acute encephalitis in children in North Telangana, Andhra Pradesh, India

A hospital-based surveillance was undertaken between May 2005 and April 2006 to elucidate the contribution of Chandipura virus (CHPV) to acute viral encephalitis cases in children, seroconversion in recovered cases and to compare the seroprevalences of anti-CHPV IgM and N antibodies in areas reporting cases with those without any case of acute viral encephalitis. During this period, 90 cases of acute encephalitis were hospitalized in the pediatric wards of Mahatma Gandhi Memorial (MGM) Hospital, Warangal. There were 49 deaths (Case Fatality Rate, i.e., CFR of 54.4%). Clinical samples and records were obtained from 52 suspected cases. The cases were below 15 years, majority in 0-4 years (35/52, 67.3%). Computerized tomography (CT) scans and cerebro-spinal fluid (CSF) picture favored viral etiology. No neurological sequelae were observed. CHPV etiology was detected in 25 cases (48.1%, n = 52; RNA in 20, IgM in 3 and N antibody seroconversion in 2). JEV etiology was detected in 5 cases (IgM in 4 cases and seroconversion in 1 case). Anti-CHPV IgM seroprevalence in contacts (26/167, 15.6%) was significantly higher (P < 0.05) than in non-contacts (11/430, 2.6%); which was also observed in children <15 years (19/90, 21.1% vs. 3/109, 2.7%). Anti-CHPV N antibody seroprevalence in <15 years contacts (66/90, 73.3%) and non-contacts (77/109, 70.6%) was significantly lower (P < 0.05) than in contacts (75/77, 97.4%) and non-contacts (302/321, 94.1%) more than 15 years respectively. CHPV appears to be the major cause of acute viral encephalitis in children in endemic areas during early monsoon months.

Study of Japanese encephalitis and other viral encephalitis in Nepali children

A hospital-based prospective cross-sectional study was conducted in children aged 1 month-14 years to identify the proportion of viral encephalitis due to Japanese encephalitis (JE) and compare the clinico-laboratory profile and outcome of JE with that of other viral encephalitis (non-JE). All probable cases of viral encephalitis on clinical and laboratory evaluation were confirmed as JE on anti-JE IgM in cerebrospinal fluid (CSF) and/or serum. Patients not having anti-JE IgM in CSF and/or serum were diagnosed as having non-JE. Of 94 cases, 58 were JE and 36 non-JE. Although practice of rearing pigs at home was associated with JE (P = 0.0001), significantly higher serum creatinine, protein, aspartate aminotransferase and CSF protein levels were observed in non-JE. Longer duration of fever was associated with complete recovery in JE whereas shorter duration of fever was associated with recovery in non-JE. Risk of neurological sequelae (P = 0.01), especially hemiparesis (P = 0.03) was significantly more in JE. Sequelae were observed at 6 weeks follow up in 18.8% of JE and 13.9% of non-JE. JE was the most common cause of viral encephalitis in eastern Nepal and should be suspected in encephalitic patients having pig rearing at home and neurological sequelae. Although duration of hospitalization and complication were higher in JE, final outcome was similar to non-JE. Longer duration of fever in JE and shorter duration of fever in non-JE correlated with recovery, while altered sensorium and focal neurological deficit were independent predictors of sequelae at 6 weeks only in JE and not in non-JE.

Complicaciones neurológicas después de un trasplante de progenitores hemopoyéticos. Estudio de 14 pacientes

The frequency and cause of neurologic complications (NC) following hematopoietic stem cell transplantation (HSCT) have changed over time. We have analyzed the NC in 185 consecutive patients who underwent HSCT in a period of 5 years in a single HSCT Unit. 185 consecutive patients underwent HSCT (44 allogeneic) between February 2000 and March 2005 to treat hematologic malignancies. Most frequent diagnoses were multiple myeloma (41 patients) and acute myeloblastic leukemia (n = 35). Demographic and clinical data, HSCT characteristics and procedure-related events with special attention to neurological findings were recorded. Imaging studies (magnetic resonance imaging and/or computerized tomography scan), cerebro-spinal fluid analyses and microbiological studies were performed in all patients developing NC. After a median follow-up of 27 months, 14 patients (7.5%) developed NC, 6 of them after an allogeneic HSCT. The most common conditioning regimen in these patients was BEAM (5/14); 6 patients submitted to allogenic-HSCT received methotrexate and cyclosporin as graft-versus-host disease prophylaxis, and intrathecal prophylaxis of relapse was administered to 3 patients. The median time to the appearance of a NC was 13 days from HSCT (range: -4 to + 135 days). Seizures (8 cases) and encephalopathy (n = 2) were the most frequent clinical manifestations. In 12 cases the cause of the NC was related to drugs, there was one case of viral encephalitis and in the remaining case was caused by hemorrhage. Two patients died, one due to thrombotic thrombocytopenic purpura attributed to cyclosporin and the other due to viral encephalitis. In our series drug toxicity was the main cause of NC (particularly seizures) following HSCT. Our results contrast with previous studies in which infections, especially of fungal origin, were the main cause of NC. These changes over time should be taken into account during diagnostic procedures.

Assessing the diagnostic contribution of lumbar puncture in geriatric patients presenting with fever and altered mental status: Does source obviate lumbar puncture?

Study objectives: Elderly patients with fever and altered mental status (AMS) are often pan-cultured to search for a source. Evaluations may be halted when an initial source is found. However, these patients may be harboring undiagnosed bacterial meningitis (BM; potentially translocated from the initial source) inadequately treated by initial antibiotic coverage. This study analyzes the contribution of lumbar puncture in these patients. A secondary objective is to analyze differences between nursing home and private residence patients. Methods: This was a multicenter (60,000 tertiary and 40,000 secondary center census) retrospective medical record review. All patients older than 65 years, with a temperature greater than 100.6°F, with new onset AMS, who had a fever evaluation (chest radiograph, urinalysis, blood cultures) inclusive of computed tomography (CT)–lumbar puncture in the emergency department were included. Excluded were patients in a known persistent vegetative state and diagnostic finding on CT (acute stroke, hemorrhage, abscess, mass). Final diagnosis was determined by composite endpoint of cerebrospinal fluid or blood culture, viral polymerase chain reaction, serology, discharge, or expiration diagnosis. A power analysis with α equal to 0.05 and β equal to 0.20 to detect a 20% difference in BM rates between positive pre-LP source and negative pre–lumbar puncture source stipulated a need for 98 subjects. Univariate analysis with appropriate tests for continuous and categoric data was used. Results: There have been 161 enrollees to date, 93 (58%) admitted from a private residence and 68 (42%) from a nursing home. Mean age was 77.6 years (range 65 to 97 years). Seventy-four (46%) patients had a non–central nervous system infection diagnosed pre–lumbar puncture: 38 pneumonias, 27 urinary tract infections, 9 other (skin, joint, intra-abdominal). Thirty-five (21%) patients had a source identified by lumbar puncture: 10 (6.2%) cases of BM, 21 (13%) cases of viral meningitis, and 4 (2.5%) cases of viral encephalitis (1 West Nile). Seventy-two percent (18/25) of patients with viral pathology on lumbar puncture had a negative pre–lumbar puncture evaluation. In patients with a positive pre–lumbar puncture source, there were 7 of 74 (9.5% confidence interval [CI] 6 to 18) cases of BM versus 3 of 87 (2.8% CI 1.5 to 7) cases of BM with a negative pre–lumbar puncture evaluation ( P P P =.37). The relative risk for nursing home patients to get lumbar puncture with a positive pre–lumbar puncture source was 0.44 (95% CI 0.14 to 0.63). This is a retrospective study of only those patients who underwent lumbar puncture. Therefore, it cannot take into account the clinical characteristics of fever/AMS patients who did not undergo lumbar puncture in nursing home patients with a positive pre–lumbar puncture source is due to the fact that many of those patients do not receive lumbar puncture. This piece of data is therefore partially inferential. A prospective study performing lumbar punctures on all appropriate patients with fever and AMS would be the next logical step. Conclusion: Patients with fever/AMS and a pre–lumbar puncture source of infection may have a higher rate (9.5% versus 2.8% in this study) of BM. When a pre–lumbar puncture source is found, nursing home patients appear less likely to receive lumbar puncture. Emergency physicians should perform lumbar punctures on all elderly patients with fever/AMS.

Geographic dynamics of viral encephalitis in Thailand

Viral encephalitis (VE) continues to be a major disease in Asia, causing serious illness which may result in death or have neurological sequelae. This study involves an ecological analysis of the climatic, geographic and seasonal patterns of clinically reported VE in Thailand from 1993 to 1998 to investigate regional and seasonal differences in disease incidence. Three thousand eight hundred and twenty nine cases of VE were clinically diagnosed nationwide during the study period by the Thai Ministry of Public Health. Spearman rank correlations of temporal, spatial and geographic variables with disease incidence were performed. The monthly incidence of VE correlated significantly with seasonal changes in temperature, relative humidity and rainfall in the north–northeast region of Thailand ( P < 0.001), whereas incidence in the south–central region correlated only with relative humidity ( P = 0.003). Spatial analysis revealed a positive correlation of disease with elevation ( P < 0.001), and negative correlations with rice-field cover ( P < 0.001), agricultural land-use ( P < 0.001) and temperature ( P = 0.004) in the north–northeast region. No significant spatial correlation was identified in the south–central region. The spatial distribution of VE suggests that etiologic variations may be responsible, in part, for the geographic patterns of disease. Active etiologic surveillance is necessary in a variety of geographic settings in order to provide physicians with information necessary for disease prevention and clinical management.

3 cases of viral encephalitis in pediatric oncohematologic department in patients at the end of chemotherapy treatment

3 cases of viral encephalitis in pediatric oncohematologic department in patients at the end of chemotherapy treatment

Viral etiology of acute childhood encephalitis in Beijing diagnosed by analysis of single samples.

To understand the viral etiology of acute childhood encephalitis in Beijing. Ninety-seven Chinese children (between 7 months and 13 years of age) with acute encephalitis were retrospectively investigated. They were treated in Beijing Children's Hospital between June, 1991, and October, 1994. Different serologic methods (immunofluorescence assay, enzyme-linked immunosorbent assay, solid phase reverse immunosorbent test) were used for detection of IgM antibody to enteroviruses, herpesviruses, mumps, measles, rubella and Japanese encephalitis virus. The viral DNA of six herpesviruses was detected by polymerase chain reaction. Viral etiology was identified in 35 of 97 (36.0%) cases. The most frequently identified pathogens were enteroviruses (15; 15.4%), followed by mumps (7; 7.2%), rubella (6; 6.1%), Japanese encephalitis virus (5; 5.1%), human herpesvirus 6 (2; 2.0%), herpes simplex virus (2; 2.0%) and Epstein-Barr virus (1; 1.0%). IgM antibody in cerebrospinal fluid was detected for enterovirus, mumps and rubella viruses. Enteroviruses were the most frequent viral pathogens of acute childhood encephalitis in Beijing. Detection of IgM in cerebrospinal fluid may be useful for diagnosis in certain cases of viral encephalitis.

Immunodiagnosis of childhood pulmonary and extrapulmonary tuberculosis using Mycobacterium tuberculosis ES antigen by penicillinase ELISA.

The diagnostic potential for detection of IgG to Mycobacterium tuberculosis excretory secretory (ES) antigen in childhood pulmonary and extrapulmonary tuberculosis was explored. IgG antibody to M. tuberculosis ES antigen was detected by indirect penicillinase ELISA. Twenty (80%) out of 25 pulmonary tuberculosis cases (clinically diagnosed and/or AFB-positive), five of nine tuberculous pleural effusion cases and only six of 69 cases in the control group were positive for IgG antibody to M. tuberculosis ES antigen. All CSF and sera were positive for IgG antibody in 12 cases of clinically diagnosed tuberculous meningitis (TBM). Out of 35 cases in the control group for TBM, all five cases of pyogenic meningitis but none of the 13 cases of viral encephalitis, five cases of enteric encephalopathy and 12 cases with no CNS infection were positive for anti-tubercular IgG antibody in CSF samples. Only two of them, i.e. one case of pyogenic meningitis and the other with no CNS infection, were positive for antibody in sera. The study demonstrated the potential of this assay in the diagnosis of tuberculosis in children where bacteriological confirmation is very difficult.

Air conditioning and television as protective factors in arboviral encephalitis risk.

In California, the advent of television and air conditioned housing has coincided with a general decrease in mosquito-borne viral encephalitis cases in humans in the past 25 years. During this same period, levels of vector populations, virus activity in vectors, birds, and horses has been high at times. Air conditioning and television encourage persons to remain indoors during summer evenings, the primary time when infected Culex tarsalis transmit western equine encephalomyelitis and St. Louis encephalitis viruses. The attack rates for these 2 diseases in 33 counties in the central valley of California, 1945-1982, were compared with the prevalence of household air conditioning and television. Encephalitis rates were negatively associated with television ownership in both cross-sectional and longitudinal analysis. Moreover, individual counties which experienced the most rapid increase in household television ownership had the greatest decline in encephalitis rates. A telephone survey conducted in Kern County revealed that air conditioner and television utilization times corresponded closely to the feeding times of Cx. tarsalis, and respondents indicated a preference to remain indoors during this time because of these appliances. It is concluded that changed behavioral patterns may protect from vector-borne diseases and be complementary to vector control programs.

The role of lumbar puncture in the evaluation of dementia: the University of Pittsburgh Study.

In a retrospective study of 80 patients over 55 years old, the efficacy of lumbar puncture in evaluating elderly demented patients was examined. Despite a cost of $381 per procedure, in addition to cerebrospinal fluid (CSF) evaluation, no diagnosis was made on the basis of the information obtained in any of the patients (53 per cent) who underwent lumbar puncture. The only abnormalities found were 11 cases of nonspecific elevations in CSF protein and one case of abnormal cellularity not related to bacterial infection. An additional 422 cases of dementia from other series were reviewed, and only four patients were found whose diagnosis could have been made by lumbar puncture--one patient had neurosyphilis, and the other three were postencephalitic. In addition, the literature on complications of lumbar puncture was reviewed. There were no serious complications of lumbar puncture in the present study. The authors concluded that although it is low-risk, lumbar puncture cannot currently be recommended for routine use in the evaluation of elderly demented patients, but should be used in evaluating demented patients under 55 years of age, patients with rapid onset or progression of dementia, patients with syphilis serology in suspected cases of viral encephalitis, and patients with signs and symptoms of fungal meningitis.

Cytoplasmic tubular aggregates and nuclear filamentous bodies in two suspected cases of viral encephalitis.

SUMMARYTwo suspected cases of viral encephalitis are presented. Viral nucleocapsids were not seen, but cytoplasmic paramyxovirus-like aggregates and nuclear filamentous bodies were frequently encountered. Both structures were seen in the same cell. Contrary to other reports, the cytoplasmic aggregates were mostly observed in hematogenous mononuclear cells, less frequently in neuronal cell elements and rarely in endothelial cells. The non-specific nature of these structures is emphasized.

Rapid diagnosis of encephalitis by immunofluorescent examination of cerebrospinal-fluid cells.

<h2>Abstract</h2> Immunofluorescent examination has been used to investigate cerebrospinalfluid cells in 95 cases where a diagnosis of viral encephalitis had been entertained. In 87 cases the immunofluorescence diagnosis of "encephalitis" or " not encephalitis " was found to have been correct; in 3 cases immunofluorescence failed to detect a viral encephalitis; and in 5 cases the sample was unsuitable for examination. In routine practice the technique is likely to be of most value in identifying those cases of viral encephalitis where the agent is sensitive to antiviral drugs (e.g., herpes simplex).

CNS Lupus Presenting As Encephalitis : A Case Report

An 18 years old female presented with several episodes of convulsions followed by unconsciousness. On admission, her Glasgow Coma Scale was 3, and other neurological and systemic examination revealed no abnormality. Initially it appeared to be a case of viral encephalitis with a background probability of glomerulonephritis. Differential diagnosis was uraemic encephalopathy and seizure disorder. However, finally it was diagnosed as a case of CNS Lupus - a rare presentation of Systemic Lupus Erythematosus (SLE). Key words: Convulsion; glomerulonephritis; encephalitis; lupus. DOI: http://dx.doi.org/10.3329/jdmc.v20i1.8588 J Dhaka Med Coll. 2011; 20(1) :82-85