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PubMed1979

Neutralizing antibody responses of humans and mice to vaccination with Venezuelan encephalitis (TC-83) virus.

Laboratory workers were vaccinated with Venezuelan encephalitis virus, strain TC-83. After 2 to 3 years, they were bled, and their sera were tested for neutralizing antibody to all known Venezuelan encephalitis subtypes and varieties. The results indicated higher titers to epizootic than to enzootic Venezuelan encephalitis viruses and suggested that individuals vaccinated with TC-83 do not produce significant neutralizing antibody to heterologous subtypes. Mice vaccinated, bled, and tested in a similar manner produced much the same antibody profiles as did the humans and resisted challenge with all Venezuelan encephalitis viruses tested. In addition, the serum dilution plaque reduction neutralization test used was shown to be highly specific and adequate for diagnosis of infections with Venezuelan encephalitis viruses.

Adult↗
PubMed2003

Relapsing herpes simplex encephalitis: pathological confirmation of viral reactivation.

This case is reported to raise awareness of herpes simplex encephalitis as a persisting brain disorder. A 66 year old immunocompetent man developed status epilepticus and died of pneumonia in the course of progressive hemiparesis, cognitive decline, and atrophy of the brain over a five year period after herpes simplex encephalitis. In addition to a completely destroyed left temporal lobe, necropsy revealed active encephalitis consisting of necrosis and lymphocyte infiltration with a large number of intranuclear inclusions in the neurones and glial cells in the markedly oedematous parenchyma of the right frontal and parietal lobes. Herpes simplex virus type 1 (HSV-1) antigen was detected by immunohistochemistry, HSV-1 DNA by in situ hybridisation, and herpes simplex virus nucleocapsids by electronmicroscopy. These clinical and pathological findings suggest that direct viral reactivation might result in a relapse of herpes simplex encephalitis, causing progressive clinical deterioration associated with the persistence of HSV-1 in the brain. This is the first case report demonstrating HSV-1 antigen, HSV-1 DNA, and herpes simplex virus nucleocapsids in a case of relapsing herpes simplex encephalitis.

Atrophy↗
PubMed2006

Entry into and production of the Japanese encephalitis virus from C6/36 cells.

OBJECTIVES: The mosquito-borne Japanese encephalitis virus is a leading cause of encephalitis worldwide. However, few studies have investigated the kinetics of Japanese encephalitis virus internalization and production in mosquito cells, and fewer still have investigated the nature of the molecules involved in the binding of the virus to mosquito cells. METHODS: Using the Aedes albopictus/Stegomyia albopicta-derived C6/36 cell line, Japanese encephalitis virus internalization and production were assayed by standard plaque assay, and virus binding was investigated through preinfection enzymatic treatment of cells and virus overlay protein-binding assay of membrane fractions in native and denaturing gels. RESULTS: The internalization of the virus was nonlinear, and intracellular infective viruses were detected 8 h after infection and exported to the medium 10 h after infection. The internalization of the virus was primarily mediated by protein elements, and several bands were observed after overlay assay to membrane proteins, although mass spectroscopy was unable to identify candidate proteins. Soluble laminin produced a marginal, but dose-dependent inhibition of infection. CONCLUSIONS: These results suggest that the mechanism of Japanese encephalitis entry, production, attachment and receptor usage are distinct from those employed by the dengue viruses.

Aedes↗
PubMed2006

Orchiectomy for suspected microscopic tumor in patients with anti-Ma2-associated encephalitis.

OBJECTIVE: To report the presence of microscopic neoplasms of the testis in men with anti-Ma2-associated encephalitis (Ma2-encephalitis) and to discuss the clinical implications. METHODS: Orchiectomy specimens were examined using immunohistochemistry with Ma2 and Oct4 antibodies. RESULTS: Among 25 patients with Ma2-encephalitis younger than 50 years, 19 had germ-cell tumors, and 6 had no evidence of cancer. These 6 patients underwent orchiectomy because they fulfilled five criteria: 1) demonstration of anti-Ma2 antibodies in association with MRI or clinical features compatible with Ma2-encephalitis, 2) life-threatening or progressive neurologic deficits, 3) age < 50 years, 4) absence of other tumors, and 5) new testicular enlargement or risk factors for germ-cell tumors, mainly cryptorchidism or ultrasound evidence of testicular microcalcifications. All orchiectomy specimens showed intratubular-germ cell neoplasms unclassified type (IGCNU) and other abnormalities including microcalcifications, atrophy, fibrosis, inflammatory infiltrates, or hypospermatogenesis. Ma2 was expressed by neoplastic cells in three of three patients examined. Even though most patients had severe neurologic deficits at the time of orchiectomy (median progression of symptoms, 10 months), 4 had partial improvement and prolonged stabilization (8 to 84 months, median 22.5 months) and two did not improve after the procedure. CONCLUSIONS: In young men with Ma2-encephalitis, 1) the disorder should be attributed to a germ-cell neoplasm of the testis unless another Ma2-expressing tumor is found, 2) negative tumor markers, ultrasound, body CT, or PET do not exclude an intratubular germ-cell neoplasm of the testis, and 3) if no tumor is found, the presence of the five indicated criteria should prompt consideration of orchiectomy.

Adult↗
PubMed1998

Atypical herpes simplex virus encephalitis diagnosed by PCR amplification of viral DNA from CSF.

OBJECTIVE: To determine the frequency of mild/atypical herpes simplex virus encephalitis (HSVE) among patients with CSF specimens submitted to a university diagnostic virology laboratory for HSV PCR. BACKGROUND: HSVE is the most commonly recognized cause of acute sporadic encephalitis in the United States. Recognized clinical features are based on autopsy- or brain biopsy-confirmed cases. This is likely to produce ascertainment bias for features associated with severe disease and under-recognition of mild or atypical cases. Amplification of HSV DNA by PCR from CSF provides a sensitive and specific method for diagnosis of HSVE. METHODS: Results of all HSV CSF PCR tests sent to a university diagnostic virology laboratory (January 1, 1993, to December 31, 1996) were reviewed. Clinical information was prospectively collected and retrospectively reviewed. Patients with positive HSV CSF PCR tests were classified as having meningitis, encephalitis, or neonatal infection. Encephalitis was considered typical or atypical based on published criteria. RESULTS: A total of 7.6% of 1,224 CSF specimens were positive for HSV DNA. CSF HSV DNA-positive patients had meningitis (52%), encephalitis (26%), neonatal infection (17%), or nonclassifiable disease (5%). A total of 17% of HSVE patients had mild or atypical disease characterized by the absence of focal findings and slow progression in the absence of antiviral therapy. Atypical HSVE was associated with HSV-2 infection (two of the four patients), immunosuppression by steroid therapy or coexisting HIV infection (three of the four patients), or disease predominantly involving the nondominant temporal lobe (two of the four patients). CONCLUSIONS: Approximately one-fifth of HSVE patients have mild or atypical disease. CSF PCR for HSV DNA should be performed in patients with febrile encephalopathy even in the absence of focal features, initial CSF pleocytosis, or abnormal CT. Mild or atypical HSVE may be associated with infection with either HSV-1 or HSV-2. Mild or atypical HSVE was frequently associated with immunocompromise or asymmetric HSV infection affecting predominantly the nondominant temporal lobe.

DNA, Viral↗
PubMed1982

Acute encephalitis of viral origin.

75 patients with acute encephalitis of confirmed or suggestive viral or virus-like etiology showed a predominance of herpes simplex virus (HSV) as an etiological agent (13.3-32.0%) in all age groups without seasonal variation and increasing in number during years. Mumps, occurring mainly in female patients, was next in order and thereafter coxsackievirus B, varicella-zoster, and adenoviruses, followed by multiple coincident infections, and a large number of occasional agents. HSV seems to have displaced tick-borne encephalitis virus as the major cause of acute encephalitis in Finland. Pregnancy appeared to increase susceptibility to HSV encephalitis. The outcome was associated with the etiological agent in the first hand, HSV and nonviral microbes appeared unfavourable, but also with the clinical symptomatology, particularly altered consciousness, mental symptoms and focal neurological signs. The need for exact and rapid diagnosis in all cases of acute encephalitis is underlined in view of the possibility of specific therapy.

Acute Disease↗
PubMedDate not supplied

Unusual acute encephalitis involving the thalamus: imaging features.

OBJECTIVE: To describe the brain CT and MR imaging findings of unusual acute encephalitis involving the thalamus. MATERIALS AND METHODS: We retrospectively reviewed the medical records and CT and/or MR imaging findings of six patients with acute encephalitis involving the thalamus. CT (n=6) and MR imaging (n=6) were performed during the acute and/or convalescent stage of the illness. RESULTS: Brain CT showed brain swelling (n=2), low attenuation of both thalami (n=1) or normal findings (n=3). Initial MR imaging indicated that in all patients the thalamus was involved either bilaterally (n=5) or unilaterally (n=1). Lesions were also present in the midbrain (n=5), medial temporal lobe (n=4), pons (n=3), both hippocampi (n=3) the insular cortex (n=2), medulla (n=2), lateral temporal lobe cortex (n=1), both cingulate gyri (n=1), both basal ganglia (n=1), and the left hemispheric cortex (n=1). CONCLUSION: These CT or MR imaging findings of acute encephalitis of unknown etiology were similar to a combination of those of Japanese encephalitis and herpes simplex encephalitis. In order to document the specific causative agents which lead to the appearance of these imaging features, further investigation is required.

Acute Disease↗
PubMed1996

Dengue encephalitis: a true entity?

Involvement of the central nervous system in dengue fever and dengue hemorrhagic fever has always been thought to be secondary to vasculitis with resultant fluid extravasation, cerebral edema, hypoperfusion, hyponatremia, liver failure, and/or renal failure. Thus, the condition has been referred to as dengue encephalopathy. Encephalitis or direct involvement of the brain by the virus was thought to be unlikely. This paper reports on six children who were seen over a period of two years presenting on the second or third day of illness with dengue encephalitis. The diagnosis was based upon a clinical picture of encephalitis and confirmed by cerebrospinal fluid (CSF) microscopy and electroencephalography changes. All six cases were confirmed dengue infections. Dengue 3 virus was isolated from the CSF of four cases and in one case, dengue 2 was detected by the polymerase chain reaction in both the CSF and blood. In the sixth case, virologic evidence was negative but dengue immunoglobulin M was detected in the CSF and blood. Since the onset of encephalitis appears early in the course of illness coinciding with the viremic phase, we postulate that the virus crosses the blood-brain barrier and directly invades the brain causing encephalitis. This study provides strong evidence that dengue 2 and 3 viruses have neurovirulent properties and behave similarly to other members of the Flaviviridae.

Antibodies, Viral↗
PubMed1992

Low-dose trimethoprim-sulfamethoxazole prophylaxis for toxoplasmic encephalitis in patients with AIDS.

OBJECTIVE: To determine the efficacy of low-dose trimethoprim-sulfamethoxazole (trimethoprim, 160 mg plus sulfamethoxazole, 800 mg; one tablet twice daily, 2 days per week) as primary prophylaxis against toxoplasmic encephalitis in patients with human immunodeficiency virus (HIV) infection and previous Pneumocystis carinii pneumonia. DESIGN: A retrospective study. SETTING: Tertiary referral teaching hospital. PATIENTS: During a 3-year period after primary episodes of P. carinii pneumonia, 60 patients received trimethoprim-sulfamethoxazole, and 95 patients received pentamidine (aerosolized in 78 patients and intravenous in 17 patients) as secondary prophylaxis. RESULTS: No patient in the trimethoprim-sulfamethoxazole group and no patient seronegative for Toxoplasma gondii developed toxoplasmic encephalitis, compared with 12 of 36 (33%; 95% Cl, 19% to 51%) seropositive patients in the pentamidine group (trimethoprim-sulfamethoxazole compared with pentamidine, P = 0.008). A significant difference was seen in the time to development of toxoplasmic encephalitis between the trimethoprim-sulfamethoxazole group (no case at 1153 days) and the pentamidine group (median time, 460 days) (P = 0.004). Neither the CD4+ lymphocyte count at the start of prophylaxis nor zidovudine therapy during the period of prophylaxis influenced the rate of toxoplasmic encephalitis in any group. CONCLUSIONS: Low-dose trimethoprim-sulfamethoxazole (four tablets per week) appears to be effective prophylaxis against toxoplasmic encephalitis in HIV-infected patients with previous P. carinii pneumonia. A prospective, randomized, controlled study is needed to further evaluate these findings.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Small cell lung carcinoma associated with paraneoplastic limbic encephalitis.

Limbic encephalitis is an unusual presentation of paraneoplastic syndrome. We report a case of small cell lung carcinoma associated with limbic encephalitis. A 67-year-old man presented with convulsions, memory impairment, and neuropsychiatric disturbances as initial symptoms. Subsequently, small cell lung carcinoma was diagnosed by bronchoscopic biopsy. The cerebrospinal fluid studies, electroencephalography, and magnetic resonance imaging findings had distinctive features compatible with paraneoplastic limbic encephalitis. The neuropsychiatric symptoms improved significantly after six cycles of systemic chemotherapy and adjuvant radiotherapy, resulting in partial remission of the tumor. A follow-up computed tomography scan of the head showed no evidence of intracranial metastasis 7 months after the diagnosis of cancer. Limbic encephalitis may be an initial manifestation of lung cancer. Greater awareness for diagnosis and early treatment of the primary tumor offers the best chance for improvement in patients with lung cancer presenting with limbic encephalitis.

Aged↗
PubMed1999

[A case of non-herpetic acute encephalitis presenting high intensity lesion at unilateral temparal cortex on MR FLAIR image].

We reported a case of non-herpetic acute encephalitis with unilateral temporal cortex lesion revealed by MR imaging and SPECT study. The patient was an eighteen years old woman who developed tonic-clonic seizure after common cold symptom. She was healthy before this episode. Neurological abnormality was only a single convulsion at onset and there was no other abnormal physical and neurological signs except for low grade fever. Electroencephalogram showed spike and slow wave complex of 2 Hz focused on a right posteriotemporal point (T 6) and an MR FLAIR (fluid-attenuated inversion recovery) image revealed a high signal intensity area at right temporal cortex. There was a decrease of cerebral blood flow in the same portion on SPECT study. This lesion was obscure on T1 and T2 MR images. Cerebrospinal fluid showed pleocytosis with normal glucose level and protein concentration. Bacterial and fungal cultures of CSF were negative and a detection of tubercule bacillus by PCR hybridization method was also negative. Although CSF findings suggested viral infection of CNS, virological study could not demonstrate infections of herpes simplex virus type 1, type 2, varicella-zoster virus, cytomegalovirus, measles virus, mumps virus, Japanese encephalitis virus, and influenza virus type A and B. After infusion of acyclovir and antibiotics, the patient was discharged from our hospital without sequelae of encephalitis. EEG was normal at this point and a high intensity area of MR FLAIR image disappeared two months later. SPECT findings were normalized six months later. The encephalitis presenting unilateral temporal cortex lesion without the infection of herpes simplex virus is thought to be very rare. Our case was distinguished from non-herpetic acute limbic encephalitis by an extent of the lesion and clinical manifestations. MR FLAIR image was useful for the detection of the lesion in this case.

Acute Disease↗
PubMedDate not supplied

[Benign encephalitis of the brain stem].

INTRODUCTION: The secondary encephalitis disorders are due to an immunological mechanism which causes demyelinating lesions of the central and peripheral nervous systems, with very variable clinical features. The pathogenesis and localization of benign encephalitis of the brain stem and the Miller Fisher syndrome (MFS) are still subject to debate. It is suggested that they may both belong to different extremes of the same nosological spectrum known as the ophthalmoplegia-ataxia-areflexia syndrome. CLINICAL CASE: We report the case of an 11 year old boy with encephalitis of the brain stem who had electromyographic alterations compatible with the Guillain-Barré syndrome, and MR images characteristic of an acute demyelinating disorder of the brainstem. CONCLUSIONS: The encephalitis of the brain stem is an uncommon condition in children which leads to diagnostic difficulty at its onset, since this is similar in other disorders such as MFS, tumours, cerebrovascular accidents and less often in the initial stages of multiple sclerosis. The clinical course is very useful to distinguish between these conditions. MR is the imaging technique of choice for diagnosis in these patients. Although there is currently no specific treatment for post-infectious encephalitis, the use of high doses of immunoglobulins may be justified in view of the physiopathological origin of the condition.

Bradycardia↗
PubMed2002

Proton MR spectroscopy in the diagnosis and differentiation of encephalitis from other mimicking lesions.

In this study, proton magnetic resonance spectroscopy (1H MRS) findings of encephalitis were reported. For comparison, other lesions mimicking encephalitis on conventional magnetic resonance (MR) imaging were included in the study. These lesions consisted of acute infarctions and low grade infiltrative gliomas. The 1H MRS findings of encephalitis and gliomas were almost the same whereas infarctions revealed high lactate levels differentiating the disorder from other two pathologies. The differentiation of encephalitis and gliomas based on MR findings could reliably made with short time follow up MR examinations where gliomas tend to grow in contrast to encephalitis which showed regression.

Adolescent↗
PubMedDate not supplied

Unilateral acute retinal necrosis occurring 2 years after herpes simplex type 1 encephalitis.

Acute retinal necrosis (ARN) syndrome is known to occur occasionally in association with or shortly after herpetic encephalitis. We describe a patient with unilateral ARN occurring 2 years after herpes simplex virus (HSV) type 1 encephalitis. A 49-year-old man presented with unilateral visual loss. He had a history of HSV-1 encephalitis 2 years previously, and had been successfully treated without a subsequent recurrence. The ophthalmologic findings were all consistent with the ARN syndrome. The same type 1 HSV was identified from ocular fluid as was identified from the patient's cerebrospinal fluid 2 years ago. There was no evidence of a recurrence of encephalitis. This case suggests that following encephalitis retinal neurons may function as a reservoir for latent HSV-1, that can be reactivated to cause ARN in situ several years later.

Encephalitis, Herpes Simplex↗
PubMed2003

[Another case of West Nile fever in the Netherlands: a man with encephalitis following a trip to Canada].

Shortly after his return to the Netherlands from a trip to Ontario, a part of Canada where infection with West-Nile virus has been reported, a 69-year-old man became increasingly confused and generally unwell, accompanied by fever. The clinical picture was compatible with viral encephalitis and this was supported by EEG findings and the results of the cerebrospinal-fluid examination. MRI of the brain did not contribute to the diagnosis. The patient was treated with aciclovir because herpes simplex encephalitis was suspected, and he recovered from his illness within a few days. The EEG normalised as well. The most important remaining symptom was diminished short-term memory function. After the patient was discharged, rising antibody titres against West-Nile virus were found in two consecutive sera; there were no antibodies to other encephalitis-causing viruses (such as Q fever virus and St. Louis encephalitis virus). This case report concerns the second imported case of West-Nile fever in the Netherlands and the first one with encephalitis.

Aged↗
PubMed1992

[Natural foci of tick-borne encephalitis in the Slovak Republic and its relation to the natural ecosystem].

To evaluate the incidence of natural foci of tick-borne encephalitis in the Slovak Republic data of the hygiene service on the morbidity from tick-borne encephalitis during the period from 1961-1988 were used as well as data from the literature and results of the author's field studies on the incidence of the common tick. The main foci of tick-borne encephalitis are in the West Slovakian region, in the Záhorské lowland, in the Váh valley up to the distrikt of Povázská Bystrica, in the area of the Low Carpathian mountains, Tribec, Vtácnik, the Nitra and Hron hills, and Kovácov hills, in the Central Slovakian region in the Krupin hills and in the East Slovakian region in the Slovak karst and Slanské hills. The incidence of common ticks and foci of tick-borne encephalitis is linked to the original oak grove communities. In Slovakia the latter comprise hornbean and oak forests, oak groves and thermophile oak forests. Areas of original communities of beech woods and spruces which grow in higher altitudes do not provide favourable conditions for the development of the common tick. Rare foci of tick-borne encephalitis of a mountainous type found in Slovakia survive probably due to the extremely favourable microclimatic conditions in these areas. Also the hygrophilous communities of alders, moorlands and dry steppes, original as well as cultivated ones, are not suitable for the common tick. This is why ticks are not found in central, northern and northeastern Slovakia, in the Rye island and lowland along the Tisa river.(ABSTRACT TRUNCATED AT 250 WORDS)

Czechoslovakia↗
PubMed1992

Relapse of herpes simplex encephalitis in children.

The polymerase chain reaction method was used to diagnose herpes simplex encephalitis in children. Initial samples of cerebrospinal fluid from 15 patients with herpes simplex encephalitis were all positive for the herpes simplex virus DNA by polymerase chain reaction assay. In terms of early diagnosis, polymerase chain reaction assay became positive significantly earlier than the detection of intrathecally produced anti-herpes simplex virus antibody using the enzyme-linked immunosorbent assay (4.4 vs 8.9 days after onset; P less than .01). Serial examinations showed that the presence of virus DNA in cerebrospinal fluid continued for 3 to 18 days after the neurologic onset (mean 10.1 days). Four of the 15 patients had a relapse of encephalitis after completing acyclovir therapy. The mean duration of initial acyclovir therapy in the recurrent group was significantly shorter than that in the nonrecurrent group. In recurring cases, herpes simplex virus DNA reappeared temporarily in the cerebrospinal fluid of two patients. These results show that polymerase chain reaction assay is a useful diagnostic tool for the early and noninvasive diagnosis of herpes simplex encephalitis in children. Results also suggest that a comparatively short duration of acyclovir therapy may be related to a relapse of herpes simplex encephalitis in some children.

Acyclovir↗
PubMed2003

[Hashimoto's encephalitis and sleep disorders].

Hashimoto's encephalitis is a rare cause of encephalitis which is improved by corticosteroid treatment. We report the case of a 42-year-old woman who developed progressive dementia associated with episodes of recurrent discorders of consciousness which rapidly improved with corticosteroids. During these episodes, no sleep activity was recorded on the holter EEG. These discorders were reversible with treatment and a normal EEG sleep pattern reappeared. At physical examination, Hashimoto's encephalitis can mimic Creutzfeld-Jakob disease. Systematic sleep-EEG recordings can be helpful for diagnosis of sleep disorders related Hashimoto's encephalitis. This case illustrates the importance of searching for antithyroid antibodies in patients with unexplained encephalitis.

Adrenal Cortex Hormones↗