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PubMed1983

Clinical aspects of La Crosse encephalitis: neurological and psychological sequelae.

Only rarely will a child continue to have focal neurologic findings, such as paresis, for as long as 8 years after LAC encephalitis. Most of the other focal neurologic findings, such as Babinski reflexes, pathologic reflexes, aphasias, choreas, dysarthrias and ataxias, resolve completely. Abnormal electroencephalographic findings during the acute period were note in 86-100% of the cases. On 1-8 year follow-up, EEG abnormalities were noted in approximately 33% of the subjects tested. Seizures are present at high frequency during acute illness and recurrent seizures may occur in 6-13% of the cases 1-8 years after infection. The cognitive and intellectual functioning of children following LAC encephalitis is not significantly different from that of the normal population. As a group, LAC encephalitis victims also function in the normal range in terms of their academic performances. There are individuals, however, who will have suffered permanent destructive lesions resulting in lowered IQ and lowered school performance. Behavioral abnormalities are difficult to measure and when present, difficult to ascribe to a definitive cause.

Adolescent↗

PubMed1981

[Clinico-virologic analysis of the incidence of tick-borne encephalitis in the Khabarovskh region].

In the Soviet Union the incidence of tick-borne encephalitis is the highest in the geographical and epidemiological region adjacent to the Amur River (zone of coniferous and broad-leaved forests). 60.43% of all cases fall on years of cyclic rise of the disease incidence. Strains of the tick-borne encephalitis virus can be isolated with a more significant frequency from the blood of encephalitis-sick patients and from the brain of the dead in the years of disease outbreaks.

Brain↗

PubMed1981

[Immunological indices of human vaccination against tick-borne encephalitis using inactivated preparations with a varying concentration of the viral antigen].

The results obtained in the determination of the immunological activity of 3 types of formalin-killed tissue-culture tick-borne encephalitis vaccine, commercial non-concentrated and concentrated by 2 different methods, in humans are presented. Judging by the data of 3 serological tests and the blast transformation test, the concentration of killed tick-borne encephalitis virus enhanced immune response to vaccination. The intensity of this response correlated with the mouse protection capacity of the vaccine batches under test. An increase in the content of viral particles in the preparation is considered to be a promising approach to enhancing the effectiveness of vaccination against tick-borne encephalitis.

Adult↗

PubMed1994

[The relationship of the therapeutic efficacy of immunoglobulin against tick-borne encephalitis to the specific activity of the preparation and the times of its administration].

A controlled clinical trial included 115 patients with meningeal and focal tick-borne encephalitis, 38 of them received nonspecific treatment alone, 77 were given adjuvant intramuscular immunoglobulin against tick-borne encephalitis. The latter are shown to improve much more rapidly than patients treated only symptomatically. When calculating adequate immunoglobulin doses, it is necessary to take in consideration not only the amount of the compound, but also the concentration of the specific antibodies. The authors propose treatment schemes for patients with meningeal and focal tick-borne encephalitis.

Acute Disease↗

PubMedDate not supplied

[The potentials for the comprehensive diagnosis of viral encephalitis in Sverdlovsk Province].

The suggested scheme of laboratory tests helped identify the etiology of viral encephalitides in 65.9% of cases. Diagnosis of tick-borne encephalitis was confirmed by laboratory findings in 93.6% of cases. Patients with Californian encephalitis were detected in the Sverdlovsk region for the first time. A rather high rate of detection of antibodies to Tahyna virus was revealed in the examined population: up to 60%. Influenza origin of encephalitis was recognized in 6.2% of cases, Lyme's disease was diagnosed in 9.3%.

Antibodies, Viral↗

PubMed1977

[Tick-born encephalitis in southeastern Bavaria (F.R. of Germany) (author's transl)].

In 1976 blood samples from 748 patients were tested for complement fixation antibodies against the virus of tickborne encephalitis. Of these, 38 had antibodies in a serum dilution of 1:8, 18 also in a dilution of 1:32 or higher. Clinical symptoms, laboratory results, time and place of illness are presented in more detailed analysis for 14 cases. From these data, it appears than tick-borne encephalitis is more wide-spread in southeastern Bavaria than has been previously supposed. In most of the cases, tick-borne encephalitis was not suspected because the patients generally did not have a bi-pattern of illness, only 6 of the 14 had a definite history of a tick-bite, and, moreover, atypical features frequently occurred in addition to CNS symptoms. The number of juvenile patients (4 out of 14) was also unexpected. Attention is drawn to the present situation with regard to passive and active immunization.

Adolescent↗

PubMed1976

[Significance of indices of potential epidemiologic valency of natural foci of tick-borne encephalitis and methods of determining them].

Potential epidemiological valency (PEV) of the natural foci of tick-borne encephalitis was characterized by the quantity of the infected ticks per unit of the area of the focal territory, and also by the section of the pathway of man's passage along this territory, at which encounter of a single viroforic tick is possible. PEV indices reflected the epidemiological intensity of the natural foci of infection both in the mastered and in the poorly developed areas, and therefore could be used for the epidemiological prognosis on tick-borne encephalitis and in epidemiological search of this infection on the newly-developing territories. The extent of PEV reduction as a result of anti-tick treatment of forests endemic by tick-borne encephalitis which as caricides with a prolonged residual action of the tick-vectors offered a possibility of assessing the epidemiological efficacy of the measures carried out the most objectively.

Animals↗

PubMed1976

[The prevention of tick-borne encephalitis (author's transl)].

Tick-borne encephalitis is one of the most frequently-encountered virus diseases of the central nervous system in Europe. Hence, prophylactic measures for the prevention of tick-borne encephalitis are of particular importance, especially since it is virtually impossible to influence the course of the manifest disease by means of current therapeutic procedures. Moreover, complications (paralysis and other sequelae) are frequent. A recently-developed vaccine (killed virus) is capable of providing easy and long-lasting protection for a large part of the population. The safety and efficacy of the vaccine was proved in 30,000 persons who were vaccinated in a field trial. Wide-scale implementation may be recommended mainly for persons under regular exposure, but also for the protection of people remaining in an endemic area for a short time only. However, if immediate protection of non-immunised persons is required, i.e. persons who discover ticks on their body or who show the presumptive signs of an existing virus infection, passive immunisation with tick-borne encephalitis immune globulin is recommended.

Adult↗

PubMed1998

Regional cerebral blood flow scintigraphy in tick-borne encephalitis and other aseptic meningoencephalitis.

UNLABELLED: In a prospective study, regional cerebral blood flow (rCBF) was studied in patients with aseptic meningoencephalitis at 6 wk and 1 yr after onset of disease. METHODS: Patients with tick-borne encephalitis ([TBE] n = 73) and meningoencephalitis of other etiology ([non-TBE] n = 56) were investigated with rCBF-scintigraphy (SPECT). SPECT images in the acute phase of disease and at long-term follow-up were analyzed for blood-flow disturbances and their localization in the central nervous system and were correlated to clinical course and outcome. RESULTS: Decreased rCBF was seen in 50% of patients after 6 wk (TBE 49%, non-TBE 50%) and in 46% (TBE 47%, non-TBE 46%) after 1 yr. The decrease in rCBF was moderate in 18% and 11% at 6 wk and in 8% and 9% at the 1-yr follow-up of TBE and non-TBE patients, respectively. Reduced rCBF was significantly more common among patients with encephalitis than among those with meningitis, and more common in males. The distribution of cerebral flow changes was predominantly patchy or multifocal. At long-term follow-up, improvement in rCBF was seen in 28 of 109 patients (26%), but worsening of decreased rCBF was demonstrated in 19 of 109 (17%). In TBE patients, remaining neurological symptoms at 6 wk of disease were associated with worsening of decreased rCBF at the 1-yr follow-up. CONCLUSION: With SPECT, rCBF changes, mostly slight and patchy or multifocal, were detected in patients with aseptic meningoencephalitis. Decreased rCBF was more frequent in patients with moderate-to-severe encephalitis, although the clinical use in predicting long-term outcomes in aseptic meningoencephalitis (e.g., TBE) seems limited.

Adolescent↗

PubMed1964

AN ATTENUATED MUTANT OF JAPANESE ENCEPHALITIS VIRUS.

In the course of studies towards the development of a live, attenuated Japanese encephalitis vaccine, an attenuated mutant (m mutant) of Japanese encephalitis virus was isolated after serial passages of a parental virus, Mukai strain, in embryonic mouse skin cultures. The low virulence of the m mutant was found to be stable in tissue cultures but reversion to virulence was observed after multiplication of the virus in mouse brain. The m mutant induced high immunity in mice after vaccination in a single intraperitoneal injection. Furthermore, a high virus yield was obtained from the m mutant in tissue culture, with titres of about 10(9.5) TCD(50) per ml. It is suggested that this mutant may be suitable for the preparation of inactivated tissue culture vaccine, but the author stresses that it cannot be recommended for tests in man until more is known about its genetic stability.

Animals↗

PubMed2003

Antibody-dependent enhancement of Murray Valley encephalitis virus virulence in mice.

Enhancement of flavivirus infection in vitro in the presence of subneutralizing concentrations of homologous or heterologous antiserum has been well described. However, the importance of this phenomenon in the enhancement of flavivirus infection in vivo has not been established. In order to study antibody-mediated enhancement of flavivirus infection in vivo, we investigated the effect of passive immunization of mice with Japanese encephalitis virus (JE) antiserum on the outcome of infection with Murray Valley encephalitis virus (MVE). We show that prior treatment of mice with subneutralizing concentrations of heterologous JE antiserum resulted in an increase in viraemia titres and in mortality following challenge with wild-type MVE. Our findings support the hypothesis that subneutralizing concentrations of antibody may enhance flavivirus infection and virulence in vivo. These findings are of potential importance for the design of JE vaccination programs in geographic areas in which MVE co-circulates. Should subneutralizing concentrations of antibody remain in the population following JE vaccination, it is possible that enhanced disease may be observed during MVE epidemics.

Animals↗

PubMed2006

[Granulomatous amebic encephalitis caused by Balamuthia mandrillaris. First case diagnosed in Chile].

The case of a 7 month-old baby boy is presented, with a history of several weeks of evolution of personality changes, convulsions and fever. While he was hospitalized, the brain image study showed multifocal cavity lesions, which varied from millimeters to 4 cm of diameter, not producing mass effect. Their biopsy revealed necrotizing encephalitis. In spite of treatment, the lesions progressed and the boy died. The autopsy demonstrated an extensive necrotizing encephalitis with fibrinoid necrotic arteritis, signs of organization, and the presence of parasitic elements with characteristics of trophozoites and cysts of free-living amoebas belonging to the genus Acanthamoeba or Balamuthia. In addition, hypoplasia-dysplasia of the thymus and signs of shock were found. The morphologic elements correspond to the disease described as granulomatous amebic encephalitis and the agent found was identified as Balamuthia mandrillaris (Centers for Diseases Control and Prevention, Atlanta, USA ).

Amebiasis↗

PubMed1990

Long-term cognitive sequelae of acyclovir-treated herpes simplex encephalitis.

Survival from untreated herpes simplex type 1 encephalitis is well known to be accompanied by severe cognitive impairments. Recently, acyclovir has been proven to be the most effective available treatment for this disease, with the expectation that it would appreciably reduce morbidity. We performed detailed assessments of four consecutive patients who received acyclovir in the early stages of biopsy-proven herpes encephalitis and who now have been followed up for 1.5 to 4 years. All four patients showed definite residual on either clinical or formal neuropsychological testing, most commonly dysnomia and impaired new learning for both verbal and visual material, even though three had normal performance on a standard clinical mental status test. All four patients were unable to function at their prior level of achievement. Therefore, despite early administration of acyclovir in herpes encephalitis, long-lasting neuropsychological residua are likely. Furthermore, cognitive deficits of prognostic importance may not be detected by clinical screening.

Acyclovir↗

PubMed1993

Rasmussen's chronic encephalitis in adults.

OBJECTIVE: Rasmussen's chronic encephalitis, a cause of intractable epilepsy in childhood, is described in three adults. SETTING: Inpatient epilepsy unit. PATIENTS: Of 11 patients with pathological confirmation of Rasmussen's encephalitis, three were adults with intractable seizures, progressive sensorimotor deficits, and cognitive decline beginning at the ages of 36, 24, and 16 years. RESULTS: Clinical, electroencephalographic, and magnetic resonance imaging findings indicated patchy, multifocal involvement of primarily one hemisphere, but the adults had more evidence of disease in the opposite hemisphere than occurs in children. The sensorimotor deficit that the adults developed was greater and the cognitive decline was less than in children. Seizure control following multilobe resection was proportionate to the amount of tissue removed. Cytomegalovirus genome was found in the resected cortical tissue of all three patients. CONCLUSIONS: Rasmussen's encephalitis is a cause of intractable epilepsy with progressive neurological deficit in adults as well as children. Cytomegalovirus may be involved in the pathogenesis of the disease.

Adolescent↗

PubMed1996

BK virus encephalitis in an immunocompetent patient.

OBJECTIVES: To describe a previously healthy patient now suffering from monophasic encephalitis caused by a primary infection with BK virus and to discuss possible risk factors for developing BK virus encephalitis. DESIGN: Case report. SETTING: Referral hospital. PATIENT: The patient was examined on referral. MAIN OUTCOME MEASURES: The main diagnostic tests performed were serology, polymerase chain reaction on cerebrospinal fluid samples, and cranial magnetic resonance imaging. RESULTS: During the course of the patient's encephalitis, an IgM titer developed against polyomavirus, followed by anti-polyomavirus IgG. Wild-type BK virus was demonstrated in cerebrospinal fluid samples. Cranial magnetic resonance imaging showed diffuse reversible white matter changes most prominent on T2-weighted images. CONCLUSION: We conclude that diagnostic tests for BK, a human polyomavirus, should be included in the screening program for encephalitogenic pathogens.

Adult↗

PubMed2004

Correlation of in vivo neuroimaging abnormalities with postmortem human immunodeficiency virus encephalitis and dendritic loss.

BACKGROUND: In the absence of significant opportunistic infection, the most common alterations on neuroimaging in the brains of patients with AIDS include enlarged cerebrospinal fluid spaces, white-matter loss, volume loss in striatal structures, and white-matter signal abnormalities. Although previous studies have linked brain viral levels to these alterations, other neuropathological mechanisms might also contribute to them. OBJECTIVE: To examine the relationship between findings on premortem magnetic resonance images and postmortem neuropathologic evidence of human immunodeficiency virus (HIV) encephalitis and neurodegeneration. DESIGN: Morphometric analysis of magnetic resonance imaging in seropositive cases with matched seronegative controls, and the correlation of these volumes to neuropathological measures in autopsied seropositive cases. SETTING: University of California, San Diego, HIV Neurobehavioral Research Center. SUBJECTS: Twenty-one seropositive subjects studied at autopsy and 19 seronegative cases. MAIN OUTCOME MEASURES: In vivo structural magnetic resonance imaging data analyzed by quantitative methods, with comparison of volumes from magnetic resonance imaging and neuropathological data from autopsies. RESULTS: The HIV-seropositive subjects demonstrated cerebrospinal fluid increases relative to seronegative controls. These increases were associated with a significant decrease in the volumes of cerebral and cerebellar white matter, caudate nucleus, hippocampus, and, to a lesser extent, cerebral cortex. The volume of cerebral white-matter tissue with elevated signal was also increased. This signal elevation in white matter predicted the autopsy diagnosis of HIV encephalitis, as well as the extent of dendritic loss as assessed by analysis of microtubule-associated protein 2 immunoreactivity. CONCLUSIONS: White-matter and cortical damage resulting from HIV disease are closely related. In vivo magnetic resonance imaging may be a valuable adjunct in the assessment of patients at risk for developing HIV encephalitis.

Adult↗

PubMed1979

Computerized tomography in infantile encephalitis.

Although computerized tomographic (CT) findings are well recognized in numerous neurologic diseases of children, CT scan abnormalities of encephalitis have only been associated with herpes simplex infection. We describe two infants, one with coxsackievirus B2 meningoencephalitis and one with clinical encephalitis, whose CT scans were similarly abnormal during the acute phase of their illness. In both infants, recovery of both neurologic and developmental deficits was accompanied by resolution of the abnormalities of the initial CT scan. Speculation is offered as to the role of the CT scan in the assistance of the physician who must evaluate both the diagnosis and prognosis of infants who have a clinical picture of encephalitis.

Coxsackievirus Infections↗

PubMed1996

Detection of both herpes simplex and varicella-zoster viruses in cerebrospinal fluid from patients with encephalitis.

Cerebrospinal fluid (CSF) samples from 46 patients with encephalitis were studied for the presence of herpes simplex virus (HSV) types 1 and 2 and/or varicella zoster virus (VZV)-specific DNA sequences by the polymerase chain reaction (PCR) assay. Patients were studied because of detection of intrathecal production of IgG antibody to HSV alone (10 patients, Group A) or to both HSV and VZV (11 patients, Group B) or because of the presence of specific anti-HSV IgG in CSF without evidence of intrathecal antibody production (25 patients, Group C). CSF samples taken between days 1 and 10 from onset of encephalitis were available from all patients, and follow-up samples (taken after 10 days from onset) were obtained from some of them. Positive PCR results were obtained in a total of 13 patients. Four patients (three from Group A and one from Group B) gave amplification of HSV type 1 DNA alone, two patients (both from Group B) showed amplification of VZV DNA alone, and seven patients (all from Group B) gave dual amplification of both HSV type 1 and VZV DNA sequences in CSF. All CSF samples from patients in Group C were negative by PCR. Ten patients with CSF samples positive by PCR lacked a prior history of herpetic cutaneous lesions. In seven patients, serum antibody tests (specific IgM detection and specific IgG avidity assays) identified both primary and recurrent infections. The results suggest that the dual presence of IgG antibody to both HSV and VZV in CSF from patients with encephalitis may reflect in some cases a dual infection of the central nervous system caused by both agents.

Adult↗