World Encephalitis Day
Encephalitis is an inflammation of the brain. It is caused either by an infection invading the brain (infectious encephalitis) or through the immune system attacking the brain in error (post-infectious or autoimmune encephalitis). World Encephalitis Day on Thursday, 22nd February 2024 is the global awareness day for people who have been directly or indirectly affected by encephalitis. Encephalitis International
UpToDate
General
Paediatrics
Articles
Autoimmune Encephalitis
Covid 19
General
Japanese Encephalitis
Podcasts
Journals
E-books
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Articles
Autoimmune Encephalitis
Characterizing cognitive function in patients with autoimmune encephalitis: an Australian prospective study
The study identified deficits in perceptual reasoning, processing speed, and working memory among chronic autoimmune encephalitis (AE) patients. Pattern analysis highlighted positive long-term cognitive outcomes for many but varied outcomes for those with ongoing difficulties. Although severely cognitively impaired patients were not included, the findings apply to AE cohorts who attend outpatient clinical neuropsychology consultations emphasizing the need for thorough cognitive assessment. The results suggest a need for further research targeting other cognitive domains, including executive functions. Journal of neurology 14 September 2023
Clinical characteristics of autoimmune encephalitis with co-existence of multiple anti-neuronal antibodies
Autoimmune encephalitis (AE) with co-existing multiple anti-neuronal antibodies is a specific subgroup, that is increasingly recognized in clinical practice. The co-existence of multiple anti-neuronal antibodies has a major impact on clinical features, disease progression, and prognosis. BMC neurology 2 January 2024
Enhancing the clinical diagnosis of the acute and subacute phases of autoimmune encephalitis and predicting the risk factors: the potential advantages of 18F-FDG PET/CT
18F-FDG PET could be more sensitive and informative than MRI in the early phases of AE. The common pattern of AE was high MTL metabolism on 18F-FDG PET, which was associated with hypometabolism of the occipital lobe, and the number of lesions on PET before treatment may be significant factors in assessing disease severity. The SUVmax of MTL hypermetabolism may serve as a prognostic biomarker in AE. BMC medical imaging 20 November 2023
Effectiveness of intra-thecal methotrexate in refractory Anti-N-methyl-d-aspartate receptor encephalitis
Intra-thecal methotrexate may be a potentially effective and relatively safe escalation option for immunomodulatory therapy of refractory anti-NMDA receptor encephalitis. Future studies on intra-thecal methotrexate -specific treatment regimens may further support its utility, efficacy, and safety in treating refractory anti-NMDA receptor encephalitis. BMC neurology 7 July 2023
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Covid-19
Prevalence, pathogenesis and spectrum of neurological symptoms in COVID‐19 and post‐COVID‐19 syndrome: a narrative review
Summary
MJA 21 August 2021
Pathophysiology, diagnosis, and management of neuroinflammation in covid-19
Although neurological complications of SARS-CoV-2 infection are relatively rare, their potential long term morbidity and mortality have a significant impact, given the large numbers of infected patients. Covid-19 is now in the differential diagnosis of a number of common neurological syndromes including encephalopathy, encephalitis, acute demyelinating encephalomyelitis, stroke, and Guillain-Barré syndrome. Physicians should be aware of the pathophysiology underlying these presentations to diagnose and treat patients rapidly and appropriately. Although good evidence has been found for neurovirulence, the neuroinvasive and neurotropic potential of SARS-CoV-2 is limited. The pathophysiology of most complications is immune mediated and vascular, or both. A significant proportion of patients have developed long covid, which can include neuropsychiatric presentations. The mechanisms of long covid remain unclear. The longer term consequences of infection with covid-19 on the brain, particularly in terms of neurodegeneration, will only become apparent with time and long term follow-up. BMJ 18 August 2023
Clinical manifestations and EEG findings in children infected with COVID-19 and exhibiting neurological symptoms
Non-specific EEG abnormalities were found in COVID-19-related encephalitis/encephalopathy. This study corroborated that a small group of pediatric patients infected by COVID-19 and showing neurological symptoms may exhibit abnormal EEG. This study could help improve the understanding of clinical and EEG characteristics in children with COVID-19 and inform triage policies in other hospitals during the COVID-19 pandemic. BMC Pediatrics 16 January 2024
Treatment of cognitive deficits and behavioral symptoms following COVID-19-associated Autoimmune Encephalitis with Intravenous Immunoglobulin: A case report and review of the literature
Coronavirus disease 2019 (COVID-19) is associated with long-term neuropsychiatric sequelae. We describe a 60-year-old male patient's history and symptom trajectory encompassing the development of behavioral symptoms and cognitive deficits following pneumonia and subsequent autoimmune encephalitis associated with COVID-19. We also describe changes in these facets with correlative changes in his immunological parameters after both acute intravenous immunoglobulin (IVIG) therapy and chronic periodic IVIG therapy every two weeks over the course of two years. We review the literature on the treatment of long COVID-19 symptoms spanning cognitive and behavioral domains. In addition, we also elucidate current literature on the role of IVIG infusions for these symptoms using our patient's presentation and improvement in symptoms as an illustrative example. Cureus 25 December 2023
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General
Analysis of the effectiveness of targeted nursing in children with severe viral Encephalitis complicated with respiratory failure
Targeted nursing can shorten the recovery period of severe viral encephalitis complicated with respiratory failure in children, speed up the recovery of motor function, and improve lung function. This nursing model has a significant application effect in children with severe viral encephalitis complicated with respiratory failure. Journal of clinical and nursing research 18 January 2024
Criminality in patients with autoimmune encephalitis: A case series
Criminal behaviours are a rare, novel, and stigmatizing residual neurobehavioural phenotype in AE, with significant social and legal implications. With caution towards overattribution, the authors suggest they occur as part of a postencephalitis limbic neurobehavioural syndrome. European journal of neurology 8 January 2024
Neurocognitive outcome in children and adolescents following infectious encephalitis
Infectious encephalitis in children is fairly uncommon, but unfavorable outcomes are seen in many survivors. The aim of this study was to prospectively describe the long-term neurocognitive consequences following infectious encephalitis in childhood. Child neuropsychology 16 November 2023
Diagnosing viral encephalitis and emerging concepts
Although etiological diagnosis remains challenging in viral encephalitis, recent advances may soon provide the clinician with additional tools. Environmental changes, host factors (such as ubiquitous use of immunosuppression), and societal trends (re-emergence of vaccine preventable diseases) are likely to change the landscape of neurologic infections that are considered and treated in clinical practice. Current opinion in neurology 17 April 2023
Addressing vaccine-preventable encephalitis in vulnerable populations
Addressing these gaps in vaccination strategies will allow for improved vaccination coverage and lead to better health outcomes for those most at risk for vaccine-preventable encephalitis. Current opinion in neurology 19 April 2023
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Japanese Encephalitis
Emergence of Japanese encephalitis in Australia: a diagnostic perspective
The unprecedented emergence of Japanese encephalitis (JE) in mainland Australia represents an outbreak of high clinical and public health significance. JE is a zoonosis spread by mosquitoes and is one of the most important causes of endemic viral encephalitis in South-East Asia and the Indian subcontinent. This review provides a comprehensive outline of currently available methods for JEV diagnosis including serology, nucleic acid amplification testing, virus isolation, sequencing and metagenomics. The relative advantages and disadvantages of the diagnostic tests are presented, as well as their value in clinical and public health contexts. This review also explores the role of mosquito, veterinary and human surveillance as part of the laboratory response to JEV. As JEV may become endemic in Australia, a collaborative and coordinated One Health approach involving animal, human and environmental health is required for optimal disease response and control. Pathology 19 August 2022
Japanese Encephalitis emergence in Australia: The potential population at risk
Japanese encephalitis virus (JEV), an RNA virus transmitted by Culex mosquitoes, primarily cycles between aquatic birds and mosquitoes with pigs as amplifying hosts, posing a significant global encephalitis threat. The emergence and spread of the Japanese encephalitis virus (JEV) in new epidemiological regions, such as recent cases in Australia and non-endemic areas like Pune, India, raise significant concerns. With an estimated 68,000 clinical cases and 13,600 to 20,400 deaths annually, JEV poses a substantial global health threat. The virus primarily affects children, with a case-fatality ratio of 20%-30% and long-term neurological sequelae in survivors. The changing epidemiology, influenced by factors like bird migration, climate change, and increased urbanization, contributes to the geographic expansion of JEV. The recent outbreaks underscore the potential for the virus to establish itself in non-endemic regions, posing a threat to populations previously considered at low risk. With limited treatment options and high rates of neurological complications, continued surveillance, traveler vaccination, and research into treatments are crucial to mitigate the impact of JEV on human health. The evolving scenario necessitates proactive measures to prevent and control the spread of the virus in both endemic and newly affected areas. Annals of medicine and surgery 22 January 2024
Modelling the risk of Japanese encephalitis virus in Victoria, Australia, using an expert-systems approach
Predictive models for vector-borne diseases (VBDs) are instrumental to understanding the potential geographic spread of VBDs and therefore serve as useful tools for public health decision-making. However, predicting the emergence of VBDs at the micro-, local, and regional levels presents challenges, as the importance of risk factors can vary spatially and temporally depending on climatic factors and vector and host abundance and preferences. We propose an expert-systems-based approach that uses an analytical hierarchy process (AHP) deployed within a geographic information system (GIS), to predict areas susceptible to the risk of Japanese encephalitis virus (JEV) emergence. This modelling approach produces risk maps, identifying micro-level risk areas with the potential for disease emergence. The results revealed that climatic conditions, especially the minimum temperature and precipitation required for JEV transmission, contributed to high-risk conditions developed during January and March of 2022 in Victoria. Compared to historical climate records, the risk of JEV emergence was increased in most parts of the state due to climate. Importantly, the model accurately predicted 7 out of the 8 local government areas that reported JEV-positive cases during the outbreak of 2022 in Victorian piggeries. This underscores the model’s potential as a reliable tool for supporting local risk assessments in the face of evolving climate change. BMC infectious diseases 8 January 2024
Current advances in Japanese Encephalitis Virus drug development
Recently, several promising and potential drug candidates were reported through drug repurposing studies, high-throughput drug library screening, and de novo design. This review focuses on the historical aspects of JEV, the biology of JEV replication, targets for therapeutic strategies, a target product profile, and drug development initiatives. Viruses 28 January 2024
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Podcasts
Japanese encephalitis virus
Dr David Williams is Group Leader of the Emergency Diseases Laboratory Diagnosis Group at the Australian Centre for Disease Preparedness at the CSIRO. He talks about Japanese encephalitis virus, to accompany a case study published by other authors at the MJA. MJA 30 May 2022
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