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OBJECTIVE To investigate the role of clinical pharmacists in the treatment of a patient with Epstein-Barr （EB） virus encephalitis. METHODS Clinical pharmacist participated in drug diagnosis and therapy for a patient with EB virus encephalitis. According to the physiological characteristics of the disease and the pharmacokinetic-pharmacodynamic characteristics of antibiotics， clinical pharmacists suggested that the dose should be adjusted as ceftriaxone 2 g， q12 h+meropenem 2 g， q8 h. Based on the uncontrolled infection of the patient， pharmacists suggested that ceftriaxone should be stopped and vancomycin 1 million U and q12 h should be used as alternative therapy. According to the results of etiology， pharmacists suggested that acyclovir should be discontinued and replaced with ganciclovir 5 mg/kg， q12 h. The electrolyte disturbance of the patient may be adverse drug reactions caused by Mannitol injection， it was recommended to stop the drug. RESULTS The clinician followed the advice of the clinical pharmacists. After treatment， the patient improved and was discharged. CONCLUSIONS Clinical pharmacists can carry out pharmaceutical care for patients with EB virus encephalitis， assist physicians in optimizing the treatment plan of patients， and ensure the effectiveness and safety of drug treatment.
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Japanese encephalitis (JE) is a leading cause of viral encephalitis in Southeast Asia. It is a serious public health issue in India, and cases have been emerging in newer areas of the country. Although vaccination efforts have already been initiated in the country since 2006 and later through the Universal Immunization Programme in 2011, still a significant reduction in the number of cases has to be achieved since an escalating trend of JE incidence has been reported in certain States such as Assam, Uttar Pradesh and West Bengal. Moreover, fresh cases of JE have been reported from certain pockets in Odisha as well. Despite the mass JE vaccination programme implemented in prioritized endemic zones in the country in 2011, a shift in the age group of JE virus (JEV) infection was noticed affecting the adult population in West Bengal. The recent detection of the circulation of genotype I (GI) in Gorakhpur, Uttar Pradesh and the co-circulation of GI and genotype III (GIII) in West Bengal are probably a warning signal for the public health personnel to strengthen the surveillance system in all endemic hotspots in the country. The abrupt emergence of JEV genotype V (GV) in China and Korea in 2009, after its first detection in Malaya in 1952, endemic countries have been cautioned to strengthen their surveillance, because GV has been suspected of getting dispersed efficiently in other parts of Asia. Moreover, the reduced protection efficiency of the JEV GIII-based vaccine against the JEV genotype V further warrants careful evaluation of the ongoing vaccination strategies in the endemic countries, anticipating the possible incursion of GV and its impact on future control strategies. In view of the above facts, the present communication reviews the current knowledge on the molecular epidemiology of JEV in India vis-a-vis the global scenario and discusses the future priorities in JEV research in India for effectively designing control strategies.
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Resumen Los virus chikungunya (CHIKV) y dengue (DENV) son arbovirus transmitidos por el mosquito Aedes. La infección por ambos virus es casi privativa de regiones tropicales y subtropicales , pero en los últimos años han aparecido casos en la mayoría de los países, lo que ha aumentado el interés en estos virus. En esta revisión se describe las manifestaciones neurológicas de CHIKV y DENV. Los cuadros neurológicos observados en pacientes infectados por estos virus son en la mayoría de los casos encefalitis y encefalopatía. También hay cuadros de mielitis y encefalomielitis aguda diseminada(ADEM) post infecciosas. Más infrecuentemente se observa compromiso periférico: síndrome de Guillain Barré(SGB) y mononeuritis. La miositis y la parálisis periódica se observan aunque raramente en la infección por DENV. El diagnóstico se realiza por serología Ig M específica o por detección de ARN viral en suero y LCR. El tratamiento es de sostén pues no hay tratamiento específico. Los pacientes con cuadros post infecciosos/inmunomediados se tratan con inmunoglobulina(IG) EV o plasmaféresis(SGB)y con metilprednisolona/IG en pacientes con ADEM. Es fundamental realizar el diagnóstico precoz de la infección por DENV y CHIKV para tratar a tiempo las complicaciones sistémicas y neurológicas, en especial las encefalitis y cuadros postinfecciosos.
Abstract Chikungunya (CHIKV) and dengue (DENV) viruses are arboviruses transmitted by the Aedes mosquito. Infection by both viruses is almost deprived of tropical and subtropical regions, but in recent years cases have appeared in most countries, which has increased the interest in these viruses. This review describes the neurological manifestations of CHIKV and DENV. The neurological pictures observed in patients infected by these viruses are in most cases encephalitis and encephalopathy. There are also post-infectious myelitis and disseminated acute encephalomyelitis (ADEM). Peripheral involvement is more rarely observed: Guillain Barré syndrome (GBS) and mononeuritis. Myositis and periodic paralysis are seen but rarely in DENV infection. The diagnosis is made by specific IgM serology or by detection of viral RNA in serum and CSF. The treatment is supportive as there is no specific treatment. Patients with post-infectious / immunomediated squares are treated with immunoglobulin (IG) EV or plasmapheresis (GBS) and with methylprednisolone / GI in patients with ADEM. Early diagnosis of infection by DENV and CHIKV is essential to treat systemic and neurological complications, especially encephalitis and postinfectious disease.
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Humans , Chikungunya virus , Dengue Virus , Encephalitis, Viral , Encephalomyelitis, Acute DisseminatedABSTRACT
Heartland virus (HRTV) is a Bunyaviridae, phlebovirus that it has recently emerged as the causative agent of human disease characterized by thrombocytopenia and leukopenia in the United States and China. It seems to be the HRTV has been also reported in China, Japan and Korea. Recently the first fatal case of HRTV disease in an 80-year-old Tennessee resident was reported (1)
Subject(s)
Encephalitis , Ticks , VirusesABSTRACT
Objective To summarize and analysis the clinical features, diagnosis and treatment of the cases which were positive for anti-N-methyl-D-aspartic acid (NMDA) receptor antibodies by indirect immunofluorescence assay (IFA). Methods We analyzed the disease process, clinical characteristics, auxiliary examination , diagnosis, treat-ment, and prognosis of five cases positive for anti NMDA receptor antibodies in their serum and cerebrospinal fluid (CSF). Results Four of the five cases positive for anti-N-methyl-D-aspartic acid (NMDA) receptor antibodies were di-agnosed with anti-NMDA receptor encephalitis and one was diagnosed with Herpes Simplex Virus Encephalitis(HSE). The five cases had a similar disease presentation including prodromal flu-like symptoms in three cases and psychiatric symptoms at onset in three cases. Four cases developed epilepsy and respiratory failure during the disease course and received treatment in the NICU. Four cases had movement disorders during the late stage of isease..Electroencephalo-graphs and brain MRI showed abnormalities in most cases. The virus infection and dysimmunity test were positive in four cases. Patients with the anti-NMDA receptor encephalitis could have a good immediate prognosis after treatment with hormone and immune globulin. However, two cases developed cancer and one case died during one year fol-low-up. Conclusion Patients with HSE may also test positive for anti-NMDA receptor antibodies. Thus, diagnosis of anti-NMDA receptor encephalitis requires a thorough evaluation including patient’s history and disease course to avoid misdiagnosis.
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Objectives To investigate the pathogenic mechanism of herpes simplex encephalitis (HSE) and the mecha-nism of action of dexamethasone and acyclovir. Methods 102 male mice were randomly assigned to normal control group, HSV-1 infection group, acyclovir-treated group and combination-treated group. The model of HSE was established by in-tracranial injection of HSV-1 in mice except normal controls. One day after intracranial injection, mice in acyclovir-treated group and combination-treated group were intragastrically administrated with acyclovir, and mice in normal control group and HSV-1 infection group were intragastrically administrated with normal saline. Three days after intracranial injection, mice in combination-treated group were intraperitoneally injected with dexamethasone and mice in other groups were in-traperitoneally injected with normal saline. The neurological injury score and the expressions of IL-2 and IL-10 of the mice brain tissues in each group were compared at 3, 6 and 9 days after model establishment. Results The survival rate of mice was lowest in HSV-1 infection group and highest in combination-treated group (P0.05). Conclusions In comparison with acyclovir monotherapy, combined treatment with dexamethasone and acyclovir for HSE can reduce the expression of IL-2 and IL-10, relieve the clinical symptoms, and increase the survival rate.
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Objective To explore MRI characteristics of virus encephalitis and its relevance with pathlological changes,and to improve understanding MRI features of virus encephalitis.Methods Seventeen cases of virus encephalitis clinically proven were collected and reviewed.The correlation between MRI findigns and pathology were analyzed.MRI examinations included plain scan and FLAIR scan in all 17 patients,among which 13 underwent contrast-enhanced MR scanning.Results The lesions mainly located at the cerebral cortex gray matter and the cerebrum subcortical gray matter nuclei.16 cases appeared as multiple foci,and 1 case was single focus.The foci had definite margins and with no obvious peripheral edema.The lesions were slightly hypo-or iso-intense on T_1WI,slightly intensity on T_2WI and obvious high signal intensity on FLAIR.After enhanced scan,the lesions were no obvious enhancement in 2 cases,enhancement line in the surfaces of the brain in 15 cases,in which the lesions showed patch enhancement in 6 cases and gyrus-like enhancement in 2 cases.Conclusion The pathological changes of viral encephalitis can be reflexed with MR imaging features,which is of important value in the differential diagnosis of virus encephalitis.
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Japanese-B virus encephalitis (JE), the most common human endemic and epidemic encephalitis, usually has a uniphasic illness with a variable outcome. A 49-year-old woman with cognitive dysfunction from JE had improved over 3 weeks. Brain MRI revealed multiple lesions in the bilateral thalamus, caudate nuclei and medial temporal lobe. Two weeks after discharge, the patient showed re-aggravation of the cognitive dysfunction and lapsed into coma. We report a patient with JE having showed biphasic illness pattern.
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Female , Humans , Middle Aged , Brain , Coma , Encephalitis , Encephalitis, Arbovirus , Temporal Lobe , Thalamus , VirusesABSTRACT
Background: Japanese Encephalitis (JE) is common in the plains and mountainous areas in Asia \u2013 Pacific. Japanese encephalitis vaccine shows effectiveness in protecting children from JE in some countries such as Japan and Korea. Objective: To evaluate the efficacy of Japanese Encephalitis (JE) vaccination in Thai Binh province during 2003-2007. Subject and Method: Prospective, retrospective and sero-epidemiological methods were carried out on 329 samples collected from viral encephalitis patients and tested by JE MAC-ELISA, the positive average was 41.6% (137/329). Result: It had dramatically dropped from 85.2% in 2003 to 8.5 % in 2007 related to the rate of JE vaccination for children from 1 to 5 years old increasing from 49 % in 2003 to 77 % in 2007. Most of JE confirmed cases were un-vaccinated. Conclusion: JE etiology cause viral encephalitis in children in Thai Binh province was reduced thanks to JE vaccination in EPI program for 1 to 5 year old children. But more than 96% (131/136) of viral encephalitis in 15 years old upward was unknown etiology, the need for further study of the etiology cause viral encephalitis in adults.
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Encephalitis, Japanese , VaccinesABSTRACT
Relapse of herpes simplex virus (HSV) encephalitis rarely occurs after acyclovir treatment. We experienced a case of relapsing HSV encephalitis in the contralateral temporal lobe, resulting in Kluver-Bucy syndrome, after a full dose acyclovir treatment. Sudden behavioral and emotional changes after HSV encephalitis treatment suggest relapsing HSV encephalitis as well as temporal lobe epilepsy.
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Acyclovir , Encephalitis , Encephalitis, Herpes Simplex , Herpes Simplex , Kluver-Bucy Syndrome , Methylmethacrylates , Polystyrenes , Recurrence , Simplexvirus , Temporal LobeABSTRACT
@# ObjectiveTo explore the clinical features and early diagnosis of virus encephalitis with mental disorder as initial symptoms.MethodsThe materials of 46 cases of virus encephalitis with mental disorder as initial symptoms from 1999 to 2003 were analyzed retrospectively.ResultsAfter antivirus treatment, most patients had good prognosis, only one patient who had fever and coma suddenly two weeks after onset was in vegetative statement.ConclusionTo the patients beginning with acute mental disorder, if they have infection, diarrhea, over-fatigue, oral herpes before disease and exhibit intelligence retardation, incontinence of stool or urine, fever, epilepsy during disease course, it is necessary to complete relative examination and monitor the disease, so as to make sure the diagnosis and guide the treatment.
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Objective To explore the clinical characteristics and diagnosis of Epstein-Barr(EB) virus encephalitis(EBE) in children. Methods The verification of EBE was based on detection of EBV DNA in cerebrospinal fluid (CSF) by fluorogenic quantitative PCR(FQ-PCR) and Nest-PCR. The clinical and CSF changes of 27 EBE cases and 26 controls were analyzed and compared. Results EB-DNA in CSF by FQ-PCR of 13 cases of EBE was (2.82?2.03)?10 3copies.There was no significant difference in clinical manifestations between EBE and HSE groups, except that WBC in CSF of EBE was lower than those of HSE.Conclusions EBE is not infrequent, about 10 % of encephalitis in children. EBE is always present independently, which is not a complication of infectious mononucleosis(IM).Detection of EBV-DNA in CSF is a sensitive and specific test for diagnosing of EBE. Early treatment may be beneficial to the prognosis of EBE.
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Objective To investigate the changes of brain angiography in patients with virus encephalitis.Methods Examining 5 patients with herpes simplex virus encephalitis and 2 patients with Epstein-Barr(EB)virus encephalitis by digital subtractiona angiography(DSA)system and compares the results with control group(including 10 headache patients).Results The results of DSA of virus encephalitis patients were all abnormal,the outcome was accelerating blood circle like irritation.The average of the whole time of brain artery and vein circle was 6.71 seconds,while the results of DSA examination of the control group were all normal,the whole time of brain circle was 10.25 seconds.There was significant difference between the two groups(P
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Objective To observe the clinical therapeutic effects of Ganciclovir on the children with virus encephalitis.Method 98 patients with virus encephalitis were randomly divided into the virazole treatment group(52 cases) and the Ganciclovir treatment group(46 cases),clinical performance and therapeutic effects were compared.Results The mean time of headache, vomiting, tetany and the recovering of mind was shorter than that of virazole treatment group.The time of fever was shorter,but has no difference in statistics. Conclusion Ganciclovir is obvious effect to treat the child virus encephalitis.
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Objective To analyze clinical characteristics of 8 cases of MELAS syndrome that misdiagnosed as herpes simplex virus encephalitis(HSE).Methods The clinical data of 8 cases of MELAS syndrome that misdiagnosed as HSE were reviewed retrospectively.Results The main manifestations of 8 cases were repeated fever,progressive mental impairment,seizures,headache,descent of eyesight and hearing,weakness of extremities.Fever was the common symptom in the 8 cases.Exercise tolerance dose of serum lactic acid levels studied in 8 cases were obviously abnormal.Imaging examinations showed laminar necrosis or atrophy in brain lobes and basal ganglia areas.Electroencephalogram(EEG) mainly showed diffused slow waves,1 patient displayed myogenic injury in electromyogram(EMG).Muscle biopsy showed red ragged fibers and abnormal mitochondria in all cases.Conclusions The clinical manifestations of MELAS syndrome are similar to HSE,but EEG and imaging results are obviously different from HSE.Exercise tolerance dose of serum lactic acid and muscle biopsy are important for diagnose of MELAS syndrome.
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São descritos os achados obtidos pela Seção de Vírus Transmitidos por Artrópodes durante os estudos sobre a epidemia de encefalite ocasionada por um arbovírus, o Rocio, do grupo Flavivírus, novo para a ciência e que significou a emergência de nova doença humana para a região Sul do Brasil, compreendendo os municípios de Peruíbe, Itanhaém, Mongaguá e outros do Vale do Ribeira, no Estado de São Paulo, em 1975. Descreve as características da área endêrnica, os métodos virológicos utilizados, a caracterização do agente etiológico, seus aspectos epidemiológicos e observações a respeito dos ciclos enzoótico e epizoótico do vírus (AU).