RESUMO
Forty-nine consecutive patients with laboratory-confirmed acute Japanese encephalitis were studied to identify risk factors present at hospital admission which were associated with a fatal outcome. Sixteen patients (33%) died. The following constellation of findings correlated with a fatal outcome: infectious virus in cerebrospinal fluid (CSF), low levels of Japanese encephalitis virus-specific IgG and IgM in both CSF and serum, and a severely depressed sensorium. Age, sex, days ill before admission, distance from home to the hospital, past medical history, CSF protein content, and CSF leukocyte count were not significant risk factors. Among patients hospitalized for acute Japanese encephalitis, a vigorous virus-specific immunoglobulin response, both systemically and locally within the central nervous system, is a good marker for survival, and may be an inherently important factor in recovery from illness.
Assuntos
Encefalite Japonesa/mortalidade , Adolescente , Anticorpos Antivirais/análise , Anticorpos Antivirais/líquido cefalorraquidiano , Líquido Cefalorraquidiano/microbiologia , Criança , Pré-Escolar , Coma , Vírus da Encefalite Japonesa (Espécie)/imunologia , Vírus da Encefalite Japonesa (Espécie)/isolamento & purificação , Encefalite Japonesa/líquido cefalorraquidiano , Encefalite Japonesa/imunologia , Encefalite Japonesa/microbiologia , Feminino , Humanos , Imunoglobulina G/análise , Imunoglobulina G/líquido cefalorraquidiano , Imunoglobulina M/análise , Imunoglobulina M/líquido cefalorraquidiano , Lactente , Masculino , Prognóstico , Análise de Regressão , Risco , Fases do SonoRESUMO
The distribution of virus and the composition of the mononuclear inflammatory response were studied in the brains of 7 children who died with Japanese encephalitis. Viral antigen was localized to neurons, with greatest involvement in the thalamus and brainstem. Quantitation of perivascular inflammatory responses showed a preponderance of T cells, but only 7 to 30% of these cells were T suppressor/cytotoxic cells. Inflammatory cells invading the parenchyma were predominantly macrophages with small numbers of T cells. B cells remained localized to perivascular cuffs. Viral antigen was progressively cleared in patients with survival of 6 days or more.
Assuntos
Antígenos Virais/imunologia , Linfócitos B/imunologia , Encefalite Japonesa/imunologia , Linfócitos T/imunologia , Anticorpos Antivirais/líquido cefalorraquidiano , Encéfalo/imunologia , Encéfalo/patologia , Criança , Pré-Escolar , Vírus da Encefalite Japonesa (Espécie)/imunologia , Encefalite Japonesa/patologia , Humanos , Técnicas Imunoenzimáticas , Imunoglobulina G/líquido cefalorraquidiano , Imunoglobulina M/líquido cefalorraquidiano , Lactente , Macrófagos/imunologia , FagocitoseRESUMO
During an epidemic of Japanese encephalitis (JE) in northern Thailand, cerebrospinal fluid (CSF) leukocytes and blood leukocytes from 28 patients with suspected JE were tested for spontaneous in vitro synthesis of antibodies to JE virus (JEV). Sixteen patients were subsequently proven to be infected with JEV. Supernatant fluids of three-day cultures of unstimulated peripheral blood mononuclear leukocytes or unstimulated unfractionated CSF leukocytes were tested for JEV IgM and IgG antibodies with isotype-specific "antibody capture" radioimmunoassays. Blood-derived leukocytes from all sixteen JEV-infected patients and CSF-derived leukocytes from four JEV-infected patients synthesized JEV antibodies. Blood-derived and CSF-derived leukocytes from all 12 patients with central nervous system infections caused by agents other than JEV uniformly failed to synthesize JEV antibodies. Virus-specific antibody-producing cells can be detected in the blood and CSF early in the clinical course of acute JE.
