A Case Report of Japanese Encephalitis Focusing on MR Findings (original) (raw)
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Japanese encephalitis presenting as transverse myelitis: An uncommon presentation
Indian Journal of Case Reports
Japanese Encephalitis Virus (JEV) is the main cause of viral encephalitis in South East Asia. Commonly, it presents as an acute encephalitic syndrome with fever, headache, seizures, and altered sensorium as clinical manifestations. However, there can be atypical presentations such as acute transverse myelitis (ATM) as the initial manifestation. Clinicians should be aware of such possibilities and myelitis due to the JE virus should be considered as a differential in children presenting with encephalomyelitis.
BMJ case reports, 2012
Japanese encephalitis (JE) is an epidemic encephalitis characterised by altered sensorium, convulsions, headache, brainstem signs with pyramidal and extrapyramidal features. Immune-mediated manifestation as acute transverse myelitis (ATM) has not been previously reported in JE. We describe a 40-year-old man who presented with an acute onset quadriparesis with urinary retention, which was preceded by fever and headache 3 weeks prior. He had elevated IgM titres against JE virus in serum and cerebrospinal fluid. MRI of cervico-thoracic spine demonstrated signal intensity alterations extending from C1 to D10 spinal segments. The patient was treated with intravenous methyl prednisolone for 5 days. He regained normal power at 6 months follow-up and repeat MRI study demonstrated complete resolution of the lesion. We conclude that in a case of JE, one should be vigilant for early diagnosis of possible complication as ATM, in which an early institution of immunomodulator therapy prevents adv...
Overview: Japanese encephalitis
Progress in Neurobiology, 2010
Japanese encephalitis (JE) is one of the most important endemic encephalitis in the world especially in Eastern and Southeastern Asia. JE affects over 50,000 patients and results in 15,000 deaths annually. JE virus is a single stranded positive sense RNA virus belonging to family flaviviridae. JE virus is transmitted through a zoonotic cycle between mosquitoes, pigs and water birds. Humans are accidentally infected and are a dead end host because of low level and transient viremia. In the northern region, large epidemics occur during summers whereas in the southern region JE tends to be endemic: cases occur throughout the year with a peak in the rainy season. Occurrence of JE is more closely related to temperature than to humidity. JE is regarded as a disease of children in the endemic areas but in the newly invaded areas, it affects both the adults and children because of the absence of protective antibodies. For every patient of JE, there are large numbers of subclinical cases (25-1000). Symptomatic JEV infection manifests with nonspecific febrile illness, aseptic meningitis or encephalitis. Encephalitis manifests with altered sensorium, seizures and focal neurological deficit. Acute flaccid paralysis may occur due to anterior horn cell involvement. A wide variety of movement disorders especially transient Parkinsonian features and dystonia (limb, axial, orofacial) are reported in 20-60% patients. JE mainly affects thalamus, corpus striatum, brainstem and spinal cord as revealed by MRI and on autopsy studies. Coinfection of JE and cysticercosis occurs because of the important role of pigs in the life cycle of both JEV and cysticercosis. Laboratory diagnosis of JE is by IgM capture ELISA, which has high sensitivity and specificity. In the absence of specific antiviral therapy, JE is managed by symptomatic and supportive therapies and preventive measures. Purified formalin inactivated mouse brain derived vaccine and live attenuated vaccine (SA 14-14-2) are available; the latter is reported to be safe, effective and cheap. The role of Chimeric recombinant attenuated JE vaccine is under investigation. Control of JE is related to the wider issues of hygiene, environment, education and economy.
Persistence of Japanese encephalitis virus in the human nervous system
Journal of Medical Virology, 1993
JEV-Specific IgM Antibodies CSF-JEV IgM was measured using the IgM capture ELISA described by Burke et al. [1985bl with one modification: biotinslated monoclonal antibody to E protein of JEV (clone 301) was used instead of peroxidase-la-KEY Japanese IgM belled hyperimmune JEV globulin as tracer antibody [Ravi et al., 1989al. antibodies, viral antigen, virus isolation JEV Antigen Detection A monoclonal antibody-based reverse passive haemagglutination test (RPHA) described earlier by Ravi et al. [1989al was used for detection of soluble JEV antigen in the CSF.
Indian Journal of Microbiology Research
Japanese encephalitis Virus (JEV) a flaviviridae family member (genus Flavivirus) is the main cause of meta-zoonotic viral encephalitis in many Asian countries. The disease was primarily reported in 1952 from Nagpur territory of Maharashtra recording nearly 16 deaths of an unknown viral encephalitis which was later awarded to be JEV; just nearer to Chandrapur reporting the present catastrophes.Hence we have undertaken present study to make a countable move not only towards the diagnosis of the diseases but also to restrict its future spread in Indian continent. Which will also aid medical practitioners to combat with this metazoonotic disorder.Amongst total suspected population nearly these 20 males and 22 females were positive. Considering monthly distribution most number of suspected cases were seen in the month of July. Most number of JEV affected population was seen more in the age group of 1 to 5 years of children and with advancement of the age reduction in the number of serop...
Neuroradiology, 1997
Japanese encephalitis (JE) is the commonest endemic encephalitis in southeast Asia, including India . The diagnosis is commonly based on demonstrating a rising titre of antibodies against JE virus in acute and convalescent sera . There is a delay of at least 7 days before the diagnosis can be confirmed. In an endemic area, it is important to differentiate JE from herpes simplex encephalitis for rational therapy with acyclovir. Our initial studies on radiological and neurophysiological changes in JE revealed characteristic thalamic lesions . In a recent study, encephalopathy with bilateral thalamotegmental involvement was reported from Japan but the possibility of JE was not considered . We report MRI changes in seven patients with JE.
Journal of Clinical Virology, 2011
Background: Japanese encephalitis (JE) has traditionally been regarded as a disease of children. The age shift in JE patients in Assam, India in last few years has become a cause of concern. Comparison on clinical features of adult and pediatric JE patients has not been evaluated. Objective: To compare clinical features of adult and pediatric with JE virus infection. patients with Acute Encephalitis Syndrome were enrolled. 259 (47.1%) were serologically confirmed as JE of which 66.4% were adult and 33.6% were pediatric. Data extracted from these patients were analyzed. Results: Fever was the most common symptom in both the adult and pediatric. When compared with adult, significantly higher percentage of pediatric had neck rigidity, convulsions, abnormal behavior, seizures and elevated aspartate transaminase (P < 0.05). Serum bilirubin levels were higher in 2.3% of adult but normal in all the pediatric. We found significantly higher mean elevated level of protein and WBC in CSF in adult (P < 0.001) and mean elevated aspartate transaminase level (P < 0.001) in pediatrics. There was no difference in mortality rate between pediatric and adult (8.2% vs. 4.4%, P = 0.647).
International Journal of Research in Medical Sciences, 2015
Japanese Encephalitis (JE), an endemic, non-contagious, mosquito borne, acute viral encephalitis, is a global health problem and about 50000 cases and 10000 deaths are recognized annually throughout Asia. 1-3 It is one of the major causes of acute viral encephalitis with high mortality and morbidity and is the most common form of epidemic viral encephalitis. 4-7 It is endemic in southern and northern parts of India and has continuous irregular outbreaks. 8 The first epidemic of JE occurred in during later half of 1955 in the North Arcot district of Tamil Nadu. 9 Since 1973, outbreaks of JE have occurred in eastern, northeastern and northern states. 8 In UP, after a lapse of score of years first outbreak occurred in 1978 in the northeastern districts. 10 JE was first time isolated in Lucknow in 1978 in KGMC from the brain tissue of a fatal case from Gorakhpur district. 3 A study from Lucknow 11 suggested that disease is endemic ABSTRACT Background: Objective of current study was to compare and evaluate different diagnostic tests to establish a reliable and less time consuming diagnostic test for prompt diagnosis of acute Japanese encephalitis cases mainly amongst children and young adults from NorthEastern part of Uttar Pradesh. Methods: A total of 100 subjects, including 50 suspected cases and 50 diseased controls were investigated to establish the diagnosis of JE in acute encephalitis patients. All CSF samples were subjected to MAC-ELISA, virus cultivation and RT-PCR. Results: Out of 50 cases, 6 showed negative results by all the three tests. 50% (22 out of 44), 47.5% (21 out of 44), and 66% (23 out of 44) were found positive by MAC-ELISA, Virus cultivation and RT-PCR respectively. The rate of detection by Virus cultivation and RT-PCR was higher in case of MAC-ELISA negative cases (57.1% and 78.5%) than that of MAC-ELISA positive cases (22.7% and 27.2%) respectively. Mean age of the patients was 12.5 years, which ranged from 1-24 years with male to female ratio of 3:1. Conclusions: The RT-PCR was found most reliable, sensitive and specific method amongst the three chosen methods for detection of JEV in suspected encephalitis patients.