动态脑电图与常规脑电图应用于病毒性脑炎诊断的效果分析

目的:探讨动态脑电图与常规脑电图应用于病毒性脑炎的应用价值。方法:选取150例病毒性脑炎患者,随机分为两组,每组各75例,常规脑电图(REEG)组采用常规脑电图检查,动态脑电图(AEEG)组采用动态脑电图检查;观察并记录脑电图异常率,不同程度病情脑电图异常率的例数,评价动态脑电图与常规脑电图对病毒性脑炎的检测灵敏度和准确度。结果:AEEG组检出的脑电图异常率明显高于REEG组(P0.05)。不同程度病情脑电图检出的患者比例,两组相比,差异没有统计学意义(F=-0.085,P0.05)。REEG组中,轻度与中度病毒性脑炎检出率相比,差异没有统计学意义(P0.05),中度与重度病毒性脑炎检出率相比,差异没有统计学意义(P0.05),重度病毒性脑炎检出率明显高于轻度(P0.05)。AEEG组中,轻度与中度病毒性脑炎检出率相比,差异没有统计学意义(P0.05),重度病毒性脑炎检出率明显高于中度和轻度(P0.05),AEEG组重度病毒性脑炎检出率明显高于REEG组(P0.05)。结论:动态脑电图作为一种无创性检查,对于病毒性脑炎具有极好的检出率,灵敏度高,适用于病毒性脑膜炎的早期辅助诊断。     

Systemic and brain macrophage infections in relation to the development of simian immunodeficiency virus encephalitis

The brains of individuals with lentiviral-associated encephalitis contain an abundance of infected and activated macrophages. It has been hypothesized that encephalitis develops when increased numbers of infected monocytes traffic into the central nervous system (CNS) during the end stages of immunosuppression. The relationships between the infection of brain and systemic macrophages and circulating monocytes and the development of lentiviral encephalitis are unknown. We longitudinally examined the extent of monocyte/macrophage infection in blood and lymph nodes of pigtailed macaques that did or did not develop simian immunodeficiency virus encephalitis (SIVE). Compared to levels in macaques that did not develop SIVE, more ex vivo virus production was detected from monocyte-derived macrophages and nonadherent peripheral blood mononuclear cells (PBMCs) from macaques that did develop SIVE. Prior to death, there was an increase in the number of circulating PBMCs following a rise in cerebrospinal fluid viral load in macaques that did develop SIVE but not in nonencephalitic macaques. At necropsy, macaques with SIVE had more infected macrophages in peripheral organs, with the exception of lymph nodes. T cells and NK cells with cytotoxic potential were more abundant in brains with encephalitis; however, T-cell and NK-cell infiltration in SIVE and human immunodeficiency virus encephalitis was more modest than that observed in classical acute herpes simplex virus encephalitis. These findings support the hypothesis that inherent differences in host systemic and CNS monocyte/macrophage viral production are associated with the development of encephalitis.     

Correlation of TBE Incidence with Red Deer and Roe Deer Abundance in Slovenia

Tick-borne encephalitis (TBE) is a virus infection which sometimes causes human disease. The TBE virus is found in ticks and certain vertebrate tick hosts in restricted endemic localities termed TBE foci. The formation of natural foci is a combination of several factors: the vectors, a suitable and numerous enough number of hosts and in a habitat with suitable vegetation and climate. The present study investigated the influence of deer on the incidence of tick-borne encephalitis. We were able to obtain data from deer culls. Using this data, the abundance of deer was estimated and temporal and spatial analysis was performed. The abundance of deer has increased in the past decades, as well as the incidence of tick-borne encephalitis. Temporal analysis confirmed a correlation between red deer abundance and tick-borne encephalitis occurrence. Additionally, spatial analysis established, that in areas with high incidence of tick-borne encephalitis red deer density is higher, compared to areas with no or few human cases of tick-borne encephalitis. However, such correlation could not be confirmed between roe deer density and the incidence of tick-borne encephalitis. This is presumably due to roe deer density being above a certain threshold so that availability of tick reproduction hosts has no apparent effect on ticks'' host finding and consequently may not be possible to correlate with incidence of human TBE.     

Diagnostic Pathways as Social and Participatory Practices: The Case of Herpes Simplex Encephalitis

Herpes simplex virus (HSV) encephalitis is a potentially devastating disease, with significant rates of mortality and co-morbidities. Although the prognosis for people with HSV encephalitis can be improved by prompt treatment with aciclovir, there are often delays involved in the diagnosis and treatment of the disease. In response, National Clinical Guidelines have been produced for the UK which make recommendations for improving the management of suspected viral encephalitis. However, little is currently known about the everyday experiences and processes involved in the diagnosis and care of HSV encephalitis. The reported study aimed to provide an account of the diagnosis and treatment of HSV encephalitis from the perspective of people who had been affected by the condition. Thirty narrative interviews were conducted with people who had been diagnosed with HSV encephalitis and their significant others. The narrative accounts reveal problems with gaining access to a diagnosis of encephalitis and shortfalls in care for the condition once in hospital. In response, individuals and their families work hard to obtain medical recognition for the problem and shape the processes of acute care. As a consequence, we argue that the diagnosis and management of HSV encephalitis needs to be considered as a participatory process, which is co-produced by health professionals, patients, and their families. The paper concludes by making recommendations for developing the current management guidelines by formalising the critical role of patients and their significant others in the identification, and treatment of, HSV encephalitis.     

EPIDEMIC ENCEPHALITIS AND SIMPLE HERPES

The purpose of this paper is to explain the state of our knowledge of the etiology of epidemic encephalitis, and especially to draw a line of demarcation between the established virus of simple herpes and the hypothetical virus of epidemic encephalitis. It had already been shown that the experimental observations on rabbits do no suffice to prove the identity of the herpes with the encephalitis virus. The discussion of the subject in this paper shows that identity cannot be postulated on the basis of the performed guinea pig experiments. Attention has been drawn to the significant fact that there is lack of harmony in the positive results of those investigators who believe that the incitants of epidemic encephalitis have been discovered. An attempt has been made to attribute some of the discrepancies reported by these investigators either to accidental and contaminating microbic agents, or to the uncovering of virulent agents preexisting in a latent state in the animals employed for inoculation, the existence of which was not previously known or suspected. Since past experience leads us to believe in a single incitant for widespread epidemic diseases, it is probable that, when certainly discovered, the microbe of epidemic encephalitis will prove to be simple and not multiple. The direct corollary to this point of view is that up to the present, the etiology of epidemic encephalitis has not been determined.     

A 4-Year Study of a Natural Tick-Borne Encephalitis Virus Focus in Hungary, 2010–2013

EcoHealth - A tick-borne encephalitis virus focus was identified in a former goat pasture that had been associated with a milk-borne encephalitis outbreak in 2007. Ticks and rodents were sampled...     

Arbovirus infections in man in British Columbia

During the summer of 1971, the first laboratory-proved cases of acute encephalitis in man due to any of the known arboviruses occurred in the south-central region of British Columbia. Five human cases of encephalitis with two deaths were diagnosed; three of these patients, including one of the fatalities, were proven in the laboratory to have contracted western equine encephalitis.During 1968 and 1969, a human serum survey undertaken in approximately 2000 life-long residents of the province discovered low levels of hemagglutinin-inhibiting and/or complement-fixing as well as neutralizing antibodies for western equine encephalitis, St. Louis encephalitis, Powassan encephalitis, California encephalitis and Colorado tick fever. Evidence of recent sub-clinical infection was detected in some cases.     

新生牛血清中乙脑抗体的检测及其方法的建立

对新生牛血清中的抗乙型脑炎病毒的抗体进行检测,并且建立一种有效可行的检测方法。以四个厂家共16批新生牛血清用蚀斑减少中和法(PRNT)对其中的乙脑抗体进行了检测。结果显示该方法检测出部分批次的新生牛血清中含有抗乙脑病毒抗体,且乙脑抗体阳性牛血清可将乙脑病毒抗原中和,对蚀斑数有较明显影响。证明作为检测牛血清中乙脑抗体的有效方法,PRNT法具有灵敏度高、重复性好的优点。以上检测说明新生牛血清中存在乙脑抗体,能将乙脑病毒中和。用于乙脑减毒活疫苗生产的新生牛血清除按照《中国生物制品主要原辅材料质控标准》进行质控外,还应进行乙脑抗体的检测。     

Tumor necrosis factor receptor-associated death domain mediated neuronal death contributes to the glial activation and subsequent neuroinflammation in Japanese encephalitis

While a number of studies have documented the importance of microglia in central nervous system (CNS) response to injury, infection and in disease state, little is known regarding how the neuronal death initiates the cascades of secondary neuroinflammation. We have exploited an experimental model of Japanese encephalitis to better understand how neuronal death following viral infection initiates microglial activation following Japanese encephalitis virus infection. We have earlier shown that the altered expression of tumor necrosis factor receptor-1 (TNFR-1) and TNFR associated death domain (TRADD) following Japanese encephalitis virus infection regulates the downstream apoptotic cascades. Here we have reported that silencing TRADD expression with small-interfering RNA reduced neuronal apoptosis and subsequent microglial and astroglial activation and release of various pro-inflammatory mediators. Our findings suggest that the engagement of TNFR-1 and TRADD following Japanese encephalitis virus infection plays a crucial role in glial activation also and influences the outcome of viral pathogenesis.     

Encephalitis after administration of live measles vaccine.

In a previously well child with no evidence of pre-existing immunologic defect a fatal encephalitis developed 10 days after administration of measles vaccine. There was pathologic evidence of an early viral encephalitis characterized by perivascular mononulcear infiltrates. Although the virus was not recovered, the diagnosis of a measles virus infection and encephalitis is supported by the postmortem findings of Warthin-Finkeldey cells in lymphoid tissues, an intranuclear inclusion in the brain and histologic changes of encephalitis.     

Antibodies against prM protein distinguish between previous infection with dengue and Japanese encephalitis viruses.

Background

In Southeast Asia, dengue viruses often co-circulate with other flaviviruses such as Japanese encephalitis virus, and due to the presence of shared antigenic epitopes it is often difficult to use serological methods to distinguish between previous infections by these flaviviruses.

Results

Convalescent sera from 69 individuals who were known to have had dengue or Japanese encephalitis virus infection were tested by western blotting against dengue, Japanese encephalitis and West Nile virus antigens. We determined that individuals who had been infected with dengue viruses had IgG responses against the premembrane protein of dengue viruses but not Japanese encephalitis, whereas individuals who had been infected with Japanese encephalitis had IgG specific for the premembrane protein of Japanese encephalitis virus but not the dengue viruses. None reacted with the premembrane protein of West Nile virus. Using the Pearson Chi Square test, it was determined that the difference between the two groups was highly significant with a p value of <0.001.

Conclusion

The use of flavivirus premembrane protein in seroepidemiological studies will be useful in determining what flaviviruses have circulated in a community.     

蜱传脑炎病毒非结构蛋白NS2B-NS3与NS5的研究进展

蜱传脑炎病毒是引起严重的中枢神经系统疾病蜱传脑炎的病原体,每年在欧洲、俄罗斯远东地区、日本和中国北部报道的蜱传脑炎病例数约为10000-12000例,且在我国和多个欧洲国家的发病率逐渐增高,正成为人类健康的潜在危害。主动免疫是预防蜱传脑炎的有效措施,包括我国在内的多个国家已研制出安全性较高的疫苗,但在我国流行省份的疫苗接种较为有限,特异性抗病毒药物的研发或许是治疗蜱传脑炎病毒感染的研究方向之一。蜱传脑炎病毒非结构蛋白NS2B-NS3与NS5因为在病毒基因组复制、加帽和宿主免疫调节中的重要作用,成为关键的抗病毒药物研发靶点。本文综述了蜱传脑炎病毒非结构蛋白NS2B-NS3与NS5的三维结构和抑制剂研发工作,为深入探究该病毒感染的分子机制和抗病毒药物研发提供参考。     

The 1952 Outbreak of Encephalitis in California (A Symposium): EPIDEMIOLOGIC ASPECTS

For the most part, epidemiologic phenomena observed in the outbreak of encephalitis in 1952 accorded with patterns that had been apparent in previous years. Ninety-seven per cent of the 414 laboratory-confirmed cases of western equine and St. Louis encephalitis in humans occurred in the 20 Central Valley counties. The cases of western equine encephalomyelitis in horses were generally scattered over the state. In the Central Valley most of the cases in horses were in animals less than two years of age; elsewhere the incidence was higher in older horses.There were no laboratory-confirmed cases of western equine or St. Louis encephalitis in humans earlier than June or later than October.In 1952 there were far more cases of western equine than of St. Louis encephalitis—a departure from the pattern in the previous seven years when there were about as many of one as of the other. No known satisfactory index is available for the prediction of the extent or type of outbreaks in humans.Approximately one-third of the cases of western equine encephalitis were in patients less than one year of age, whereas there were no cases of the St. Louis disease in patients that young.The incidence of western equine encephalitis in persons under 5 years of age was about the same for girls as for boys. In higher age brackets, males with western equine encephalitis outnumbered females 2 to 1. The corresponding ratio for St. Louis encephalitis was only 1.2 to 1.     

Regional Impact of Climate on Japanese Encephalitis in Areas Located near the Three Gorges Dam

Background

In this study, we aim to identify key climatic factors that are associated with the transmission of Japanese encephalitis virus in areas located near the Three Gorges Dam, between 1997 and 2008.

Methods

We identified three geographical regions of Chongqing, based on their distance from the Three Gorges Dam. Collectively, the three regions consisted of 12 districts from which study information was collected. Zero-Inflated Poisson Regression models were run to identify key climatic factors of the transmission of Japanese encephalitis virus for both the whole study area and for each individual region; linear regression models were conducted to examine the fluctuation of climatic variables over time during the construction of the Three Gorges Dam.

Results

Between 1997 and 2008, the incidence of Japanese encephalitis decreased throughout the entire city of Chongqing, with noticeable variations taking place in 2000, 2001 and 2006. The eastern region, which is closest to the Three Gorges Dam, suffered the highest incidence of Japanese encephalitis, while the western region experienced the lowest incidence. Linear regression models revealed that there were seasonal fluctuations of climatic variables during this period. Zero-Inflated Poisson Regression models indicated a significant positive association between temperature (with a lag of 1 and 3 months) and Japanese encephalitis incidence, and a significant negative association between rainfall (with a lag of 0 and 4 months) and Japanese encephalitis incidence.

Conclusion

The spatial and temporal trends of Japanese encephalitis incidence that occurred in the City of Chongqing were associated with temperature and rainfall. Seasonal fluctuations of climatic variables during this period were also observed. Additional studies that focus on long-term data collection are needed to validate the findings of this study and to further explore the effects of the Three Gorges Dam on Japanese encephalitis and other related diseases.     

Novel strategy for treatment of viral central nervous system infection by using a cell-permeating inhibitor of c-Jun N-terminal kinase

Viral encephalitis is a major cause of morbidity and mortality worldwide, yet there is no proven efficacious therapy for most viral infections of the central nervous system (CNS). Many of the viruses that cause encephalitis induce apoptosis and activate c-Jun N-terminal kinase (JNK) following infection. We have previously shown that reovirus infection of epithelial cell lines activates JNK-dependent apoptosis. We now show that reovirus infection resulted in activation of JNK and caspase-3 in the CNS. Treatment of reovirus-infected mice with a cell-permeating peptide that competitively inhibits JNK activity resulted in significantly prolonged survival of intracerebrally infected mice following an otherwise lethal challenge with T3D (100 x 50% lethal dose). Protection correlated with reduced CNS injury, reduced neuronal apoptosis, and reduced c-Jun activation without altering the viral titer or viral antigen distribution. Given the efficacy of the inhibitor in protecting mice from viral encephalitis, JNK inhibition represents a promising and novel treatment strategy for viral encephalitis.     

St. Louis encephalitis in southern Ontario: laboratory studies for arboviruses.

The first reported outbreak of St. Louis encephalitis in Canada occurred in the summer of 1975 in southern Ontario -- in the Windsor-Sarnia-Chatham area, the Niagara region and the city of Toronto. Hemmagglutination inhibition and complement fixation testing of serum samples collected during the outbreak confirmed that St. Louis encephalitis virus was the etiologic agent. Furthermore, this virus was isolated from brain tissue of a patient who died. This outbreak was probably an extension of the outbreak that occurred in the United States that summer. It was the first outbreak of arbovirus encephalitis in the province of Ontario.     

Correlates of SIV encephalitis in rhesus monkeys.

Necropsy records from 204 SIV-infected rhesus monkeys that had been inoculated with various strains of SIV and had died of SIV-related disease were reviewed. The relationship of SIV encephalitis with other parameters was evaluated. Encephalitis was associated with the presence of syncytial cells in other tissues, with persistent or early recurrent antigenemia, with a selective decrease in CD4+CD29+ blood lymphocytes, and with a shortened time of survival. Monkeys whose lymphocytes produced high levels of virus in culture also had a higher incidence of encephalitis. SIV was more frequently isolated from the brains of animals with encephalitis. No other clear associations were detected.     

Interferon γ in acute and subacute encephalitis

Intrathecal synthesis of interferon γ was shown in 14 out of 16 samples of cerebrospinal fluid collected in the first days of disease in adults, children, and newborn infants with herpes encephalitis. This synthesis was concomitant with that of interferon α and was switched off when the specific antibodies in the central nervous system increased. No endogenous interferon γ was detected in 11 serum samples or 13 samples of cerebrospinal fluid collected early in the course of the disease from patients with measles encephalitis and rubella encephalitis, or in serum and cerebrospinal fluid samples from seven patients with subacute sclerosing panencephalitis. In serum collected after the 10th day after the onset of neurological symptoms interferon γ was present at low concentrations in only three out of 11 serum specimens from patients with measles encephalitis or rubella encephalitis.Interferon γ was present in patients with acute herpes encephalitis and there was active virus replication, but it was not present in postinfectious encephalitis. Possibly the local production of specific antibodies masks the viral antigens and switches off the induction of interferons.