A Preliminary Randomized Double Blind Placebo-Controlled Trial of Intravenous Immunoglobulin for Japanese Encephalitis in Nepal

Rayamajhi, Ajit; Nightingale, Sam; Bhatta, Narendra; Singh, Rupa; Ledger, Elizabeth; Bista, Krishna; Lewthwaite, Penny; Mahaseth, C; Turtle, Lance; Robinson, Jaimie; Galbraith, Sareen E.; Wnęk, Małgorzata; Johnson, Barbara W.; Faragher, Brian; Griffiths, Michael J.; Solomon, Tom

doi:10.1371/journal.pone.0122608

Cited by 42 publications

(34 citation statements)

References 78 publications

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“…Recently, immunotherapy of virus infections using high titer antibodies has been documented [ 35 , 36 ]. Clinical evidence supports that intravenous immunoglobulin containing JEV antibodies have a positive effect on treating patients with JE [ 37 , 38 ]. A similar treatment effect was also reported in patients with West Nile virus infection [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Neutralizing Antibodies to Japanese Encephalitis Virus among High-Risk Age Groups in South Korea, 2010

Lee

Cha

et al. 2016

PLoS ONE

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After an extensive vaccination policy, Japanese encephalitis (JE) was nearly eliminated since the mid-1980s in South Korea. Vaccination in children shifted the affected age of JE patients from children to adults. However, an abrupt increase in JE cases occurred in 2010, and this trend has continued. The present study aimed to investigate the prevalence of neutralizing antibodies to the JE virus (JEV) among high-risk age groups (≥40 years) in South Korea. A plaque reduction neutralization test was conducted to evaluate the prevalence of neutralizing antibodies to JEV in 945 subjects within four age groups (30–39, 40–49, 50–59, and 60–69 years) in 10 provinces. Of the 945 enrolled subjects, 927 (98.1%) exhibited antibodies against JEV. No significant differences were found in the prevalence of neutralizing antibodies according to sex, age, or occupation. However, there were significant differences in the plaque reduction rate according to age and occupation; oldest age group had a higher reduction rate, and subjects who were employed in agriculture or forestry also had a higher value than the other occupations. We also found that three provinces (Gangwon, Jeonnam, and Gyeongnam) had a relatively lower plaque reduction rate than the other locations. In addition, enzyme-linked immunosorbent assays were conducted to determine recent viral infections and 12 (2.2%) subjects were found to have been recently infected by the virus. In conclusion, the present study clearly indicated that the prevalence of neutralizing antibodies has been maintained at very high levels among adult age groups owing to vaccination or natural infections, or both. In the future, serosurveillance should be conducted periodically using more representative samples to better understand the population-level immunity to JE in South Korea.

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Section: Discussionmentioning

confidence: 99%

Prevalence of Neutralizing Antibodies to Japanese Encephalitis Virus among High-Risk Age Groups in South Korea, 2010

Lee

Cha

et al. 2016

PLoS ONE

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“…In some instances, IVIG has been used on a limited basis with mixed results. In a pediatric population in Nepal with JEV, IVIG at 400 mg/kg daily for 5 days resulted in higher antibodies and interleukin (IL)-4 and IL-6 concentrations in treated patients compared with those receiving standard of care 105. Clinical outcomes, however, remained the same in both the groups.…”

Section: Management Of Cns Viral Diseasementioning

confidence: 98%

Management of Viral Central Nervous System Infections: A Primer for Clinicians

Bookstaver

Mohorn

Shah

et al. 2017

J Cent Nerv Syst Dis

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Viruses are a common cause of central nervous system (CNS) infections with many host, agent, and environmental factors influencing the expression of viral diseases. Viruses can be responsible for CNS disease through a variety of mechanisms including direct infection and replication within the CNS resulting in encephalitis, infection limited to the meninges, or immune-related processes such as acute disseminated encephalomyelitis. Common pathogens including herpes simplex virus, varicella zoster, and enterovirus are responsible for the greatest number of cases in immunocompetent hosts. Other herpes viruses (eg, cytomegalovirus, John Cunningham virus) are more common in immunocompromised hosts. Arboviruses such as Japanese encephalitis virus and Zika virus are important pathogens globally, but the prevalence varies significantly by geographic region and often season. Early diagnosis from radiographic evidence and molecular (eg, rapid) diagnostics is important for targeted therapy. Antivirals may be used effectively against some pathogens, although several viruses have no effective treatment. This article provides a review of epidemiology, diagnostics, and management of common viral pathogens in CNS disease.

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“…44 A similar strategy has been proposed in the treatment of several neuroinvasive viral infections including WNV and Japanese encephalitis. 45,46 In AFM, other treatments that have been frequently used include steroids and plasma exchange. 12 These are commonly used treatments for inflammatory or antibody-mediated disorders of the spinal cord, but theoretically both therapies may have a negative impact on the immune system's ability to fight viral infection, and steroids are certainly thought to worsen outcomes in enterovirus 71-associated neurological disease.…”

Section: Management Of Acute Phasementioning

confidence: 99%

Acute Flaccid Myelitis: A Clinical Review

Murphy

Pardo

2020

Semin Neurol

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Acute flaccid myelitis (AFM) is an emerging disorder primarily affecting children that is characterized by acute flaccid paralysis accompanied by abnormalities of the spinal cord gray matter on magnetic resonance imaging. In most cases, prodromal fever or respiratory symptoms occur, followed by acute-onset flaccid limb weakness. Respiratory, axial, bulbar, facial, and extraocular muscles may also be affected. The clinical manifestations have been described as “polio-like,” due to striking similarities to cases of poliomyelitis. The primary site of injury in AFM is the anterior horn cells of the spinal cord, resulting in a motor neuronopathy. Seasonal peaks of cases have occurred in the United States every 2 years since 2012. However, AFM remains a rare disease, which can make it challenging for physicians to recognize and differentiate from other causes of acute flaccid paralysis such as Guillain–Barre syndrome, spinal cord stroke, and transverse myelitis. Epidemiological evidence suggests that AFM is linked to a viral etiology, with nonpolio enteroviruses (in particular enterovirus D68) demonstrating a plausible association. The epidemiology, possible etiological factors, clinical features, differential diagnosis, treatment, and outcomes of AFM are discussed in this review.

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A Preliminary Randomized Double Blind Placebo-Controlled Trial of Intravenous Immunoglobulin for Japanese Encephalitis in Nepal

Cited by 42 publications

References 78 publications

Prevalence of Neutralizing Antibodies to Japanese Encephalitis Virus among High-Risk Age Groups in South Korea, 2010

Prevalence of Neutralizing Antibodies to Japanese Encephalitis Virus among High-Risk Age Groups in South Korea, 2010

Management of Viral Central Nervous System Infections: A Primer for Clinicians

Acute Flaccid Myelitis: A Clinical Review

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