Japanese encephalitis associated acute encephalitis syndrome cases in West Bengal, India: A sero‐molecular evaluation in relation to clinico‐pathological spectrum

Abstract

Japanese encephalitis (JE) is a major public health problem in Asia and worldwide and it is responsible mainly for viral acute encephalitis syndrome (AES). The sole etiologic agent of JE is Japanese encephalitis virus (JEV). Although JE/AES cases have been regarded traditionally as a disease of children, a growing number of patients with JE/AES cases are also seen in the adult age group every year in the state of West Bengal, India in spite of vaccination. Therefore, a systematic study was performed to differentiate and characterize the clinico-pathological parameters and viral diversity among the patients of different age groups. Viral diversity was also evaluated from the JE/AES cases, depending on their disease severity. A total of 441 JE/AES cases were included in this study. By MAC-ELISA, 111 samples were found JEV IgM positive and among the IgM negative cases, 26 samples were found RT-PCR positive against JEV infection. Neck rigidity, abnormal behavior, convulsion, protein in CSF, WBC in CSF, and aspartate transaminase in blood differed significantly among the patients of pediatric-adolescent and adult group in both IgM positive and RT-PCR positive cases. Viral diversity was increased significantly in the pediatric-adolescent group compared to adult patients. Interestingly, with the rise in disease severity the viral diversity was found to be increased among the patients, irrespective of their age distribution. Based on clinico-pathological parameters and analysis of viral diversity, it can be concluded that viral diversity which occurs naturally is likely to affect disease severity, especially in the patients of pediatric-adolescent group.

Clinical characteristics and short-term outcomes of Japanese encephalitis in pediatric and adult patients: a retrospective study in Northern China

“…According to our study, serological results were noted. The elevated level of CSF protein in pediatric and adult patients in the present study conformed to the published article (19). A previous study found that CSF protein levels were related to neurological symptoms.…”

The spatiotemporal distribution and prognostic factors of Japanese encephalitis in Shanxi Province, China, 2005–2022

“…JEV infection can induce endothelial cells and astrocytes to produce mediators that regulate JEV production while destroying the integrity of the blood-brain barrier ( Patabendige et al., 2018 ), increasing the CSF protein. A previous study discovered that CSF protein levels were linked to neurological symptoms, suggesting that abnormal intrathecal protein synthesis results in poor prognosis ( Sarkar et al., 2015 ). Furthermore, CSF sugar levels in patients with JE were either normal or slightly elevated.…”

Japanese Encephalitis among Adults: A Review

“…21,22,66,67,[69][70][71] Other differences between children and adults have also been reported, but not consistently; these include a higher rate of neck stiffness, abnormal behavior, electroencephalogram abnormalities and a lower level of consciousness among children and higher mean or median cerebrospinal fluid white cell counts and protein levels among adults. 21,22,[65][66][67]69,71 Although results in studies of outcome following JE have again been variable, many studies suggest the case fatality rate might be higher among adults than children; however, among survivors, sequelae might be more frequent among children. 21,22,65,67,69,[72][73][74][75] This suggests that children with severe disease are more likely to survive but end up with severe neurologic and other sequelae.…”