&lt;p&gt;Comparisons Between Infectious and Autoimmune Encephalitis: Clinical Signs, Biochemistry, Blood Counts, and Imaging Findings&lt;/p&gt;

Huang, Chen-Na; Tian, Xiaofeng; Jiang, Shumin; Chang, Sheng-Hui; Wang, Nan; Liu, Mingqi; Zhang, Qiuxia; Li, Ting; Zhang, Linjie; Yang, Li

doi:10.2147/ndt.s274487

Cited by 11 publications

(16 citation statements)

References 48 publications

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“…One theory for the lower WBC in the blood of infectiousnonbacterial encephalitis patients is potential disruption of bone marrow hematopoiesis and subsequent reduced progenitor cell lineages due to infectious-nonbacterial infection. 15 Our study was able to identify higher CSF-to-serum WBC ratios in both infectious and infectious-nonbacterial encephalitis compared to AE. To our knowledge, no study has compared the WBC ratios in IE and AE.…”

Section: Discussionmentioning

confidence: 59%

“…16 One study examined patients with or AE but did not find any significant differences between the groups in serum complete blood count, basic metabolic panel, or CSF cell count and protein. 15 The California Encephalitis Project 10 and the Infectious Disease Society of America 11 have characterized the clinical profile of IE.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies have characterized the clinical profile of IE and AE, but these studies had (1) a smaller study of 95 patients, 15 (2) evaluated infectious or autoimmune encephalitis biomarkers in isolation, 10,11 or (3) examined a more limited number of laboratory markers (e.g., serum ANA, TPO, CSF profile [cell count, protein, glucose, and OCB], and brain MRI, but no serum WBC, inflammatory markers [ESR, CRP, lactate], or EEG data) 16 . One study examined patients with IE or AE but did not find any significant differences between the groups in serum complete blood count, basic metabolic panel, or CSF cell count and protein 15 . The California Encephalitis Project 10 and the Infectious Disease Society of America 11 have characterized the clinical profile of IE.…”

Section: Discussionmentioning

confidence: 99%

“…However, this trend was not seen when comparing the infectious (e.g., bacterial, and infectious‐nonbacterial) to AE groups. One theory for the lower WBC in the blood of infectious‐nonbacterial encephalitis patients is potential disruption of bone marrow hematopoiesis and subsequent reduced progenitor cell lineages due to infectious‐nonbacterial infection 15 …”

Section: Discussionmentioning

confidence: 99%

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Determining an infectious or autoimmune etiology in encephalitis

Hoang

Robinson‐Papp

et al. 2022

Ann Clin Transl Neurol

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Objectives Early presentation and workup for acute infectious (IE) and autoimmune encephalitis (AE) are similar. This study aims to identify routine laboratory markers at presentation that are associated with IE or AE. Methods This was a multi‐center retrospective study at three tertiary care hospitals in New York City analyzing demographic and clinical data from patients diagnosed with definitive encephalitis based on a confirmed pathogen and/or autoantibody and established criteria for clinical syndromes. Results Three hundred and thirty‐three individuals with confirmed acute meningoencephalitis were included. An infectious‐nonbacterial (NB) pathogen was identified in 151/333 (45.40%), bacterial pathogen in 95/333 (28.50%), and autoantibody in 87/333 (26.10%). NB encephalitis was differentiated from AE by the presence of fever (NB 62.25%, AE 24.10%; p < 0.001), higher CSF white blood cell (WBC) (median 78 cells/μL, 8.00 cells/μL; p < 0.001), higher CSF protein (76.50 mg/dL, 40.90 mg/dL; p < 0.001), lower CSF glucose (58.00 mg/dL, 69.00 mg/dL; p < 0.001), lower serum WBC (7.80 cells/μL, 9.72 cells/μL; p < 0.050), higher erythrocyte sedimentation rate (19.50 mm/HR, 13.00 mm/HR; p < 0.05), higher C‐reactive protein (6.40 mg/L, 1.25 mg/L; p = 0.005), and lack of antinuclear antibody titers (>1:40; NB 11.54%, AE 32.73%; p < 0.001). CSF‐to‐serum WBC ratio was significantly higher in NB compared to AE (NB 11.3, AE 0.99; p < 0.001). From these findings, the association of presenting with fever, CSF WBC ≥50 cells/μL, and CSF protein ≥75 mg/dL was explored in ruling‐out AE. When all three criteria are present, an AE was found to be highly unlikely (sensitivity 92%, specificity 75%, negative predictive value 95%, and positive predictive value 64%). Interpretations Specific paraclinical data at initial presentation may risk stratify which patients have an IE versus AE.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Determining an infectious or autoimmune etiology in encephalitis

Hoang

Robinson‐Papp

et al. 2022

Ann Clin Transl Neurol

View full text Add to dashboard Cite

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“…Infectious encephalitis is caused when an infectious agent enters the body, mainly viruses, but some cases of primary encephalitis are caused by bacteria, fungi, or parasites. The common viral causes of encephalitis include HSV, JEV, varicella zoster, measles, mumps, rabies, and rubella [ 185 – 187 ].…”

Section: Discussionmentioning

confidence: 99%

Cytokines and chemokines profile in encephalitis patients: A meta-analysis

et al. 2022

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Background Encephalitis is caused by autoimmune or infectious agents marked by brain inflammation. Investigations have reported altered concentrations of the cytokines in encephalitis. This study was conducted to determine the relationship between encephalitis and alterations of cytokine levels in cerebrospinal fluid (CSF) and serum. Methods We found possibly suitable studies by searching PubMed, Embase, Scopus, and Web of Science, systematically from inception to August 2021. 23 articles were included in the meta-analysis. To investigate sources of heterogeneity, subgroup analysis and sensitivity analysis were conducted. The protocol of the study has been registered in PROSPERO with a registration ID of CRD42021289298. Results A total of 23 met our eligibility criteria to be included in the meta-analysis. A total of 12 cytokines were included in the meta-analysis of CSF concentration. Moreover, 5 cytokines were also included in the serum/plasma concentration meta-analysis. According to the analyses, patients with encephalitis had higher CSF amounts of IL-6, IL-8, IL-10, CXCL10, and TNF-α than healthy controls. The alteration in the concentration of IL-2, IL-4, IL-17, CCL2, CXCL9, CXCL13, and IFN-γ was not significant. In addition, the serum/plasma levels of the TNF-α were increased in encephalitis patients, but serum/plasma concentration of the IL-6, IL-10, CXCL10, and CXCL13 remained unchanged. Conclusions This meta-analysis provides evidence for higher CSF concentrations of IL-6, IL-8, IL-10, CXCL10, and TNF-α in encephalitis patients compared to controls. The diagnostic and prognostic value of these cytokines and chemokines should be investigated in future studies.

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Autoimmune encephalitis: what the radiologist needs to know

Sanvito,

Pichiecchio,

Paoletti

et al. 2024

Neuroradiology

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Autoimmune encephalitis is a relatively novel nosological entity characterized by an immune-mediated damage of the central nervous system. While originally described as a paraneoplastic inflammatory phenomenon affecting limbic structures, numerous instances of non-paraneoplastic pathogenesis, as well as extra-limbic involvement, have been characterized. Given the wide spectrum of insidious clinical presentations ranging from cognitive impairment to psychiatric symptoms or seizures, it is crucial to raise awareness about this disease category. In fact, an early diagnosis can be dramatically beneficial for the prognosis both to achieve an early therapeutic intervention and to detect a potential underlying malignancy. In this scenario, the radiologist can be the first to pose the hypothesis of autoimmune encephalitis and refer the patient to a comprehensive diagnostic work-up – including clinical, serological, and neurophysiological assessments.In this article, we illustrate the main radiological characteristics of autoimmune encephalitis and its subtypes, including the typical limbic presentation, the features of extra-limbic involvement, and also peculiar imaging findings. In addition, we review the most relevant alternative diagnoses that should be considered, ranging from other encephalitides to neoplasms, vascular conditions, and post-seizure alterations. Finally, we discuss the most appropriate imaging diagnostic work-up, also proposing a suggested MRI protocol.

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<p>Comparisons Between Infectious and Autoimmune Encephalitis: Clinical Signs, Biochemistry, Blood Counts, and Imaging Findings</p>

Cited by 11 publications

References 48 publications

Determining an infectious or autoimmune etiology in encephalitis

Determining an infectious or autoimmune etiology in encephalitis

Cytokines and chemokines profile in encephalitis patients: A meta-analysis

Autoimmune encephalitis: what the radiologist needs to know

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