Role of Intravenous Immunoglobulin Administration in Japanese Encephalitis

Caramello, Pietro; Canta, Francesca; Balbiano, Rosanna; Lipani, Filippo; Ariaudo, Silvia; Agostini, Maura De; Calleri, Guido; Boglione, Lucio; Di, Antonino

doi:10.1086/509644

Cited by 28 publications

(18 citation statements)

References 7 publications

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“…Contrary to TBE, mortality rate is high in the range of 25 to 30%. Sequelae are observed in about 50% of those who survive [28,29]. A 49-year-old Italian traveller to Vietnam with a severe form of JE showed extensive T2-weighted hyper intensities in a MRI scan.…”

Section: Discussionmentioning

confidence: 99%

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May early intervention with high dose intravenous immunoglobulin pose a potentially successful treatment for severe cases of tick-borne encephalitis?

Růžek

Dobler²,

Niller

2013

BMC Infect Dis

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BackgroundArthropod-borne viral encephalitis of diverse origins shows similar clinical symptoms, histopathology and magnetic resonance imaging, indicating that the patho mechanisms may be similar. There is no specific therapy to date. However, vaccination remains the best prophylaxis against a selected few. Regardless of these shortcomings, there are an increasing number of case reports that successfully treat arboviral encephalitis with high doses of intravenous immunoglobulins.DiscussionTo our knowledge, high dose intravenous immunoglobulin has not been tested systematically for treating severe cases of tick-borne encephalitis. Antibody-dependent enhancement has been suspected, but not proven, in several juvenile cases of tick-borne encephalitis. Although antibody-dependent enhancement during secondary infection with dengue virus has been documented, no adverse effects were noticed in a controlled study of high dose intravenous immunoglobulin therapy for dengue-associated thrombocytopenia. The inflammation-dampening therapeutic effects of generic high dose intravenous immunoglobulins may override the antibody-dependent enhancement effects that are potentially induced by cross-reactive antibodies or by virus-specific antibodies at sub-neutralizing levels.SummaryAnalogous to the increasing number of case reports on the successful treatment of other arboviral encephalitides with high dose intravenous immunoglobulins, we postulate whether it may be possible to also treat severe cases of tick-borne encephalitis with high dose intravenous immunoglobulins as early in the course of the disease as possible.

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Section: Discussionmentioning

confidence: 99%

“…After three weeks he was discharged with slight symptoms of speech, motor and mental activity remaining, but with a normal MRI. Only a slight deficit in recent memory was observed one month after his discharge [28,29]. …”

Section: Discussionmentioning

confidence: 99%

May early intervention with high dose intravenous immunoglobulin pose a potentially successful treatment for severe cases of tick-borne encephalitis?

Růžek

Dobler²,

Niller

2013

BMC Infect Dis

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“…Theoretically, IVIG purified from pooled plasma of healthy donors from JE-endemic zones would have high titers of specific neutralizing antibody, as a large part of the population is postulated to have been exposed to the virus, and thus have antibodies 48, 49 . In fact, IVIG that is not hyper-immune to JEV has already been reported to impart therapeutic benefits in the recovery from JE 50 . This concept has also been adopted for West Nile virus infection with some success 51, 52 .…”

Section: Therapeutic Approach To Japanese Encephalitis: Dark Clouds Wmentioning

confidence: 99%

Recent advances in Japanese encephalitis

Basu

Dutta

2017

F1000Res

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Japanese encephalitis is a flaviviral disease that is endemic to the South, Southeast Asia, and Asia Oceania regions. Given that about 60% of the world’s population (about 7.4 billion) resides in this region (about 4.4 billion), this disease poses a significant threat to global health. Active vaccination campaigns conducted in endemic countries have led to a decrease in the number of reported cases over the years. In this article, we strive to briefly highlight recent advances in understanding the role of microRNAs in disease pathology, focus on providing brief summaries of recent clinical trials in the field of Japanese encephalitis therapeutics, and review the current prophylactic strategies.

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“…Treatment with high-dose IVIG has been shown to be effective against various infectious diseases, including Flavivirus infection [148]. The treatment of a single JE patient with IVIG, begun on day 6 of hospitalization, was shown to be successful, although whether the IVIG contained anti-JE antibodies was not mentioned [149]. Therefore, IVIG treatment for JE is considered to be effective.…”

Section: Intravenous Immunoglobulinmentioning

confidence: 99%

Potential chemotherapeutic targets for Japanese encephalitis: current status of antiviral drug development and future challenges

Ishikawa

Konishi

2015

Expert Opinion on Therapeutic Targets

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Although the development of effective anti-JE drugs is an urgent issue, only supportive care is currently available. Recent progress in our understanding of the viral replication machinery and immune evasion strategies has identified new targets for anti-JE drug development. To date, most candidate drugs have only been evaluated in single-drug formulations, and efficient drug delivery to the CNS has virtually not been considered. However, an effective anti-JE treatment is expected to be achieved with multiple-drug formulations and a targeted drug delivery system in the near future.

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Role of Intravenous Immunoglobulin Administration in Japanese Encephalitis

Cited by 28 publications

References 7 publications

May early intervention with high dose intravenous immunoglobulin pose a potentially successful treatment for severe cases of tick-borne encephalitis?

May early intervention with high dose intravenous immunoglobulin pose a potentially successful treatment for severe cases of tick-borne encephalitis?

Recent advances in Japanese encephalitis

Potential chemotherapeutic targets for Japanese encephalitis: current status of antiviral drug development and future challenges

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