Severe Japanese encephalitis with multiple intracranial hemorrhages

Abstract

Rationale:Intracranial hemorrhage occurs infrequently in Japanese encephalitis (JE), and even less frequently with hemorrhage occurring twice. In this report, we describe the clinical features and outcomes of a patient with confirmed JE combined with hemorrhage twice.Patient concerns:The patient, a 71-year-old Asian woman, was admitted to the hospital with symptoms of hemiplegia following fever and diarrhea. Soon her condition worsened and a decreased level of consciousness, respiratory failure, and paralysis of extremities occurred.The brain diffusion-weighted imaging sequence showed suspicious abnormal signals in bilateral thalami. Japanese encephalitis virus immunoglobulin M antibody was detected in her serum and cerebrospinal fluid samples, so the patient was diagnosed with JE. During treatment, her condition became aggravated and the brain computed tomography (CT) scan showed multiple lobar hemorrhages. One month later, the multiple lobar hemorrhages occurred again, as observed by a brain CT scan.Diagnosis:JE with multiple intracranial hemorrhages.Interventions:The patient was treated comprehensively, including surgery, lowering her intracranial pressure and ventilator-assisted breathing.Outcomes:One month later, the patient underwent another surgical procedure for intracranial hemorrhage and suffered a serious neurological disorder.Lessons:Severe intracranial hemorrhage may occur in elderly patients with JE, especially in those with poor vascular condition. Therefore, when treating such patients, great caution, as well as early detection and prevention, should be taken in case of the occurrence of severe intracranial hemorrhage.

Proteomic landscape subtype and clinical prognosis of patients with the cognitive impairment by Japanese encephalitis infection

“…Nearly half of patients with JE (12 in 26, 46.14%) progressed, developed rapid respiratory failure, and received mechanical ventilation with tracheotomy. The neurophilic characteristics of the JEV causes central respiratory failure in the early central infection stage [ 19 – 21 ]. The mortality rate of cases in our study was 15.4% (4 in 26), lower than the 20–30% reported by Solomon et al [ 22 ], but higher than the 4.4% reported by Lo et al [ 23 ].…”

Type I IFN signaling limits hemorrhage-like disease after infection with Japanese encephalitis virus through modulating a prerequisite infection of CD11b+Ly-6C+ monocytes

“…This means that the different types of disease (e.g., encephalitis and vascular syndrome) may depend on the degree to which flaviviruses inhibit IFN-I signaling, even though the degree of IFN-I signaling inhibition by NS proteins derived from flaviviruses is unknown. Indeed, JEV infection is increasingly, but infrequently, reported as causing intracranial hemorrhage with JE [ 79 , 80 ], and neurological signs of DenV infection are increasingly reported [ 81 – 83 ]. JEV is a proven neurotrophic virus and mainly targets neuronal cells in the CNS, whereas DenV is considered a non-neurotrophic virus.…”

Japanese Encephalitis with Global Aphasia- A Case Report

“…The diagnostic evaluation of JE was done with the help of detect virus-specific IgM antibodies by analysing serum or cerebrospinal fluid. Craniocerebral MRI and CSF examination are of great significance for early diagnosis [13]. In our case CSF analysis was done for detection of IgM, CT scan and MRI scan were done for the clinical diagnosis.…”