Successful treatment of echovirus meningoencephalitis in sex-linked agammaglobulinaemia by intrathecal and intravenous injection of high titre gammaglobulin

Abstract

A 7-year-old boy with sex-linked agammaglobulinaemia developed meningoencephalitis caused by echovirus type 11. He had convulsions, right hemiplegia, cortical motor aphasia, left abducens nerve paralysis, left hypoglossal nerve paralysis, and later became unconscious. Treatment by intravenous injection of conventional gammaglobulin and intrathecal alpha-interferon brought no clinical improvement, but intrathecal administration together with intravenous injection of gammaglobulin containing a high titre of anti-echovirus type 11 antibody was associated with a dramatic improvement in his clinical symptoms. After subsequent periodical (once or twice a week) administration of specific gammaglobulin for 8 months, the echovirus in his cerebrospinal fluid was no longer detected. These findings suggest that intrathecal injection combined with intravenous injection of high titre anti-echovirus type 11 antibody was effective in treating this case of echovirus meningoencephalitis in sex-linked agammaglobulinaemia.

The Role for Intravenous Immunoglobulin in the Treatment of West Nile Virus Encephalitis

“…However, intraventricular or intrathecal administration would deliver higher levels of immunoglobulins to the CSF. This idea is supported by the examples of enteroviral encephalitis in which some patients did not have a response to IVIG until immunoglobulin was directly infused into the CSF [6][7][8].…”

“…The degree to which the patient's underlying chronic lymphocytic leukemia and associated hypogammaglobulinemia played a role in acquisition of this infection is unknown. However, deficiencies of humoral immunity have been linked to an increased risk of viral infection [2][3][4][5], and, in patients with hypogammaglobulinemia, some of these infections have responded to treatment with IVIG [6][7][8][9]. IVIG has been used successfully against viral infections even in patients who are not hypogammaglobulinemic; examples include treatment of parvovirus in HIV-infected persons [10], treatment of Argentine hemorrhagic fever [11], and treatment of disseminated vaccinia after smallpox vaccination [12].…”

Role of the virology laboratory in diagnosis and management of patients with central nervous system disease

“…Others have been successful in using intrathecal or intraventricular immunoglobulin in combination with i.v. immunoglobulin (45,73,91).…”

Passive Immunity in Prevention and Treatment of Infectious Diseases

“…Six patients substantially improved. IVIG plus intraventricular IVIG has cleared infection in some but not all patients (44,96,111).…”