Introduction: The etiology of encephalitis involves an enormous range and can be classified as infectious or immune-mediated. There are several factors influencing its prognosis and has been associated with significant morbidity and mortality. This study aims to evaluate the clinico-epidemiologic characteristics and outcomes of infectious and immune-mediated encephalitis among pediatric patients. Methodology: Retrospective descriptive cross-sectional study that included patients aged 6 months to 17 years old with encephalitis in a tertiary hospital between January 2010 to December 2020 Results: A total of 23 cases were reviewed and 60.87% were infectious while that of immune-mediated was 39.13%. Among those with identified infectious cause, Mycoplasma pneumonia was the most common (28.57%). Infectious encephalitis was more common among younger males (35.71%) while immune-mediated affected female adolescents more (55.56%). The most common neurologic manifestation was altered mental status and/or behavioral changes. Treatment such as antibiotics (78.26%), anticonvulsant therapy (78.26%), and steroids (43.48%) were given. All immune-mediated cases received steroids. More than half of patients had complete recovery (56.52%). Conclusion Pediatric encephalitis should be considered among patients with neurologic dysfunction with or without systemic involvement. Behavioral changes in an apparently well child should prompt clinicians to consider anti-NMDAR encephalitis, especially if viral studies are negative and with no other known cause. Viruses remain to be the most common etiology, but other possible causes should be highly considered such as anti-NMDAR and Mycoplasma. A normal CSF analysis, imaging and/or encephalography (EEG) may not totally exclude encephalitis. Prognosis is relatively good hence an early diagnosis and initiation of appropriate management is important.
Encephalitis ; Infectious Encephalitis ; Encephalitis, Viral ; Mycoplasma

An increasing number of neuronal autoantibodies which target cell surface or synaptic proteins have been discovered over the last decade. Autoimmune encephalitis refers to this new category of autoimmune-mediated neurological disorders, which involve the central nervous system. Recent studies have established that autoimmune encephalitis is now the major cause of encephalitis, which was previously considered to be encephalitis of an unknown etiology. Moreover, the fact that autoimmune encephalitis is potentially treatable with immunomodulating therapy has changed the paradigm for the diagnosis and treatment of acute encephalitis syndrome. We herein review the pathophysiology, clinical manifestations, diagnosis, and treatment of autoimmune encephalitis with a focus on corticosteroid therapy as the first-line immunotherapy. In addition, regarding the diagnostic approach, we emphasize the differentiation between autoimmune and infectious encephalitis, because this distinction is not necessarily clear-cut in real clinical practice and should be considered when determining the initiation and type of immunotherapy.
Autoantibodies ; Autoimmune Diseases of the Nervous System ; Central Nervous System ; Diagnosis ; Encephalitis ; Glucocorticoids ; Immunotherapy ; Infectious Encephalitis ; Nervous System Diseases ; Neurons

Streptococcus dysgalactiae subspecies equisimilis (SDSE) is an emerging pathogen in animals and humans. Herein, we describe two clinical swine cases of SDSE infection presenting with lameness, neurological signs, or sudden death. Pathological examination indicated suppurative arthritis, encephalitis, and multifocal abscesses in kidney and heart. The β-hemolytic colonies obtained from joint samples of each case were identified as SDSE. The two isolates had low minimum inhibitory concentrations for β-lactams, and they presented the same virulence gene profile (slo⁻/sagA⁺/pSTKP8⁺). Molecular analysis by multilocus sequence typing identified the SDSE isolates from cases 1 and 2 as sequence types 315 and 252, respectively.
Abscess ; Animals ; Arthritis, Infectious ; Death, Sudden ; Encephalitis ; Heart ; Humans ; Joints ; Kidney ; Microbial Sensitivity Tests ; Multilocus Sequence Typing ; Streptococcus ; Swine ; Virulence

An 11-year-old girl was diagnosed with encephalitis due to Epstein-Barr virus(EBV). She was admitted to our hospital due to convulsion and decreased consciousness after several days of fever, sore throat and headache. Cerebrospinal fluid analysis showed lymphocyte-dominant pleocytosis and markedly elevated levels of protein. Magnetic resonance imaging(MRI) finding was normal, except for marked leptomeningeal enhancement. Even though she had signs and symptoms of infectious mononucleosis, EBV infection could not be considered as the underlying cause of the encephalitis until IgM for the viral capsid antigen of EBV had been detected in her blood. After treatment with acyclovir, a high dose of methylprednisolone and intravenous immunoglobulin, the neurological symptoms improved rapidly. She has not suffered from any neurological complications in the four months since being discharged. EBV infection should be considered as the main etiology in cases of childhood encephalitis, although there is no evidence of infectious mononucleosis existed.
Acyclovir ; Capsid ; Child ; Consciousness ; Encephalitis ; Epstein-Barr Virus Infections ; Fever ; Headache ; Herpesvirus 4, Human ; Humans ; Immunoglobulin M ; Immunoglobulins ; Infectious Mononucleosis ; Leukocytosis ; Magnetic Resonance Spectroscopy ; Methylprednisolone ; Pharyngitis ; Seizures

OBJECTIVETo understand clinical features of in-patients with varicella and complications in our hospital during 1980-1999.

METHODSAge distribution, season characteristics, complication, occurrence of hospitalized varicella patients in 1980-1999 were analyzed.

RESULTSVaricella mainly occurred in pre-school and school children, most cases were seen in winter and spring. There were 240 hospitalized varicella patients, 160 of whom had complications, 126 patients scattered in 1994-1996 (78.75%). The most often seen complication was skin infection which occurred in 71 patients (44.38%); the second was encephalitis, which occurred in 29 patients (18.12%).

CONCLUSIONSThe occurrence of varicella increased and the disease seemed to be more serious.

Adolescent ; Age Distribution ; Chickenpox ; complications ; epidemiology ; Child ; Child, Preschool ; China ; epidemiology ; Encephalitis ; etiology ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Retrospective Studies ; Skin Diseases, Infectious ; etiology

Hashimoto's encephalopathy (HE) is a rare, poorly understood, autoimmune disease characterized by symptoms of acute or subacute encephalopathy associated with increased anti-thyroid antibody levels. Here, we report a case of a 14-year-old girl with HE and briefly review the literature. The patient presented with acute mental changes and seizures, but no evidence of infectious encephalitis. In the acute stage, the seizures did not respond to conventional antiepileptic drugs, including valproic acid, phenytoin, and topiramate. The clinical course was complicated by the development of acute psychosis, including bipolar mood, insomnia, agitation, and hallucinations. The diagnosis of HE was supported by positive results for antithyroperoxidase and antithyroglobulin antibodies. Treatment with methylprednisolone was effective; her psychosis improved and the number of seizures decreased. HE is a serious but curable, condition, which might be underdiagnosed if not suspected. Anti-thyroid antibodies must be measured for the diagnosis. HE should be considered in patients with diverse neuropsychiatric manifestations.
Adolescent ; Antibodies ; Anticonvulsants ; Autoantibodies ; Autoimmune Diseases ; Brain Diseases ; Dihydroergotamine ; Infectious Encephalitis ; Fructose ; Hallucinations ; Hashimoto Disease ; Humans ; Methylprednisolone ; Phenytoin ; Psychotic Disorders ; Seizures ; Sleep Initiation and Maintenance Disorders ; Valproic Acid

In order to investigate the antiviral effect of chinonin against Herpes simplex virus (HSV), the encephalitis model in mice and skin infection model in guinea pigs were established by HSV- I and HSV-II infection respectively. Acyclovir was used as the positive reference drug to evaluate the antiviral capacity of chinonin. Chinonin showed an obvious therapeutic effect on encephalitis in mice at doses of 25 and 50 mg/kg. At both dosages, chinonin demonstrated stronger protection than acyclovir (1 and 5 mg/kg) to the infected mice from death. It was also found that chinonin could treat the skin infection in guinea pigs effectively. The therapeutic effect of chinonin was similar to that of acyclovir (5 mg/kg) at 25 mg/kg but obviously better than that at 50 and 75 mg/ kg. In conclusion, chinonin is a potential candidate for the treatment against HSV.
Acyclovir ; therapeutic use ; Animals ; Antiviral Agents ; pharmacology ; Encephalitis ; drug therapy ; virology ; Glycosides ; pharmacology ; Guinea Pigs ; Herpes Simplex ; drug therapy ; Herpesvirus 1, Human ; drug effects ; Herpesvirus 2, Human ; drug effects ; Mice ; Simplexvirus ; drug effects ; Skin Diseases, Infectious ; drug therapy ; Xanthenes ; pharmacology ; Xanthones