Abstract Cytomegalovirus (CMV) and Toxoplasma gondii infections are typically associated with immunocompromised individuals, in whom they can cause severe central nervous system (CNS) complications. However, their concurrent manifestation in immunocompetent hosts (IMCh) is exceptionally rare and underreported. We present the case of a 51-year-old immunocompetent male with a three-month history of progressive headache, nausea, and intermittent joint pain, without neurological deficits. Imaging revealed chronic infarcts in the basal ganglia and frontal lobe, as well as multifocal lesions in the periventricular area. Serological testing indicated high-avidity IgG for both CMV and T. gondii, consistent with chronic latent infections. Despite being HIV-negative and without prior immunosuppressive therapy, the patient exhibited hematologic abnormalities, including thrombocytopenia, lymphopenia, and eosinophilia. Treatment with valganciclovir, cotrimoxazole, and clindamycin led to symptomatic improvement. This case underscores the diagnostic challenges of CMV encephalitis and cerebral toxoplasmosis in IMCh, where nonspecific symptoms and overlapping radiological findings may mimic other etiologies such as stroke. Given the neurotropic nature of T. gondii and the hematologic impact of CMV, coinfection—though rare—should be considered in patients with atypical CNS symptoms and hematological abnormalities, even in the absence of immunodeficiency. This report showed the need for heightened clinical suspicion and thorough evaluation to avoid misdiagnosis and ensure timely intervention. Clinicians should recognize that serious manifestations of CMV and toxoplasmosis are possible in IMCh and may present subtly, necessitating comprehensive serologic and imaging workups for accurate diagnosis and management.
CMV ; encephalitis ; cerebral toxoplasmosis ; immunocompetent host

Abstract The Nipah virus (NiV) is a highly pathogenic zoonotic virus associated with recurrent outbreaks in South and Southeast Asia. Since its first identification in 1998 among the pig farmers in Sungai Nipah Village in Malaysia, NiV has demonstrated high case fatality rates (40–75%) and significant epidemic potential. At that time, the virus spread to Singapore, and human cases were also identified in India, Bangladesh, and Philippine afterwards. No human cases have been reported in Indonesia; the country remains on high alert due to geographic concerns and the intensity of mobilization of people. To review the current global epidemiological situation of Nipah virus (as of 2026), evaluate public health preparedness, and analyze ongoing research efforts, including vaccine and therapeutic development.Nipah virus outbreaks remain geographically concentrated in Bangladesh and India, with seasonal spillover events linked primarily to bat-to-human transmission through contaminated food products. Human-to-human transmission occurs but remains limited. Improved surveillance, rapid case isolation, and contact tracing have reduced outbreak sizes in recent years. Vaccine candidates are currently in Phase II clinical trials.While the global pandemic risk remains low at present, the Nipah virus continues to represent a high-consequence emerging pathogen. Sustained surveillance, vaccine development, ecological research, and strengthened health systems are critical to mitigating future risks.
Nipah virus ; zoonotic diseases ; emerging infections ; encephalitis ; outbreak preparedness

Listeria brainstem encephalitis with myelitis is extremely rare in clinical practice.Since the clinical manifestations are non-specific,MRI is helpful for diagnosis.Positive cerebrospinal fluid culture is considered the gold standard for diagnosis.This article reports a case of an immunocompetent individual with listeria brainstem encephalitis with myelitis,aiming to enhance the awareness of this condition.
Humans ; Brain Stem/pathology* ; Diagnostic Errors ; Encephalitis/complications* ; Encephalomyelitis, Acute Disseminated/diagnosis* ; Listeriosis/complications* ; Myelitis/complications*

OBJECTIVES: To investigate the value of peripheral blood monocyte-to-lymphocyte ratio (MLR) and neutrophil-to-lymphocyte ratio (NLR) in evaluating the severity and prognosis of pediatric viral encephalitis (VE). METHODS: A retrospective analysis was performed for the clinical data of 268 children with VE who were admitted to the Department of Pediatrics, Zhucheng People's Hospital, from February 2020 to September 2024. According to the Glasgow Coma Scale (GCS) score, the children were divided into critical group (109 children; GCS score ≤8) and non-critical group (159 children; GCS score >8). According to the results of Glasgow Outcome Scale after follow-up for six months, the children were divided into poor prognosis group (84 children; grade 1-3) and good prognosis group (184 children; grade 4-5). The influencing factors for disease severity and prognosis were analyzed, and the value of peripheral blood MLR and NLR in predicting disease severity and prognosis was assessed. RESULTS: The multivariate logistic regression analysis showed that high neutrophil (NEU) count, high MLR, high NLR, and low lymphocyte (LYM) count were closely associated with the critical condition and poor prognosis in children with VE (P<0.05). The receiver operating characteristic curve analysis showed that MLR and NLR had an area under the curve (AUC) of 0.772 and 0.883, respectively, for predicting critical illness in children with VE (P<0.05), as well as an AUC of 0.715 and 0.930, respectively, for predicting poor prognosis (P<0.05). CONCLUSIONS Peripheral blood MLR and NLR are associated with critical condition and poor prognosis and can be used as biomarkers for assessing the disease severity and prognosis in children with VE on admission.
Humans ; Prognosis ; Male ; Female ; Child, Preschool ; Child ; Retrospective Studies ; Neutrophils ; Lymphocytes ; Infant ; Encephalitis, Viral/diagnosis* ; Monocytes ; Adolescent ; Logistic Models ; ROC Curve

Anti–N-methyl-D-aspartate (NMDA) receptor encephalitis is a neurologic disease first identified by Dr Josep Dalmau and colleagues at the University of Pennsylvania in 2007. The first confirmed case of anti-NMDA receptor encephalitis reported in the Philippines was published in the Philippine Journal of Neurology last August 2012; it was entitled “A rare disease with a unique feature: Anti-NMDA receptor encephalitis and mesenteric teratoma”. Anti-NMDA receptor encephalitis is an autoimmune disease where the body creates antibodies against the NMDA receptors in the brain, in which antibodies disrupt normal brain signaling, causing brain swelling, or encephalitis; many reports claim that it is often misdiagnosed due to atypical presentation that overlaps neurologic and psychiatric symptoms, in which it is difficult to recognize, and that may delay management.
Anti-N-Methyl-D-Aspartate Receptor Encephalitis ; N-Methylaspartate ; D-Aspartic Acid ; Receptors, N-Methyl-D-Aspartate

Objective To prepare mouse monoclonal antibodies against the ectodomain of E2 (E2ecto) glycoprotein of Western equine encephalitis virus (WEEV). Methods A prokaryotic expression plasmid pET-28a-WEEV E2ecto was constructed and transformed into BL21 (DE3) competent cells. E2ecto protein was expressed by IPTG induction and presented mainly as inclusion bodies. Then the purified E2ecto protein was prepared by denaturation, renaturation and ultrafiltration. BALB/c mice were immunized with the formulated E2ecto protein using QuickAntibody-Mouse5W as an adjuvant via intramuscular route, boosted once at an interval of 21 days. At 35 days post-immunization, mice with antibody titer above 1×10⁴ were inoculated with E2ecto intraperitoneally, and spleen cells were fused with SP2/0 cells three days later. Hybridoma cells secreting specific monoclonal antibodies were screened by the limited dilution method, and ascites were prepared after intraperitoneal inoculation of hybridoma cells. The subtypes and titers of the antibodies in ascites were assayed by ELISA. The biological activity of the mAb was identified by immunofluorescence assay(IFA) on BHK-21 cells which were transfected with eukaryotic expression plasmid pCAGGS-WEEV-CE3E2E1. The specificity of the antibodies were evaluated with E2ecto proteins from EEEV and VEEV. Results Purified WEEV E2ecto protein was successfully expressed and obtained. Four monoclonal antibodies, 3G6G10, 3D7G2, 3B9E8 and 3D5B7, were prepared, and their subtypes were IgG2c(κ), IgM(κ), IgM(κ) and IgG1(κ), respectively. The titers of ascites antibodies 3G6G10, 3B9E8 and 3D7G2 were 10⁵, and 3D5B7 reached 10⁷. None of the four antibody strains cross-reacted with other encephalitis alphavirus such as VEEV and EEEV. Conclusion Four strains of mouse mAb specifically binding WEEV E2ecto are successfully prepared.
Horses ; Animals ; Mice ; Encephalitis Virus, Western Equine ; Ascites ; Immunosuppressive Agents ; Antibodies, Monoclonal ; Immunoglobulin M

Humans ; Anti-N-Methyl-D-Aspartate Receptor Encephalitis/therapy* ; Child ; Receptors, N-Methyl-D-Aspartate/immunology* ; Prognosis ; Immunotherapy/methods* ; Autoantibodies/blood*

To investigate the risk factors of poor prognosis and recurrence in patients with anti-NMDAR encephalitis. A single center, observational cohort study was used to retrospectively analyze 44 patients with anti NMDAR encephalitis hospitalized in the Department of Neurology of Beijing Tong Ren Hospital from January 2014 to October 2020. The results showed that the interval from onset to immunotherapy in the poor prognosis group was significantly longer than that in the good prognosis group (t=2.045,P=0.047), and the course of disease in the poor prognosis group was significantly longer than that in the good prognosis group (t=4.127,P=0.000 2). The number of patients with clinical manifestations of dyskinesia was significantly increased (Fisher exact test: P=0.014). The patients with abnormal brain MRI in the poor prognosis group were significantly more than those in the good prognosis group (Fisher exact test: P=0.017), and the patients with slow wave>50% in the poor prognosis group were significantly more than those with slow wave <50% (Fisher exact test: P<0.001). Patients with the first onset of immunotherapy time <3 months, long course of disease, high intracranial pressure, and high cerebrospinal fluid protein are prone to relapse. Bivariate logistic regression analysis showed that patients with dyskinesia, abnormal brain MRI, and slow wave EEG more than 50% were risk factors for poor prognosis (OR values were 4.687, 4.978, and 24.500, respectively; P values were 0.018, 0.016, and 0.000, respectively). The time of first-line immunotherapy for the first onset<3 months was the risk factor for recurrence (OR 17.231, P=0.010). In conclusion, dyskinesia, abnormal brain MRI and slow wave of EEG more than 50% may be the risk factors for poor prognosis of patients. The duration of immunotherapy less than 3 months after the first onset might be the risk factor for recurrence.
Humans ; Anti-N-Methyl-D-Aspartate Receptor Encephalitis/cerebrospinal fluid* ; Retrospective Studies ; Neoplasm Recurrence, Local ; Risk Factors ; Dyskinesias

OBJECTIVES: To study the clinical features of children with autoimmune encephalitis (AE) secondary to epidemic encephalitis B (EEB). METHODS: A retrospective analysis was performed on the medical data of five children with EEB with "bipolar course" who were treated in Children's Hospital Affiliated to Zhengzhou University from January 2020 to June 2022. RESULTS: Among the five children, there were three boys and two girls, with a median age of onset of 7 years (range 3 years 9 months to 12 years) and a median time of 32 (range 25-37) days from the onset of EEB to the appearance of AE symptoms. The main symptoms in the AE stage included dyskinesia (5/5), low-grade fever (4/5), mental and behavioral disorders (4/5), convulsion (2/5), severe disturbance of consciousness (2/5), and limb weakness (1/5). Compared with the results of cranial MRI in the acute phase of EEB, the lesions were enlarged in 3 children and unchanged in 2 children showed on cranial MRI in the AE stage. In the AE stage, four children were positive for anti-N-methyl-D-aspartate receptor antibody (one was also positive for anti-γ-aminobutyric acid type B receptor antibody), and one was negative for all AE antibodies. All five children in the AE stage responded to immunotherapy and were followed up for 3 months, among whom one almost recovered and four still had neurological dysfunction. CONCLUSIONS EEB can induce AE, with anti-N-methyl-D-aspartate receptor encephalitis as the most common disease. The symptoms in the AE stage are similar to those of classical anti-N-methyl-D-aspartate receptor encephalitis. Immunotherapy is effective for children with AE secondary to EEB, and the prognosis might be related to neurological dysfunction in the acute phase of EEB.
Male ; Female ; Humans ; Child ; Infant, Newborn ; Anti-N-Methyl-D-Aspartate Receptor Encephalitis ; Retrospective Studies ; Hashimoto Disease/therapy* ; Encephalitis, Arbovirus

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune inflammatory disease of the central nervous system, and little is known about its immune mechanism at present. There is a lack of disease-related biomarkers in cerebrospinal fluid except anti-NMDAR antibody, which leads to delayed diagnosis and treatment in some patients. Therefore, there has been an increasing number of studies on related cytokines in recent years to assess whether they can be used as new biomarkers for evaluating disease conditions and assisting diagnosis and treatment. Current studies have shown that some cytokines may be associated with the progression of anti-NMDAR encephalitis, and this article reviews the research advances in such cytokines associated with anti-NMDAR encephalitis.
Humans ; Cytokines ; Anti-N-Methyl-D-Aspartate Receptor Encephalitis/therapy* ; Biomarkers