Encephalitis
Encephalitis is defined as a brain inflammatory process associated with neurologic dysfunction. CNS dysfunction includes seizures, focal neurologic findings, and alteration in mental status. The inflammation can result from different processes: immune disorders, cancer, toxic or metabolic encephalopathies, vascular disorders, or infectious diseases. Infectious encephalitis is mainly caused by viruses, with herpes simplex virus (HSV) being the most frequently isolated. However, recent studies have emphasized the role of bacteria, especially mycoplasma pneumoniae, fungi, and parasites.
Pathogenesis
There are at least two forms of infection-related encephalitis: primary and post- or parainfectious. Primary encephalitis results from direct CNS invasion by the offending agent, and the gray matter often is targeted. A post-infectious or parainfectious encephalitis presents much like primary encephalitis, but the illness is not caused by direct CNS infection. In post/parainfectious encephalitis, neurologic effects are the consequence of the host’s immune response, which often affects the white matter.
Causes
Viruses, bacteria, fungi, and parasites all can cause encephalitis. Herpesviruses, varicella, and arboviruses were the viral causes reported most frequently. From a practical standpoint, there are too many possible causes of encephalitis for every patient to receive an exhaustive evaluation. Focused historical questions may establish the risk of specific causes and guide the prioritization of testing.
Immunologic Features
In the autoimmune encephalitides, the antibodies bind to extracellular epitopes of cell-surface proteins and cause reversible neuronal dysfunction. These features may explain the better outcomes for patients with autoimmune encephalitides, as compared with the outcomes for patients with neurologic syndromes related to antibodies against intracellular proteins, in which neuronal loss is frequent and cytotoxic T-cell mechanisms predominate.
Herpes simplex encephalitis, and possibly other viral encephalitides, can trigger antibodies against the NMDAR and other neuronal cell-surface proteins; such antibodies might explain relapsing neurologic symptoms that arise weeks after the onset of herpes simplex encephalitis.
Imaging and Ancillary Studies
Magnetic resonance imaging (MRI) is much more sensitive than CT scans for acute changes associated with encephalitis. Electroencephalography (EEG) can be a helpful adjunct in the early assessment of encephalitis. EEG may be needed to assess seizure activity and may help localize the region of encephalitic involvement. Compared with CT scans, EEG is considerably more sensitive in detecting focal encephalitis at the time of presentation.
Treatment
The composition and duration of treatment for encephalitis depend on the underlying cause. Of the viral causes, only HSV and varicella have well-established therapy. In contrast, most bacterial, fungal, and parasitic causes have accepted treatments for systemic infection. Patients whose diagnosis is infectious encephalitis should receive empiric acyclovir for HSV and antibacterial agents for meningitis until bacterial and viral study results are available. In cases of suspected postinfectious encephalitis or encephalitis of unknown cause, a neurologist and an infectious disease specialist should be consulted regarding the use of intravenous immune globulin (IVIG), corticosteroids, or other immune system modulators.
Studies of how autoantibodies alter the structure and function of synaptic proteins and cause symptoms are critical for an understanding of the underlying pathogenic mechanisms, which in turn could lead to the development of new treatment strategies. Creative Biolabs is a leading international biotechnology company. We are flexible to meet the unique needs of client projects, please feel free to contact us.
- iNeuMab™ Mouse Anti-LRP1 Monoclonal Antibody (CBP3363) (Cat#: NAB-0720-Z6479)
- iNeuMab™ Anti-ApoC3 BBB Shuttle Antibody (NRZP-1022-ZP3503) (Cat#: NRZP-1022-ZP3503)
- iNeuMab™ Anti-CD20 Antibody (NRP-0422-P1230) (Cat#: NRP-0422-P1230)
- iNeuMab™ Anti-Amyloid Beta 1-15 Antibody (NRP-0422-P867) (Cat#: NRP-0422-P867)
- iNeuMab™ Anti-ApoC3 BBB Shuttle Antibody (NRZP-1022-ZP3505) (Cat#: NRZP-1022-ZP3505)
- iNeuMab™ Anti-GARP Antibody (NRP-0422-P1639) (Cat#: NRP-0422-P1639)
- iNeuMab™ Anti-SEZ6 Antibody (NRP-0422-P517) (Cat#: NRP-0422-P517)
- iNeuMab™ Mouse Anti-SHANK3 Monoclonal Antibody (CBP929) (Cat#: NAB-0720-Z3477)
- iNeuMab™ Anti-TREM2 BBB Shuttle Antibody (NRZP-1022-ZP4114) (Cat#: NRZP-1022-ZP4114)
- Mouse Anti-Human α-Synuclein Phospho (Tyr39) (CBP3706) (Cat#: NAB201250LS)
- Mouse Retinal Ganglion Cells (Cat#: NCL2110P145)
- Rat Muller Cell (Cat#: NCL2110P040)
- Green Fluorescent BACE1 Cell Lines (Cat#: NCL2110P214)
- Mouse Microglia N9 (Cat#: NCL2110P073)
- Green Fluorescent Alpha-synuclein Cell Line (Cat#: NCL2110P209)
- Mouse Glioma Cell Line GL261 (Cat#: NCL-2108P28)
- Rat Retinal Muller Cell Line, Immortalized (Cat#: NCL-21P6-192)
- Immortalized Human Cerebral Microvascular Endothelial Cells (Cat#: NCL-2108-P020)
- Mouse Glioma Cell Line GL261-GFP (Cat#: NCL-2108P04)
- Human Blood Brain Barrier Model (Cat#: NCL-2103-P187)
- Human Poly ADP ribose polymerase,PARP Assay Kit (Cat#: NRZP-1122-ZP62)
- Beta Amyloid (1-40), Aggregation Kit (Cat#: NRZP-0323-ZP199)
- Human GFAP ELISA Kit [Colorimetric] (Cat#: NPP2011ZP383)
- Beta Amyloid (1-42), Aggregation Kit (Cat#: NRZP-0323-ZP200)
- Amyloid beta 1-42 Kit (Cat#: NRP-0322-P2170)
- Alpha Synuclein Aggregation Kit (Cat#: NRZP-1122-ZP15)
- Alpha-Synuclein Aggregation Assay Kit (Cat#: NRZP-1122-ZP37)
- Human Tau Aggregation Kit (Cat#: NRP-0322-P2173)
- AAV2 Full Capsids, Reference Standards (Cat#: NTC2101070CR)
- Dextran, NHS Activated (Cat#: NRZP-0722-ZP124)
- VSV-eGFP (Cat#: NTA-2011-ZP20)
- ABCA1 Antisense Oligonucleotide (NV-2106-P27) (Cat#: NV-2106-P27)
- Rat Parkinson disease (autosomal recessive, juvenile) 2, parkin (Park2) (NM_020093) ORF clone/lentiviral particle, Myc-DDK Tagged (Cat#: NEP-0621-R0041)
- Lenti of Mouse synuclein, alpha (Snca) transcript variant (NM_001042451) ORF clone, mGFP Tagged (Cat#: NEP-0521-R0864)
- Human presenilin 1 (PSEN1), transcript variant 2 (NM_007318) ORF clone, TurboGFP Tagged (Cat#: NEP-0421-R0140)
- Human huntingtin-associated protein 1 (HAP1) transcript variant 2 (NM_177977) ORF clone, Myc-DDK Tagged (Cat#: NEP-0521-R0676)
- App Rat amyloid beta (A4) precursor protein (App)(NM_019288) ORF clone, Untagged (Cat#: NEP-0421-R0053)
- Human apolipoprotein E (APOE) (NM_000041) ORF clone, Untagged (Cat#: NEP-0421-R0232)
- Mouse SOD1 shRNA Silencing Adenovirus (Cat#: NV-2106-P14)
- Human superoxide dismutase 3, extracellular (SOD3) (NM_003102) ORF clone, Untagged (Cat#: NEP-0521-R0808)
- Human superoxide dismutase 1, soluble (SOD1) (NM_000454) ORF clone, TurboGFP Tagged (Cat#: NEP-0521-R0748)
- NeuroBiologics™ Monkey Cerebrospinal Fluid (Cat#: NRZP-0822-ZP495)
- NeuroBiologics™ Mouse Cerebrospinal Fluid (Cat#: NRZP-0822-ZP497)
- NeuroBiologics™ Pig Cerebrospinal Fluid (Cat#: NRZP-0822-ZP498)
- NeuroBiologics™ Rat Cerebrospinal Fluid (Cat#: NRZP-0822-ZP496)
- NeuroBiologics™ Human Cerebrospinal Fluid (Cat#: NRZP-0822-ZP491)
- NeuroPro™ Anti-IDUA BBB Shuttle Protein (Cat#: NRZP-0423-ZP502)
- NeuroPro™ Anti-IDUA BBB Shuttle Protein (Cat#: NRZP-0423-ZP498)
- NeuroPro™ Anti-idursulfase BBB Shuttle Protein (Cat#: NRZP-0423-ZP497)
- NeuroPro™ Anti-GDNF BBB Shuttle Protein (Cat#: NRZP-0423-ZP509)
- NeuroPro™ Anti-NAGLU BBB Shuttle Protein (Cat#: NRZP-0423-ZP506)
- NeuroPro™ Anti-IDS BBB Shuttle Protein (Cat#: NRZP-0423-ZP503)
- NeuroPro™ Anti-SGSH BBB Shuttle Protein (Cat#: NRZP-0423-ZP505)
- NeuroPro™ Anti-GDNF BBB Shuttle Protein (Cat#: NRZP-0423-ZP500)
- NeuroPro™ Anti-TNFR BBB Shuttle Protein (Cat#: NRZP-0423-ZP501)
- NeuroPro™ Anti-ASA BBB Shuttle Protein (Cat#: NRZP-0423-ZP504)