Annals of Clinical Neurophysiology

The Korean Society of Clinical Neurophysiology (대한임상신경생리학회)
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Comparison of the Demographic and Laboratory Profiles of Patients with Aseptic Meningitis and Encephalitis: Significance of Age and C-reactive Protein

무균성수막염과 뇌염환자 사이의 인구학과 검사소견의 비교: 나이와 C-반응단백질의 중요성

  • Park, Kang Min (Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Shin, Kyong Jin (Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Ha, Sam Yeol (Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Park, Jin Se (Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Park, Bong Soo (Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Kim, Sung Eun (Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine)
  • 박강민 (인제대학교 의과대학 해운대백병원 신경과) ;
  • 신경진 (인제대학교 의과대학 해운대백병원 신경과) ;
  • 하삼열 (인제대학교 의과대학 해운대백병원 신경과) ;
  • 박진세 (인제대학교 의과대학 해운대백병원 신경과) ;
  • 박봉수 (인제대학교 의과대학 해운대백병원 내과) ;
  • 김성은 (인제대학교 의과대학 해운대백병원 신경과)
  • Received : 2013.12.23
  • Accepted : 2014.10.01
  • Published : 2014.12.31
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Abstract

Background: Viruses can cause either meningitis or encephalitis. It is unclear why some people suffer from aseptic meningitis, and others acquire aseptic encephalitis when infected with the same viral pathogens. The aim of this study was to compare demographic and laboratory factors between patients with aseptic meningitis and encephalitis. Methods: The demographic and laboratory differences were analyzed according to age, sex, diabetes, hypertension, C-reactive protein in the blood, white blood cell and protein in the cerebrospinal fluid, and glucose ratio (cerebrospinal fluid/blood). Additionally, we analyzed the nation-wide differencesin age between the patients with aseptic meningitis and those with encephalitis in Korea. Results: The patients with aseptic encephalitis were older, more likely to have hypertension, and had higher levels of C-reactive protein than did the patients with aseptic meningitis. However, the numbers of white blood cells in the cerebrospinal fluid were significantly higher in the patients with meningitis than in the patients with encephalitis. Multivariable analysis revealed that age >49 years, hypertension and a C-reactive protein level >5.81 mg/dL were independent and significant variables in the prediction of aseptic encephalitis. Additionally, the patients with aseptic encephalitis were older than those with aseptic meningitis in the nation-wide Korean database. Conclusions: Older age, hypertension, and higher levels of C-reactive protein are useful factors for the prediction of aseptic encephalitis.

Keywords

References

  1. Kennedy PG. Viral encephalitis: causes, differential diagnosis, and management. J Neurol Neurosurg Psychiatry 2004;75 Suppl 1:i10-15. https://doi.org/10.1136/jnnp.2003.034280
  2. Romero JR, Newland JG. Viral meningitis and encephalitis: traditional and emerging viral agents. Semin Pediatr Infect Dis 2003;14:72-82. https://doi.org/10.1053/spid.2003.127223
  3. Tuppeny M. Viral meningitis and encephalitis. Crit Care Nurs Clin North Am 2013;25:363-380. https://doi.org/10.1016/j.ccell.2013.04.003
  4. Whitley RJ, Gnann JW. Viral encephalitis: familiar infections and emerging pathogens. Lancet 2002;359:507-513. https://doi.org/10.1016/S0140-6736(02)07681-X
  5. Chaudhuri A, Kennedy PG. Diagnosis and treatment of viral encephalitis. Postgrad Med J 2002;78:575-583. https://doi.org/10.1136/pmj.78.924.575
  6. Ropper AH, Adams R. Adams and Victor's principles of neurology, 8th ed. New York: McGraw-Hill Medical Pub. Division. 2005;631-656.
  7. Zhang JR, Tuomanen E. Molecular and cellular mechanisms for microbial entry into the CNS. J Neurovirol 1999;5:591-603. https://doi.org/10.3109/13550289909021288
  8. Farrall AJ, Wardlaw JM. Blood-brain barrier: ageing and microvascular disease--systematic review and meta-analysis. Neurobiol Aging 2009;30:337-352. https://doi.org/10.1016/j.neurobiolaging.2007.07.015
  9. Kaya M, Kalayci R, Kucuk M, Arican N, Elmas I, Kudat H, et al. Effect of losartan on the blood-brain barrier permeability in diabetic hypertensive rats. Life Sci 2003;73:3235-3244. https://doi.org/10.1016/j.lfs.2003.06.014
  10. Wilson AC, Clemente L, Liu T, Bowen RL, Meethal SV, Atwood CS. Reproductive hormones regulate the selective permeability of the blood-brain barrier. Biochim Biophys Acta 2008;1782:401-407. https://doi.org/10.1016/j.bbadis.2008.02.011
  11. Abbott NJ. Inflammatory mediators and modulation of bloodbrain barrier permeability. Cell Mol Neurobiol 2000;20:131-147. https://doi.org/10.1023/A:1007074420772
  12. Lossinsky AS, Shivers RR. Structural pathways for macromolecular and cellular transport across the blood-brain barrier during inflammatory conditions. Review. Histol Histopathol 2004;19:535-564.
  13. Kim MA, Park KM, Kim SE, Oh MK. Acute symptomatic seizures in CNS infection. Eur J Neurol 2008;15:38-41. https://doi.org/10.1111/j.1468-1331.2008.02097.x
  14. Longo DL, Harrison TR. Harrison's principles of internal medicine. 18th ed. New York, London: McGraw-Hill, 2012;3417-3426.
  15. Kupila L, Vuorinen T, Vainionpaa R, Hukkanen V, Marttila RJ, Kotilainen P. Etiology of aseptic meningitis and encephalitis in an adult population. Neurology 2006;66:75-80. https://doi.org/10.1212/01.wnl.0000191407.81333.00
  16. Steiner I, Budka H, Chaudhuri A, Koskiniemi M, Sainio K, Salonen O, et al. Viral encephalitis: a review of diagnostic methods and guidelines for management. Eur J Neurol 2005;12:331-343. https://doi.org/10.1111/j.1468-1331.2005.01126.x
  17. Steiner I, Budka H, Chaudhuri A, Koskiniemi M, Sainio K, Salonen O. Viral meningoencephalitis: a review of diagnostic methods and guidelines for management. Eur J Neurol 2010;17:e999-957. https://doi.org/10.1111/j.1468-1331.2010.02970.x
  18. Abbott NJ, Ronnback L, Hansson E. Astrocyte-endothelial interactions at the blood-brain barrier. Nat Rev Neurosci 2006;7:41-53. https://doi.org/10.1038/nrn1824
  19. Haorah J, Heilman D, Knipe B, Chrastil J, Leibhart J, Ghorpade A, et al. Ethanol-induced activation of myosin light chain kinase leads to dysfunction of tight junctions and blood-brain barrier compromise. Alcohol Clin Exp Res 2005;29:999-1009. https://doi.org/10.1097/01.ALC.0000166944.79914.0A
  20. Lin JJ, Lin KL, Chiu CH, Hsia SH, Chou IJ, Lin YT, et al. Antineuronal Antibodies and Infectious Pathogens in Severe Acute Pediatric Encephalitis. J Child Neurol 2012.
  21. Zindler E, Zipp F. Neuronal injury in chronic CNS inflammation. Best Pract Res Clin Anaesthesiol 2010;24:551-562. https://doi.org/10.1016/j.bpa.2010.11.001
  22. Cusick MF, Libbey JE, Patel DC, Doty DJ, Fujinami RS. Infiltrating Macrophages are Key to the Development of Seizures Following Virus Infection. J Virol 2013;87:1849-1860. https://doi.org/10.1128/JVI.02747-12
  23. Rathore SK, Dwibedi B, Kar SK, Dixit S, Sabat J, Panda M. Viral aetiology and clinico-epidemiological features of acute encephalitis syndrome in eastern India. Epidemiol Infect 2014;24:1-8.
  24. Hsuchou H, Kastin AJ, Mishra PK, Ran W. C-Reactive Protein Increases BBB Permeability: Implications for Obesity and Neuroinflammation. Cell Physiol Biochem 2012;30:1109-1119. https://doi.org/10.1159/000343302
  25. Ray P, Badarou-Acossi G, Viallon A, Boutoille D, Arthaud M, Trystram D, et al. Accuracy of the cerebrospinal fluid results to differentiate bacterial from non bacterial meningitis, in case of negative gram-stained smear. Am J Emerg Med 2007;25:179-184. https://doi.org/10.1016/j.ajem.2006.07.012
  26. Prieto-Gonzalez S, Escode R, Coloma E, Grau JM. Amoxicillin-induced acute aseptic meningitis. J Clin Neurosci 2011;18:443-444. https://doi.org/10.1016/j.jocn.2010.07.122