Clinical Outcomes of Japanese Encephalitis after Combination Treatment of Immunoglobulin, Ribavirin, and Interferon-α2b

Abstract

Background and Purpose Japanese encephalitis (JE) is caused by the JE virus of the Flaviviridae family and is spread by mosquito bites, and no specific antiviral treatment for it exists. Here we describe the clinical presentations, laboratory findings, clinical outcomes, and adverse events after combination treatment of immunoglobulin, ribavirin, and interferon-α2b administered to patients with JE. Methods Data were collected and reviewed from a prospective cohort of encephalitis patients admitted to Seoul National University Hospital between August 1, 2010 and October 31, 2019. We reviewed the medical records of the patients diagnosed with JE and treated either with supportive care only or with combination treatment of intravenous immunoglobulin, oral ribavirin, and subcutaneous interferon-α2b. Results Eleven patients were diagnosed with laboratory-confirmed JE based on the diagnosis criteria of JE. The median age was 61 years, and five patients were male. Eight patients were treated with the combination therapy, while three patients received supportive management only. Four of the eight patients (50%) treated with the combination therapy showed partial recovery, while one patient (12.5%) showed complete recovery. Two patients experienced hemolytic anemia related to ribavirin and febrile reaction to immunoglobulin, respectively. Among the three patients who received supportive management only, one (33.3%) showed partial recovery and the other two (67.7%) did not show improvement. Conclusions Combination treatment of immunoglobulin, ribavirin, and interferon-α2b was found to be tolerable in JE in this study. Further studies of appropriate designs and involving larger numbers of patients are warranted to explore the efficacy of this combination therapy.

Deep Proteomics Network and Machine Learning Analysis of Human Cerebrospinal Fluid in Japanese Encephalitis Virus Infection

“…To date, to our knowledge, two studies have utilized unbiased techniques to examine the CSF proteome in human patients with confirmed JEV infection; while they demonstrate the feasibility of the methods, the patients were not confirmed by seroneutralization and included relatively small numbers of patients (10 and 26 JE patients). , There have been a handful of studies utilizing ELISA methods to target specific proteins; however, these rarely used power calculations in their experimental design, nor did they include adequate controls. − Analysis of the transcriptome and proteome in animal models − and cell culture ,,− have been performed; however, the comparability to human CSF and comparison with other neurological infections is limited. Furthermore, mRNA expression does not directly correlate with that of the corresponding protein …”

Deep proteomics network and machine learning analysis of human cerebrospinal fluid in Japanese encephalitis virus infection

“…To date, to our knowledge, two studies have utilized unbiased techniques to examine the CSF proteome in human patients with confirmed JEV infection; while they demonstrates the feasibility of the methods, the patients were not confirmed by seroneutralisation and included relatively small numbers of patients (10 and 26 JE patients) (46,47). There have been a handful of studies utilizing ELISA methods to target specific proteins, however these rarely used power calculations in their experimental design, nor did they include adequate controls (48)(49)(50)(51)(52)(53). Analysis of the transcriptome and proteome in animal models (54)(55)(56)(57)(58) and cell culture (48,54,(59)(60)(61)(62)(63)(64) have been performed, however the comparability to human CSF and comparison with other neurological infections is limited.…”

Safety and immunogenicity following co-administration of Yellow fever vaccine with Tick-borne encephalitis or Japanese encephalitis vaccines: Results from an open label, non-randomized clinical trial

“…Infection with these viruses is associated with significant morbidities, hospitalization costs, sick leave-associated costs, and loss of productivity as well as over 100,000 of fatal outcomes per year [2,4,[6][7][8][9]. No specific treatment for these diseases exists, though development of antiviral drug candidates has been initiated [10][11][12][13][14]. There are, however, licensed vaccines against these flaviviruses [15][16][17].…”