Management of Japanese Encephalitis: A Current Update

Abstract

Japanese encephalitis (JE) continues to be one of the world's most serious infections with no definitive treatment or guidelines. The high morbidity and mortality rate among symptomatic patients warrant the need for further investigation in this regard. Our review focuses on the recent updates on Japanese encephalitis treatment. For that reason, we used an advanced PubMed search with JE and drugs like minocycline, interferon, ribavirin, immunoglobulin, dexamethasone, and acyclovir. All research was done in full papers written in the English language and conducted in humans. This review aims to compare and analyze recent papers regarding JE treatment to guide healthcare providers with the latest information and make evidence-based decisions when presented with this infection. Overall, only minocycline had promising results because one of the two studies showed statistically significant results. The second study showed positive trends in children over 12 years and patients who survived on the first day of hospitalization. The study with intravenous immunoglobulin (IVIG) did not improve the outcomes; however, it increased the levels of neutralizing antibodies. Further study with higher doses may change the outcomes in patients with JE. The other drugs failed to show promising results.

Perspective Chapter: Zoonosis – Brucellosis a Clinically Relevant Bacterial Disease

“…Many vectors, such as mosquitoes, fleas, mites, and ticks, play a crucial role in the transmission of diseases from animals to other animals and human, for example, Japanese encephalitis, plague, scrub typhus, etc. [15][16][17].…”

Molecular pathogenesis of Japanese encephalitis and possible therapeutic strategies

“…Despite the emergence of JEV in non-endemic countries, it is surprising to see that effective treatments and anti-JEV drugs are still unavailable, and in the last ten years (2011 to 2020), only four clinical trials have been conducted [ 195 – 198 ]. Turtle and Solomon have reviewed all of the drugs tested in clinical trials, including dexamethasone [ 199 ], interferon [ 200 ], ribavirin [ 201 ], IVIG [ 198 ], and minocycline [ 195 , 197 ], and further updates about the drugs in clinical trials, together with their methodology, outcomes, and limitations have been published by Ajibowo et al Only minocycline showed promising results in all the clinical trials drugs [ 202 ]. Turtle and Solomon also reviewed the drugs showing protective efficacy in animal models and significant anti-JEV activities in vitro .…”

Novel antiviral discoveries for Japanese encephalitis virus infections through reporter virus‐based high‐throughput screening

“…Previous estimates have indicated that over three billion people live in countries with JEV transmission, resulting in an estimated 68 000 clinical cases and over 13 000 fatalities annually 5 . While less than 1% of JEV infections manifest symptoms in humans, clinical encephalitis cases have a mortality rate ranging from 10% to 30%, and 30%−50% of survivors experience long‐term neurological or psychiatric sequelae 6,7 …”

“…It's important to note that JE cases have also occurred in non‐endemic areas, and vaccines are not generally recommended for these areas 9 . Several drugs, including minocycline, interferon, ribavirin, immunoglobulin, dexamethasone, and acyclovir, have been explored in clinical trials for the treatment of JE but have not shown promising results 7 . This underscores the pressing need for further research in this field to develop definitive treatments and guidelines.…”