Marked Elevation of Excitatory Amino Acids in Cerebrospinal Fluid Obtained From Patients With Rotavirus‐Associated Encephalopathy

Abstract

Rotavirus is the most common cause of severe gastroenteritis in young children; however, its pathogenesis and immunity are not completely understood. Even less well recognized is rotavirus-induced central nervous system (CNS) involvement, which has been associated with seizure, encephalopathy and death, among others. To elucidate the host response to rotavirus infection, we retrospectively examined neurotransmitter amino acids in the cerebrospinal fluid (CSF) of 19 children with CNS involvement associated with rotavirus infection. Subjects were classified into two groups: those with encephalopathy followed by prolonged seizure (encephalopathy group) and those who had experienced afebrile, brief cluster of seizures without encephalopathy (cluster group). The levels of glutamate, glycine, and taurine in the encephalopathy group were significantly higher than those in the cluster group. Increased levels of excitatory amino acids in the CSF may induce neurological disorders and be related to disorder severity. To the best of our knowledge, this is the first report regarding amino acids in the CSF obtained from patients with rotavirus-induced CNS involvement. Further study is necessary to elucidate the role of CSF amino acid levels in rotavirus-induced CNS involvement.

Rotavirus-Associated Hospitalization in Children With Subsequent Autoimmune Disease

“…Our results support previous studies linking rotavirus-induced autoimmunity to arthritis, vasculitis, and neurologic diseases . Previous studies indicated that rotavirus infection could potentially trigger autoimmunity in immune-privileged sites, including the intestine, pancreas, brain, kidney, and lymph nodes .…”

Benign convulsions in children with mild gastroenteritis

“…On the other hand, it was recently demonstrated that the concentration of neurotransmitter amino acids (i.e., glutamate, glycine, and taurine) in the CSF of children with RV infection and CNS involvement were significantly higher in patients who had experienced prolonged seizures with encephalopathy than in those with CwG. 47 On the contrary, the hypothesis that particular RV genotypes could be the cause of CwG is debated. Choi et al detected the P 4 G2 genotype at a higher frequency than other genotypes in children with CwG.…”

Rotavirus infection-associated central nervous system complications: clinicoradiological features and potential mechanisms

“…116) A clinical study showed that, in 19 children with CNS involvement associated with rotavirus infection, excitatory neurotransmitter levels (glutamate, glycine, and taurine) in the CSF were higher in patients with prolonged seizures accompanied by encephalopathy than in patients with a brief cluster of seizures without encephalopathy. 117) As mentioned earlier, viral encephalitis tends to demonstrate asymmetrical focal lesions on MRI as in herpes simplex virus encephalitis, while rotavirus-associated encephalopathy is generally characterized by bilateral symmetry, the predilection of cerebral white matter including the corpus callosum, and the lesions are well-demarcated, particularly on DWI.…”

“…A previous report showed elevated PGE2 and PGF2 levels in the plasma and stool of rotavirus-infected children [ 116 ]. A clinical study showed that, in 19 children with CNS involvement associated with rotavirus infection, excitatory neurotransmitter levels (glutamate, glycine, and taurine) in the CSF were higher in patients with prolonged seizures accompanied by encephalopathy than in patients with a brief cluster of seizures without encephalopathy [ 117 ].…”