ENCEPHALITIS Edited by Sergey Tkachev Encephalitis http://dx.doi.org/10.5772/46041 Edited by Sergey Tkachev Contributors Zakareya Gamie, Almas Khawar Ahmed, Mohammed M Hassoon, Karunamoorthi Annamalai Kaliyaperumal, Resat Ozaras, Ilker Balkan, Shailendra K Saxena, Hiroshi Shoji, Natalia Plekhova, Larisa Somova, Galina Leonova, Yurii Kaminsky, Anna Fisenko, Yongxin Yu, Durga Datt Joshi, Justin Jang Hann Chu, Wei-June Chen, Guey-Chuen Perng, Sergey Tkachev, SEREFNUR Oztürk, Hakan Ekmekci, Fahrettin Ege, Chieko Kai, Tomoyuki Honda, Misako Yoneda, Hiroki Sato, Halyna Biletska, Ihor Lozynski Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2013 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. 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Publishing Process Manager Ana Pantar Technical Editor InTech DTP team Cover InTech Design team First published January, 2013 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Encephalitis, Edited by Sergey Tkachev p. cm. ISBN 978-953-51-0925-9 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface VII Section 1 Encephalitis Clinical Diagnostics and Treatment 1 Chapter 1 The Clinical Management of the Patient with Encephalitis 3 Almas Khawar Ahmed, Zakareya Gamie and Mohammed M. Hassoon Chapter 2 Cerebrospinal Fluid Abnormalities in Viral Encephalitis 21 Hakan Ekmekci, Fahrettin Ege and Serefnur Ozturk Chapter 3 Spontaneous Intracranial Hypotension: What An Infectious Disease Physician Should Know? 33 Ilker Inanc Balkan and Resat Ozaras Chapter 4 Acute Viral Encephalitis/Encephalopathy in an Emergency Hospital in Japan: A Retrospective Study of 105 Cases in 2002 – 2011 43 Hiroshi Shoji, Masaki Tachibana, Tomonaga Matsushita, Yoshihisa Fukushima and Shimpei Sakanishi Chapter 5 Review on Japanese Encephalitis Outbreak Cases in Nepal During the Year 2011 55 Durga Datt Joshi and Jeevan Smriti Marg Section 2 Encephalitis Causative Agents 71 Chapter 6 Arboviral Encephalitis 73 Guey-Chuen Perng and Wei-June Chen Chapter 7 Genetic and Biological Properties of Original TBEV Strains Group Circulating in Eastern Siberia 95 I.V. Kozlova, M.M. Verkhozina, T.V. Demina, Yu.P. Dzhioev, S.E. Tkachev, L.S. Karan, E.K. Doroshchenko, O.V. Lisak, O.V. Suntsova, A.I. Paramonov, O.O. Fedulina, A.O. Revizor and V.I. Zlobin Chapter 8 The Pathomorphology of Far Eastern Tick-Borne Encephalitis 113 Larisa M. Somova, Galina N. Leonova, Natalia G. Plekhova, Yurii V. Kaminsky and Anna Y. Fisenko Chapter 9 Active Natural Foci of Tick-Borne Neuroinfection in the North- West Region of Ukraine 145 I. Lozynski, H. Biletska, O. Semenyshyn, V. Fedoruk, O. Drul, I. Ben, A. Shulgan and R. Morochkovski Chapter 10 Japanese Encephalitis Virus: The Complex Biology of an Emerging Pathogen 161 Shailendra K. Saxena, Sneham Tiwari, Rakhi Saxena, Asha Mathur and Madhavan P. N. Nair Chapter 11 Development of Japanese Encephalitis Attenuated Live Vaccine Virus SA14-14-2 and its Charcteristics 181 Yongxin Yu Chapter 12 Yellow Fever Encephalitis: An Emerging and Resurging Global Public Health Threat in a Changing Environment 207 Kaliyaperumal Karunamoorthi Chapter 13 The Fatal Case of Lyssavirus Encephalitis in the Russian Far East 231 Galina N. Leonova, Larisa M. Somova, Sergei I. Belikov, Il’ya G. Kondratov, Natalya G. Plekhova, Natalya V. Krylova, Elena V. Pavlenko, Mikhail P. Tiunov and Sergey E. Tkachev Chapter 14 Pathogenesis of Encephalitis Caused by Persistent Measles Virus Infection 251 Tomoyuki Honda, Misako Yoneda, Hiroki Sato and Chieko Kai Chapter 15 Viral Encephalitis with Focus on Human Enteroviruses 263 Po-Ying Chia and Justin Jang Hann Chu ContentsVI Preface Encephalitises are a group of inflammatory human and animal diseases of brain caused essentially by different pathogens. In spite of evident success in approaches for prevention, diagnostics and treatment during the last decades, the encephalitises of different etiology still constitute a menace for thousands of people all around the world. Recently, three-volume book was published by InTech, including the first “Flavivirus Encephalitis” (edited by Daniel Růžek), the second “Non-Flavivirus Encephalitis” (edited by Sergey Tkachev) and the third “Pathogenesis of Encephalitis” (edited by Daisuke Hayasaka) parts, which can be found on InTech site (http://www.intechopen.com). But a lot of different aspects and information were not included in these volumes so we decided to publish the additional book. The first part of this book is devoted to encephalitis clinical diagnostics and treatment. Proper diagnosis definition is an important step in encephalitis treatment so the 1st chapter considers the questions of clinical management of the patient and includes step-by-step instructions for encephalitis diagnostics. In some cases the abnormalities in encephalitis clinical course or symptoms similar to encephalitis can be observed so the physicians should pay special attention to such patients. The 2nd and 3rd chapter describe the cerebrospinal fluid abnormalities that could be seen in some cases during the viral encephalitis and the cases of spontaneous intracranial hypotension that could be erroneously taken for encephalitis. One of the important questions of any pathogen study is the epidemiology and monitoring and prediction of the epidemiological situation. Chapters 4 and 5 give the example of such monitoring of the encephalitis cases caused by viral pathogens in Japan and Nepal. The members of different virus species are known to be the causative agents of encephalitis, so the second part of the book is devoted to viral pathogens, their epidemiology, pathology and diagnostics. Probably, the arboviruses (and especially members of the genus Flavivirus) are known to be one of the most known and frequent causative agents of encephalitis, so the following chapters are about arboviruses-induced encephalitises. The short review on causative agents of arboviral encephalitis is presented in Chapter 6. Chapters 7-12 are devoted to flaviviruses, their epidemiology, pathology and vaccine design. The attention should be paid to chapter seven which presents new tick-borne encephalitis virus group that was demonstrated to cause focal forms of tick-borne encephalitis with lethal outcome and has high pathogenic potential. Other virus species are also known to be the causative agents of encephalitis, so the last chapters are devoted to non-arbovirus pathogens. Chapter 13 describes the fatal case of Lissavirus encephalitis on the Russian Far-East. The detailed characteristics of the genetic, biological and pathological properties of isolated virus strain were determined. Chapter 14 is devoted to issues of pathogenesis of encephalitis caused by measles virus. The last chapter of the book focuses on encephalitis caused by enteroviruses which (especially Enterovirus71 (EV71)) have been documented to cause epidemics. The authors and editors of the book hope that this work might increase the interest in this field of research and that the readers will find it useful for their investigations and clinical usage. Also I would like to thank my family, parents and colleagues who gave me a lot of support during the work on this book. Sergey Tkachev Laboratory of Molecular Microbiology, Institute of Chemical Biology and Fundamental Medicine SB RAS, Novosibirsk, Russia PrefaceVIII Section 1 Encephalitis Clinical Diagnostics and Treatment [...]... Murray Valley encephalitis virus, Japanese encephalitis virus, Hendra virus Central America Rabies virus, Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, St Louis encephalitis virus, Europe West Nile virus, Tick-born encephalitis virus, India, Nepal Rabies virus, Japanese encephalitis virus, Middle East West Nile virus Russia Tick-born encephalitis. .. http://dx.doi.org/10.5772/54590 Epidemiology or risk factors Possible infectious agent(s) for encephalitis Mosquitoes Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, St Louis encephalitis virus, Murray Valley encephalitis virus, Japanese encephalitis virus, West Nile virus Ticks Tick-born encephalitis virus, Powassan virus, Occupation Exposure to animals Rabies... virus, Eastern equine encephalitis virus, Western equine encephalitis virus, St Louis encephalitis virus, Southeast Asia, China, Pasific Rim Japanese encephalitis virus, Tick-born encephalitis virus, Nipah virus Unvaccinated status VZV, Japanese encephalitis virus, Poliovirus, Measles virus, Mumps virus, Rubella virus Table 1 Possible Etiology of Viral Encephalitis [1] 23 24 Encephalitis Clinical findings... panencephalitis (SSPE)) Parkinsonism Japanese encephalitis virus, St Louis encephalitis virus, West Nile virus, Nipah virus, Poliomyelitis-like flaccid paralysis Japanese encephalitis virus, West Nile virus, Tick-born encephalitis virus, Enterovirus (enterovirus-71, coxsackieviruses), Poliovirus Rhombencephalitis HSV, West Nile virus, Enterovirus 71 Table 2 Possible etiological agents of viral Encephalitis. .. Infant and children Eastern equine encephalitis virus, Japanese encephalitis virus, Murray Valley encephalitis virus, Influenza virus, La crosse virus Elderly persons Eastern equine encephalitis virus, St Louis encephalitis virus, West Nile virus, sporadic Creutzfeldt –Jacob disease (sCJD) Animal contacts Bats Rabies virus, Nipah virus Birds West Nile virus, Eastern equine encephalitis virus, Cats Japanese... with encephalitis Depending on the aetiological agent seizures can be very common In HSE virus encephalitis eliptogenic centres are located in the temporal and frontal cortices[6] A seizure in a patient with HSV encephalitis is an indication of a poorer prognosis In JE encephalitis periods of seizures alternating to periods of altered consciousness are common, they are however not as common in WN encephalitis. .. virus, Eastern equine encephalitis virus, Western equine encephalitis virus, Hendra virus Skunks Rabies virus, Swine Japanese encephalitis virus, Nipah virus Immunocompromised persons Varicella zoster virus (VZV), CMV, Human herpesvirus 6, West Nile virus, HIV, JC virus Unpasteurized milk Insect contact Tick-born encephalitis virus, Cerebrospinal Fluid Abnormalities in Viral Encephalitis http://dx.doi.org/10.5772/54590... the midbrain, cerebellum, and pontine lesions[51] Eastern equine encephalitis produces focal radiographic signs what distinguishes it from HSV encephalitis involvement of the basal ganglia and thalami[52] An MRI preformed on a patient with Epstein-Barr virus encephalitis could show focal lesions in the basal ganglia[53] The tick-borne encephalitis MRI revealed pronounced signal abnormalities in the... used to preform serology tests in order to identify any possible viral causes of encephalitis As the most common causes of encephalitis are viral, serology is a useful tool for diagnosis the aetiological agents of encephalitis Routine PCR diagnosis of HSE type 1 and 2 is a highly sensitive and specific method for diagnosing encephalitis[ 57] The identification of West Nile virus immunoglobulin M in cerebrospinal... Diagnosis and treatment of viral encephalitis : A Chaudhuri, P G E Kennedy 5 Treatment of measles encephalitis with adrenal steroids : John E Allen 6 Interferon-α protects mice against lethal infection with StLouisencephalitis virus delivered by the aerosol and subcutaneous routes : T.J.G Brooks, R.J Phillpotts Table 6 The treatment modalities for viral aetiological agents of encephalitis The next most common . Review on Japanese Encephalitis Outbreak Cases in Nepal During the Year 2011 55 Durga Datt Joshi and Jeevan Smriti Marg Section 2 Encephalitis Causative Agents 71 Chapter 6 Arboviral Encephalitis 73 Guey-Chuen. including the first “Flavivirus Encephalitis (edited by Daniel Růžek), the second “Non-Flavivirus Encephalitis (edited by Sergey Tkachev) and the third “Pathogenesis of Encephalitis (edited by Daisuke. includes step-by-step instructions for encephalitis diagnostics. In some cases the abnormalities in encephalitis clinical course or symptoms similar to encephalitis can be observed so the physicians