Autoimmune encephalitis after Japanese encephalitis in children: A prospective study

Area of Science:

• Neuroimmunology
• Infectious Diseases
• Autoimmune Disorders

Background:

• Japanese encephalitis (JE) is a significant cause of neurological morbidity.
• Autoimmune encephalitis is an emerging complication following JE.
• Identifying predictors and triggers of post-JE autoimmune encephalitis is crucial for patient outcomes.

Purpose of the Study:

• To investigate anti-neuronal surface antibodies in JE patients.
• To identify serum predictors of autoimmune encephalitis post-JE.
• To correlate antibody presence with clinical outcomes.

Main Methods:

• Prospective study of 31 JE patients.
• Detection of anti-neuronal surface antibodies and cytokines in serum and CSF during acute and convalescent phases.
• Analysis of JE virus RNA in CSF during relapse.
• One-year follow-up for clinical outcomes.

Main Results:

• No anti-neuronal surface antibodies detected at JE onset.
• Five patients developed autoimmune encephalitis in the convalescent phase, with anti-N-methyl-D-aspartate receptor (NMDAR), anti-gamma-aminobutyric acid-B receptor (GABA_BR), or other antibodies.
• Autoimmune encephalitis patients had poorer one-year outcomes (p=0.044).
• Elevated serum CXCL13 and IL-6, and CSF CXCL13, BAFF, CXCL10, MMP-9 in the convalescent phase of autoimmune encephalitis patients.

Conclusions:

• Anti-NMDAR and anti-GABA_BR antibodies, along with others against unknown antigens, can cause autoimmune encephalitis post-JE.
• Autoimmune encephalitis following JE is associated with a worse prognosis.
• Serum CXCL13 shows potential as a predictor for autoimmune encephalitis after JE.