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Pathogen and Antibody Identification in Children with Encephalitis in Myanmar

Maria M Galardi1, Gavin M Sowa2, Cameron D Crockett1

  • 1Department of Neurology, Washington University School of Medicine, St. Louis, MO.

Annals of Neurology
|November 29, 2022
PubMed
Abstract

Insights

Advanced diagnostic tests significantly improved the identification of treatable infectious and autoimmune causes of pediatric encephalitis in Myanmar, a region where such studies are rare. These findings highlight the need for accessible advanced testing globally to improve encephalitis diagnosis and outcomes.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Immunology

Background:

  • Prospective studies on encephalitis are infrequent in low- and middle-income countries where the condition is prevalent.
  • Myanmar, a Southeast Asian nation, faces a significant burden of pediatric encephalitis.

Purpose of the Study:

  • To compare the diagnostic yield of local versus advanced diagnostic tests for pediatric encephalitis in Myanmar.
  • To assess the effectiveness of advanced technologies in identifying treatable causes of encephalitis.

Main Methods:

  • A prospective study was conducted at Yangon Children's Hospital from 2016-2018.
  • Two cohorts were analyzed: Cohort 1 (n=65) received local diagnostic testing, while Cohort 2 (n=38) underwent advanced tests including autoantibody assays and multiplex PCR panels for infections.
  • Advanced tests included cell-based assays, tissue immunostaining, cultured neuron studies, BioFire FilmArray Meningitis/Encephalitis panel, metagenomic sequencing, and VirScan.

Main Results:

  • Of 52 cases in Cohort 1, 83% had presumed infectious encephalitis (2% confirmed), and 17% had presumed autoimmune encephalitis.
  • Of 31 cases in Cohort 2, 74% had presumed infectious encephalitis (3% confirmed by local tests), and 26% had presumed autoimmune encephalitis.
  • Advanced tests in Cohort 2 confirmed an additional 32% of infections, identified 13% as possible infections, and diagnosed 16% with N-methyl-D-aspartate receptor antibody encephalitis.

Conclusions:

  • Advanced diagnostic technologies substantially increase the identification of treatable infectious and autoimmune etiologies in pediatric encephalitis.
  • The development of affordable advanced diagnostic tests is a global priority for improving encephalitis diagnosis and patient prognosis.
  • Implementing advanced testing strategies can significantly enhance the management of encephalitis in resource-limited settings.

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