Enterovirus 71 encephalomyelitis and Japanese encephalitis can be distinguished by topographic distribution of inflammation and specific intraneuronal detection of viral antigen and RNA.
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Enterovirus 71 encephalomyelitis and Japanese encephalitis can be distinguished by topographic distribution of inflammation and specific intraneuronal detection of viral antigen and RNA.
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Authors:
Address: Faculty of Medicine, University of Malaya, Malaysia; Yan Chai Hospital, Hong Kong, NIMHANS, Bangalore, India; PGIMER, Chandigarh, India; National Cheng Kung University, Taiwan; Centre for Forensic Science, Singapore; Singapore General Hospital; Centre Hospitalier Universitaire, Brest, France; Universiti Sarawak Malaysia, National Institute of Infectious Diseases, Tokyo, Japan.
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Aims: To investigate if two important epidemic viral encephalitis in children, Enterovirus 71 (EV71) encephalomyelitis and Japanese encephalitis (JE) whose clinical and pathological features may be non-specific and overlapping, could be distinguished. Methods: Tissue sections from the central nervous system of infected cases were examined by light microscopy, immunohistochemistry and in situ hybridization. Results: All 13 cases of EV71 encephalomyelitis collected from Asia and France invariably showed stereotyped distribution of inflammation in the spinal cord, brainstem, hypothalamus, cerebellar dentate nucleus, and to a lesser extent, cerebral cortex and meninges. Anterior pons, corpus striatum, thalamus, temporal lobe, hippocampus and cerebellar cortex were always uninflamed. In contrast, the 8 JE cases studied showed inflammation involving most neuronal areas of the central nervous system, including the areas that were uninflamed in EV71 encephalomyelitis. Lesions in both infections were non-specific, consisting of perivascular and parenchymal infiltration by inflammatory cells, oedematous/necrolytic areas, microglial nodules and neuronophagia. Viral inclusions were absent. Conclusions: Immunohistochemistry and in situ hybridization assays were useful to identify the causative virus, localising viral antigens and RNA, respectively, almost exclusively to neurons. The stereotyped distribution of inflammatory lesions in EV71 encephalomyelitis appears to be very useful to help distinguish it from JE. © 2012 The Authors. Neuropathology and Applied Neurobiology © 2012 British Neuropathological Society.
© 2012 The Authors. Neuropathology and Applied Neurobiology © 2012 British Neuropathological Society.
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