Encephalitis Surveillance through the Emerging Infections Program, 1997–2010 - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

FULL-TEXT ►

Encephalitis Surveillance through the Emerging Infections Program, 1997–2010 - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 9—September 2015
THEME ISSUE
Emerging Infections Program

CME ACTIVITY - Emerging Infections Program

Encephalitis Surveillance through the Emerging Infections Program, 1997–2010

On This Page

• Medscape CME Activity
• Materials and Methods
• Results
• Discussion
• Suggested Citation

Tables

• Table 1
• Table 2
• Table 3

Downloads

• PDF [471 KB - 6 pgs]
• RIS [TXT - 2 KB]

Karen C. Bloch  and Carol A. Glaser

Author affiliations: Vanderbilt University, Nashville, Tennessee, USA (K.C. Bloch); Kaiser Permanente, Oakland, California, USA (C.A. Glaser)

Suggested citation for this article

Abstract

Encephalitis is a devastating illness that commonly causes neurologic disability and has a case fatality rate >5% in the United States. An etiologic agent is identified in <50% of cases, making diagnosis challenging. The Centers for Disease Control and Prevention Emerging Infections Program (EIP) Encephalitis Project established syndromic surveillance for encephalitis in New York, California, and Tennessee, with the primary goal of increased identification of causative agents and secondary goals of improvements in treatment and outcome. The project represents the largest cohort of patients with encephalitis studied to date and has influenced case definition and diagnostic evaluation of this condition. Results of this project have provided insight into well-established causal pathogens and identified newer causes of infectious and autoimmune encephalitis. The recognition of a possible relationship between enterovirus D68 and acute flaccid paralysis with myelitis underscores the need for ongoing vigilance for emerging causes of neurologic disease.

Encephalitis is a potentially devastating illness: the related case-fatality rate in the United States is >5% (1), and substantial neurologic disability is common among survivors. Historically, this syndromic illness has been difficult to diagnose: an etiologic agent was identified in <50% of encephalitis cases in the United States diagnosed during 1987–1998 (2). A major barrier to diagnosis during that period was the lack of sensitive, noninvasive laboratory techniques to identify central nervous system pathogens. However, by the early 1990s, PCR was proven to be comparable to brain biopsy for the diagnosis of herpes simplex virus (HSV) encephalitis, without the need for an invasive surgical procedure (3). There was optimism that application of PCR could also improve microbiologic diagnoses of encephalitis infections caused by other pathogens and, by extension, the outcome of the illnesses. The Emerging Infections Program (EIP), which is funded by the Centers for Disease Control and Prevention, initiated the Encephalitis Project, a syndromic surveillance program for encephalitis in existing EIP sites beginning in New York in 1997, California in 1998, and Tennessee in 2000, and all ending by 2010.

Dr. Bloch is an Associate Professor in Medicine (Infectious Diseases) and Health Policy at Vanderbilt University in Nashville. She served as the principal investigator for the Tennessee Unexplained Encephalitis Surveillance Project. Her research interests focus on the study of encephalitis and arthropod-borne infections.

Dr. Glaser is a pediatric infectious disease physician at Kaiser Permanente in Oakland, California who served as the principal investigator for the California Encephalitis Project. Her primary research interests are zoonotic illness and neurologic disease.

Acknowledgment

Support for the EIP Encephalitis Project was provided by a grant from the Centers for Disease Control and Prevention Emerging Infections Program to the California Department of Health (U50/CCU915546-09) and to the Tennessee Department of Health (U50/CCU416123-09).

References

1. Vora NM, Holman RC, Mehal JM, Steiner CA, Blanton J, Sejvar J. Burden of encephalitis-associated hospitalizations in the United States, 1998–2010. Neurology. 2014;82:443–51 . DOIPubMed
2. Khetsuriani N, Holman RC, Anderson LJ. Burden of encephalitis-associated hospitalizations in the United States, 1988–1997. Clin Infect Dis.2002;35:175–82 . DOIPubMed
3. Lakeman FD, Whitley RJ. Diagnosis of herpes simplex encephalitis: application of polymerase chain reaction to cerebrospinal fluid from brain-biopsied patients and correlation with disease. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. J Infect Dis.1995;171:857–63 . DOIPubMed
4. Venkatesan A, Tunkel AR, Bloch KC, Lauring AS, Sejvar J, Bitnun A, ; International Encephalitis Consortium. Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the International Encephalitis Consortium. Clin Infect Dis. 2013;57:1114–28. DOIPubMed
5. DuBray K, Anglemyer A, LaBeaud AD, Flori H, Bloch K, Joaquin KS, Epidemiology, outcomes and predictors of recovery in childhood encephalitis: a hospital-based study. Pediatr Infect Dis J. 2013;32:839–44 .PubMed
6. Campbell WP, Huang C. Sequence comparisons of medium RNA segment among 15 California serogroup viruses. Virus Res. 1999;61:137–44.DOIPubMed
7. Huang C, Campbell W, Grady L, Kirouac I, LaForce FM. Diagnosis of Jamestown Canyon encephalitis by polymerase chain reaction. Clin Infect Dis.1999;28:1294–7. DOIPubMed
8. Huang C, Morse D, Slater B, Anand M, Tobin E, Smith P, Multiple-year experience in the diagnosis of viral central nervous system infections with a panel of polymerase chain reaction assays for detection of 11 viruses. Clin Infect Dis. 2004;39:630–5. DOIPubMed
9. Bloch KC, Glaser C. Diagnostic approaches for patients with suspected encephalitis. Curr Infect Dis Rep. 2007;9:315–22. DOIPubMed
10. Hicar MD, Edwards K, Bloch K. Powassan virus infection presenting as acute disseminated encephalomyelitis in Tennessee. Pediatr Infect Dis J.2011;30:86–8. DOIPubMed
11. Tunkel AR, Glaser CA, Bloch KC, Sejvar JJ, Marra CM, Roos KL, ; Infectious Diseases Society of America. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2008;47:303–27. DOIPubMed
12. Glaser CA, Gilliam S, Schnurr D, Forghani B, Honarmand S, Khetsuriani N, ; California Encephalitis Project. In search of encephalitis etiologies: diagnostic challenges in the California Encephalitis Project, 1998–2000. Clin Infect Dis. 2003;36:731–42. DOIPubMed
13. Christie LJ, Honarmand S, Talkington DF, Gavali SS, Preas C, Pan CY, Pediatric encephalitis: what is the role of Mycoplasma pneumoniae? Pediatrics.2007;120:305–13. DOIPubMed
14. Glaser CA, Honarmand S, Anderson LJ, Schnurr DP, Forghani B, Cossen CK, Beyond viruses: clinical profiles and etiologies associated with encephalitis. Clin Infect Dis. 2006;43:1565–77. DOIPubMed
15. Glaser CA, Gilliam S, Honarmand S, Tureen JH, Lowenstein DH, Anderson LJ, Refractory status epilepticus in suspect encephalitis. Neurocrit Care.2008;9:74–82. DOIPubMed
16. Singh RK, Joshi SM, Potter DM, Leber SM, Carlson MD, Shellhaas RA. Cognitive outcomes in febrile infection-related epilepsy syndrome treated with the ketogenic diet. Pediatrics. 2014;134:e1431–5. DOIPubMed
17. Weinberg A, Bloch KC, Li S, Tang YW, Palmer M, Tyler KL. Dual infections of the central nervous system with Epstein-Barr virus. J Infect Dis.2005;191:234–7. DOIPubMed
18. Yao K, Honarmand S, Espinosa A, Akhyani N, Glaser C, Jacobson S. Detection of human herpesvirus-6 in cerebrospinal fluid of patients with encephalitis. Ann Neurol. 2009;65:257–67. DOIPubMed
19. Gable MS, Sheriff H, Dalmau J, Tilley DH, Glaser CA. The frequency of autoimmune N-methyl-D-aspartate receptor encephalitis surpasses that of individual viral etiologies in young individuals enrolled in the California Encephalitis Project. Clin Infect Dis. 2012;54:899–904. DOIPubMed
20. To TM, Soldatos A, Sheriff H, Schmid DS, Espinosa N, Cosentino G, Insights into pediatric herpes simplex encephalitis from a cohort of 21 children from the California Encephalitis Project, 1998–2011. Pediatr Infect Dis J. 2014;33:1287–8. DOIPubMed
21. Fowlkes AL, Honarmand S, Glaser C, Yagi S, Schnurr D, Oberste MS, Enterovirus-associated encephalitis in the California encephalitis project, 1998–2005. J Infect Dis. 2008;198:1685–91. DOIPubMed
22. Christie LJ, Loeffler AM, Honarmand S, Flood JM, Baxter R, Jacobson S, Diagnostic challenges of central nervous system tuberculosis. Emerg Infect Dis. 2008;14:1473–5. DOIPubMed
23. Schuster FL, Yagi S, Gavali S, Michelson D, Raghavan R, Blomquist I, Under the radar: Balamuthia amebic encephalitis. Clin Infect Dis.2009;48:879–87. DOIPubMed
24. Lynch M, Lee B, Azimi P, Gentsch J, Glaser C, Gilliam S, Rotavirus and central nervous system symptoms: cause or contaminant? Case reports and review. Clin Infect Dis. 2001;33:932–8. DOIPubMed
25. Arnold JC, Singh KK, Milder E, Spector SA, Sawyer MH, Gavali S, Human metapneumovirus associated with central nervous system infection in children. Pediatr Infect Dis J. 2009;28:1057–60. DOIPubMed
26. Dalmau J, Tüzün E, Wu HY, Masjuan J, Rossi JE, Voloschin A, Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol. 2007;61:25–36. DOIPubMed
27. Gable MS, Gavali S, Radner A, Tilley DH, Lee B, Dyner L, Anti-NMDA receptor encephalitis: report of ten cases and comparison with viral encephalitis. Eur J Clin Microbiol Infect Dis. 2009;28:1421–9. DOIPubMed
28. Armangue T, Leypoldt F, Málaga I, Raspall-Chaure M, Marti I, Nichter C, Herpes simplex virus encephalitis is a trigger of brain autoimmunity. Ann Neurol. 2014;75:317–23 . DOIPubMed
29. Pahud BA, Glaser CA, Dekker CL, Arvin AM, Schmid DS. Varicella zoster disease of the central nervous system: epidemiological, clinical, and laboratory features 10 years after the introduction of the varicella vaccine. J Infect Dis. 2011;203:316–23. DOIPubMed
30. Melekhin VV, Karem KL, Damon IK, Bloch KC. Encephalitis after secondary smallpox vaccination. Clin Infect Dis. 2009;48:e1–2. DOIPubMed
31. Pahud BA, Rowhani-Rahbar A, Glaser C, Gavali S, Salibay CJ, Fireman B, Lack of association between childhood immunizations and encephalitis in California, 1998–2008. Vaccine. 2012;30:247–53. DOIPubMed
32. Honarmand S, Glaser CA, Chow E, Sejvar JJ, Preas CP, Cosentino GC, Subacute sclerosing panencephalitis in the differential diagnosis of encephalitis. Neurology. 2004;63:1489–93. DOIPubMed
33. Rellosa N, Bloch KC, Shane AL, Debiasi RL. Neurologic manifestations of pediatric novel H1N1 influenza infection. Pediatr Infect Dis J.2011;30:165–7. DOIPubMed
34. Centers for Disease Control and Prevention. ArboNET. West Nile virus disease cases and deaths reported to CDC by year and clinical presentation, 1999–2013 [cited 2015 Feb 10].http://www.cdc.gov/westnile/resources/pdfs/cummulative/99_2013_CasesAndDeathsClinicalPresentationHumanCases.pdf
35. Briese T, Jia XY, Huang C, Grady LJ, Lipkin WI. Identification of a Kunjin/West Nile-like flavivirus in brains of patients with New York encephalitis.Lancet. 1999;354:1261–2. DOIPubMed
36. Francisco AM, Glaser C, Frykman E, Cole B, Cheung M, Meyers H, 2004 California pediatric West Nile virus case series. Pediatr Infect Dis J.2006;25:81–4. DOIPubMed
37. Jean CM, Honarmand S, Louie JK, Glaser CA. Risk factors for West Nile virus neuroinvasive disease, California, 2005. Emerg Infect Dis.2007;13:1918–20. DOIPubMed
38. Ayscue P, Van Haren K, Sheriff H, Waubant E, Waldron P, Yagi S, ; Centers for Disease Control and Prevention. Acute flaccid paralysis with anterior myelitis—California, June 2012–June 2014. MMWR Morb Mortal Wkly Rep. 2014;63:903–6 .PubMed
39. Centers for Disease Control and Prevention. Notes from the field: acute flaccid myelitis among persons aged ≤21 years—United States, August–November 2014. MMWR Morb Mortal Wkly Rep. 2015;63:1243–4 .PubMed
40. Messacar K, Schreiner TL, Maloney JA, Wallace A, Ludke J, Oberste MS, A cluster of acute flaccid paralysis and cranial nerve dysfunction temporally associated with an outbreak of enterovirus D68 in children in Colorado, USA. Lancet. 2015;385:1662–71. DOIPubMed

Tables

• Table 1. Case definition for encephalitis in the Emerging Infections Program Encephalitis Project, 1997–2010
• Table 2. Core diagnostic testing algorithm for the Emerging Infections Program Encephalitis Project, 1997–2010
• Table 3. Emerging Infections Program Encephalitis Project clinical profiles, 1997–2010

Suggested citation for this article: Bloch KC, Glaser CA. Encephalitis surveillance through the Emerging Infections Program, 1997–2010. Emerg Infect Dis. 2015 Sep [date cited]. http://dx.doi.org/10.3201/eid2109.150295

DOI: 10.3201/eid2109.150295