Format

Send to

Choose Destination
PLoS One. 2016 Jan 25;11(1):e0146288. doi: 10.1371/journal.pone.0146288. eCollection 2016.

Characteristic Cytokine and Chemokine Profiles in Encephalitis of Infectious, Immune-Mediated, and Unknown Aetiology.

Author information

1
The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
2
The Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
3
NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom.
4
Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom.
5
Public Health England, London, United Kingdom.
6
Influenza and measles laboratory, IOC, Fiocruz, Rio de Janeiro, Brazil.
7
Chelsea and Westminster NHS Foundation Trust, London, United Kingdom.
8
Vaccine Evaluation Unit, Public Health England, Manchester, United Kingdom.

Abstract

BACKGROUND:

Encephalitis is parenchymal brain inflammation due to infectious or immune-mediated processes. However, in 15-60% the cause remains unknown. This study aimed to determine if the cytokine/chemokine-mediated host response can distinguish infectious from immune-mediated cases, and whether this may give a clue to aetiology in those of unknown cause.

METHODS:

We measured 38 mediators in serum and cerebrospinal fluid (CSF) of patients from the Health Protection Agency Encephalitis Study. Of serum from 78 patients, 38 had infectious, 20 immune-mediated, and 20 unknown aetiology. Of CSF from 37 patients, 20 had infectious, nine immune-mediated and eight unknown aetiology.

RESULTS:

Heat-map analysis of CSF mediator interactions was different for infectious and immune-mediated cases, and that of the unknown aetiology group was similar to the infectious pattern. Higher myeloperoxidase (MPO) concentrations were found in infectious than immune-mediated cases, in serum and CSF (p = 0.01 and p = 0.006). Serum MPO was also higher in unknown than immune-mediated cases (p = 0.03). Multivariate analysis selected serum MPO; classifying 31 (91%) as infectious (p = 0.008) and 17 (85%) as unknown (p = 0.009) as opposed to immune-mediated. CSF data also selected MPO classifying 11 (85%) as infectious as opposed to immune-mediated (p = 0.036). CSF neutrophils were detected in eight (62%) infective and one (14%) immune-mediated cases (p = 0.004); CSF MPO correlated with neutrophils (p<0.0001).

CONCLUSIONS:

Mediator profiles of infectious aetiology differed from immune-mediated encephalitis; and those of unknown cause were similar to infectious cases, raising the hypothesis of a possible undiagnosed infectious cause. Particularly, neutrophils and MPO merit further investigation.

PMID:
26808276
PMCID:
PMC4726626
DOI:
10.1371/journal.pone.0146288
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Public Library of Science Icon for PubMed Central
Loading ...
Support Center