Korean J Clin Neurophysiol.  2014 Dec;16(2):55-61. 10.14253/kjcn.2014.16.2.55.

Comparison of the Demographic and Laboratory Profiles of Patients with Aseptic Meningitis and Encephalitis: Significance of Age and C-reactive Protein

Affiliations
  • 1Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea. epidoc@inje.ac.kr
  • 2Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Abstract

BACKGROUND
Viruses can cause either meningitis or encephalitis. It is unclear why some people suffer from aseptic meningitis, and others acquire aseptic encephalitis when infected with the same viral pathogens. The aim of this study was to compare demographic and laboratory factors between patients with aseptic meningitis and encephalitis.
METHODS
The demographic and laboratory differences were analyzed according to age, sex, diabetes, hypertension, C-reactive protein in the blood, white blood cell and protein in the cerebrospinal fluid, and glucose ratio (cerebrospinal fluid/blood). Additionally, we analyzed the nation-wide differencesin age between the patients with aseptic meningitis and those with encephalitis in Korea.
RESULTS
The patients with aseptic encephalitis were older, more likely to have hypertension, and had higher levels of C-reactive protein than did the patients with aseptic meningitis. However, the numbers of white blood cells in the cerebrospinal fluid were significantly higher in the patients with meningitis than in the patients with encephalitis. Multivariable analysis revealed that age >49 years, hypertension and a C-reactive protein level >5.81 mg/dL were independent and significant variables in the prediction of aseptic encephalitis. Additionally, the patients with aseptic encephalitis were older than those with aseptic meningitis in the nation-wide Korean database.
CONCLUSIONS
Older age, hypertension, and higher levels of C-reactive protein are useful factors for the prediction of aseptic encephalitis.

Keyword

Blood-brain barrier; Meningitis; Encephalitis; Age; C-reactive protein

MeSH Terms

Blood-Brain Barrier
C-Reactive Protein*
Cerebrospinal Fluid
Encephalitis*
Glucose
Humans
Hypertension
Korea
Leukocytes
Meningitis
Meningitis, Aseptic*
C-Reactive Protein
Glucose

Reference

1.Kennedy PG. Viral encephalitis: causes, differential diagnosis, and management. J Neurol Neurosurg Psychiatry. 2004. 75(Suppl 1):i10–15.
Article
2.Romero JR., Newland JG. Viral meningitis and encephalitis: traditional and emerging viral agents. Semin Pediatr Infect Dis. 2003. 14:72–82.
Article
3.Tuppeny M. Viral meningitis and encephalitis. Crit Care Nurs Clin North Am. 2013. 25:363–380.
Article
4.Whitley RJ., Gnann JW. Viral encephalitis: familiar infections and emerging pathogens. Lancet. 2002. 359:507–513.
Article
5.Chaudhuri A., Kennedy PG. Diagnosis and treatment of viral encephalitis. Postgrad Med J. 2002. 78:575–583.
Article
6.Ropper AH., Adams R. Adams and Victor's principles of neurology, 8th ed. New York: McGraw-Hill Medical Pub. Division. 2005. 631–656.
7.Zhang JR., Tuomanen E. Molecular and cellular mechanisms for microbial entry into the CNS. J Neurovirol. 1999. 5:591–603.
Article
8.Farrall AJ., Wardlaw JM. Blood-brain barrier: ageing and microvascular disease--systematic review and meta-analysis. Neurobiol Aging. 2009. 30:337–352.
9.Kaya M., Kalayci R., Kucuk M., Arican N., Elmas I., Kudat H, et al. Effect of losartan on the blood-brain barrier permeability in diabetic hypertensive rats. Life Sci. 2003. 73:3235–3244.
Article
10.Wilson AC., Clemente L., Liu T., Bowen RL., Meethal SV., Atwood CS. Reproductive hormones regulate the selective permeability of the blood-brain barrier. Biochim Biophys Acta. 2008. 1782:401–407.
Article
11.Abbott NJ. Inflammatory mediators and modulation of blood-brain barrier permeability. Cell Mol Neurobiol. 2000. 20:131–147.
12.Lossinsky AS., Shivers RR. Structural pathways for macromolecular and cellular transport across the blood-brain barrier during inflammatory conditions. Review. Histol Histopathol. 2004. 19:535–564.
13.Kim MA., Park KM., Kim SE., Oh MK. Acute symptomatic seizures in CNS infection. Eur J Neurol. 2008. 15:38–41.
Article
14.Longo DL., Harrison TR. Harrison's principles of internal medicine. 18th ed.New York, London: McGraw-Hill;2012. p. 3417–3426.
15.Kupila L., Vuorinen T., Vainionpaa R., Hukkanen V., Marttila RJ., Kotilainen P. Etiology of aseptic meningitis and encephalitis in an adult population. Neurology. 2006. 66:75–80.
Article
16.Steiner I., Budka H., Chaudhuri A., Koskiniemi M., Sainio K., Salonen O, et al. Viral encephalitis: a review of diagnostic methods and guidelines for management. Eur J Neurol. 2005. 12:331–343.
Article
17.Steiner I., Budka H., Chaudhuri A., Koskiniemi M., Sainio K., Salonen O. Viral meningoencephalitis: a review of diagnostic methods and guidelines for management. Eur J Neurol. 2010. 17:e999–957.
Article
18.Abbott NJ., Ronnback L., Hansson E. Astrocyte-endothelial interactions at the blood-brain barrier. Nat Rev Neurosci. 2006. 7:41–53.
Article
19.Haorah J., Heilman D., Knipe B., Chrastil J., Leibhart J., Ghorpade A, et al. Ethanol-induced activation of myosin light chain kinase leads to dysfunction of tight junctions and blood-brain barrier compromise. Alcohol Clin Exp Res. 2005. 29:999–1009.
Article
20.Lin JJ., Lin KL., Chiu CH., Hsia SH., Chou IJ., Lin YT, et al. Antineuronal Antibodies and Infectious Pathogens in Severe Acute Pediatric Encephalitis. J Child Neurol. 2012.
Article
21.Zindler E., Zipp F. Neuronal injury in chronic CNS inflammation. Best Pract Res Clin Anaesthesiol. 2010. 24:551–562.
Article
22.Cusick MF., Libbey JE., Patel DC., Doty DJ., Fujinami RS. Infiltrating Macrophages are Key to the Development of Seizures Following Virus Infection. J Virol. 2013. 87:1849–1860.
Article
23.Rathore SK., Dwibedi B., Kar SK., Dixit S., Sabat J., Panda M. Viral aetiology and clinico-epidemiological features of acute encephalitis syndrome in eastern India. Epidemiol Infect. 2014. 24:1–8.
Article
24.Hsuchou H., Kastin AJ., Mishra PK., Ran W. C-Reactive Protein Increases BBB Permeability: Implications for Obesity and Neuroinflammation. Cell Physiol Biochem. 2012. 30:1109–1119.
Article
25.Ray P., Badarou-Acossi G., Viallon A., Boutoille D., Arthaud M., Trystram D, et al. Accuracy of the cerebrospinal fluid results to differentiate bacterial from non bacterial meningitis, in case of negative gram-stained smear. Am J Emerg Med. 2007. 25:179–184.
Article
26.Prieto-Gonzalez S., Escode R., Coloma E., Grau JM. Amoxicillin-induced acute aseptic meningitis. J Clin Neurosci. 2011. 18:443–444.
Full Text Links
  • KJCN
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr