Pathogen and Antibody Identification in Children with Encephalitis in Myanmar

Maria M. Galardi; Gavin M. Sowa; Cameron D. Crockett; Robert Rudock; Alyssa E. Smith; Ei E. Shwe; Thidar San; Kyaw Linn; Aye Mya M. Aye; Prashanth S. Ramachandran; Maham Zia; Anne E. Wapniarski; Isobel A. Hawes; Chaw S. Hlaing; Ei H. Kyu; Cho Thair; Yi Y. Mar; Nway Nway; Gregory A. Storch; Kristine M. Wylie; Todd N. Wylie; Josep Dalmau; Michael R. Wilson; Soe S. Mar

doi:10.1002/ana.26560

Pathogen and Antibody Identification in Children with Encephalitis in Myanmar

Maria M. Galardi, Gavin M. Sowa, Cameron D. Crockett, Robert Rudock, Alyssa E. Smith, Ei E. Shwe, Thidar San, Kyaw Linn, Aye Mya M. Aye, Prashanth S. Ramachandran, Maham Zia, Anne E. Wapniarski, Isobel A. Hawes, Chaw S. Hlaing, Ei H. Kyu, Cho Thair, Yi Y. Mar, Nway Nway, Gregory A. Storch, Kristine M. WylieTodd N. Wylie, Josep Dalmau, Michael R. Wilson, Soe S. Mar

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Abstract

Objective: Prospective studies of encephalitis are rare in regions where encephalitis is prevalent, such as low middle-income Southeast Asian countries. We compared the diagnostic yield of local and advanced tests in cases of pediatric encephalitis in Myanmar. Methods: Children with suspected subacute or acute encephalitis at Yangon Children's Hospital, Yangon, Myanmar, were prospectively recruited from 2016–2018. Cohort 1 (n = 65) had locally available diagnostic testing, whereas cohort 2 (n = 38) had advanced tests for autoantibodies (ie, cell-based assays, tissue immunostaining, studies with cultured neurons) and infections (ie, BioFire FilmArray multiplex Meningitis/Encephalitis multiplex PCR panel, metagenomic sequencing, and pan-viral serologic testing [VirScan] of cerebrospinal fluid). Results: A total of 20 cases (13 in cohort 1 and 7 in cohort 2) were found to have illnesses other than encephalitis. Of the 52 remaining cases in cohort 1, 43 (83%) had presumed infectious encephalitis, of which 2 cases (4%) had a confirmed infectious etiology. Nine cases (17%) had presumed autoimmune encephalitis. Of the 31 cases in cohort 2, 23 (74%) had presumed infectious encephalitis, of which one (3%) had confirmed infectious etiology using local tests only, whereas 8 (26%) had presumed autoimmune encephalitis. Advanced tests confirmed an additional 10 (32%) infections, 4 (13%) possible infections, and 5 (16%) cases of N-methyl-D-aspartate receptor antibody encephalitis. Interpretation: Pediatric encephalitis is prevalent in Myanmar, and advanced technologies increase identification of treatable infectious and autoimmune causes. Developing affordable advanced tests to use globally represents a high clinical and research priority to improve the diagnosis and prognosis of encephalitis. ANN NEUROL 2023;93:615–628.

Original language	English
Pages (from-to)	615-628
Number of pages	14
Journal	Annals of neurology
Volume	93
Issue number	3
DOIs	https://doi.org/10.1002/ana.26560
State	Published - Mar 2023

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Galardi, M. M., Sowa, G. M., Crockett, C. D., Rudock, R., Smith, A. E., Shwe, E. E., San, T., Linn, K., Aye, A. M. M., Ramachandran, P. S., Zia, M., Wapniarski, A. E., Hawes, I. A., Hlaing, C. S., Kyu, E. H., Thair, C., Mar, Y. Y., Nway, N., Storch, G. A., ... Mar, S. S. (2023). Pathogen and Antibody Identification in Children with Encephalitis in Myanmar. Annals of neurology, 93(3), 615-628. https://doi.org/10.1002/ana.26560

@article{c77f75d6183d4129bacb32ae525fc7b9,

title = "Pathogen and Antibody Identification in Children with Encephalitis in Myanmar",

abstract = "Objective: Prospective studies of encephalitis are rare in regions where encephalitis is prevalent, such as low middle-income Southeast Asian countries. We compared the diagnostic yield of local and advanced tests in cases of pediatric encephalitis in Myanmar. Methods: Children with suspected subacute or acute encephalitis at Yangon Children's Hospital, Yangon, Myanmar, were prospectively recruited from 2016–2018. Cohort 1 (n = 65) had locally available diagnostic testing, whereas cohort 2 (n = 38) had advanced tests for autoantibodies (ie, cell-based assays, tissue immunostaining, studies with cultured neurons) and infections (ie, BioFire FilmArray multiplex Meningitis/Encephalitis multiplex PCR panel, metagenomic sequencing, and pan-viral serologic testing [VirScan] of cerebrospinal fluid). Results: A total of 20 cases (13 in cohort 1 and 7 in cohort 2) were found to have illnesses other than encephalitis. Of the 52 remaining cases in cohort 1, 43 (83%) had presumed infectious encephalitis, of which 2 cases (4%) had a confirmed infectious etiology. Nine cases (17%) had presumed autoimmune encephalitis. Of the 31 cases in cohort 2, 23 (74%) had presumed infectious encephalitis, of which one (3%) had confirmed infectious etiology using local tests only, whereas 8 (26%) had presumed autoimmune encephalitis. Advanced tests confirmed an additional 10 (32%) infections, 4 (13%) possible infections, and 5 (16%) cases of N-methyl-D-aspartate receptor antibody encephalitis. Interpretation: Pediatric encephalitis is prevalent in Myanmar, and advanced technologies increase identification of treatable infectious and autoimmune causes. Developing affordable advanced tests to use globally represents a high clinical and research priority to improve the diagnosis and prognosis of encephalitis. ANN NEUROL 2023;93:615–628.",

author = "Galardi, {Maria M.} and Sowa, {Gavin M.} and Crockett, {Cameron D.} and Robert Rudock and Smith, {Alyssa E.} and Shwe, {Ei E.} and Thidar San and Kyaw Linn and Aye, {Aye Mya M.} and Ramachandran, {Prashanth S.} and Maham Zia and Wapniarski, {Anne E.} and Hawes, {Isobel A.} and Hlaing, {Chaw S.} and Kyu, {Ei H.} and Cho Thair and Mar, {Yi Y.} and Nway Nway and Storch, {Gregory A.} and Wylie, {Kristine M.} and Wylie, {Todd N.} and Josep Dalmau and Wilson, {Michael R.} and Mar, {Soe S.}",

note = "Publisher Copyright: {\textcopyright} 2022 American Neurological Association.",

year = "2023",

month = mar,

doi = "10.1002/ana.26560",

language = "English",

volume = "93",

pages = "615--628",

journal = "Annals of neurology",

issn = "0364-5134",

number = "3",

}

Galardi, MM, Sowa, GM, Crockett, CD, Rudock, R, Smith, AE, Shwe, EE, San, T, Linn, K, Aye, AMM, Ramachandran, PS, Zia, M, Wapniarski, AE, Hawes, IA, Hlaing, CS, Kyu, EH, Thair, C, Mar, YY, Nway, N, Storch, GA , Wylie, KM , Wylie, TN, Dalmau, J, Wilson, MR & Mar, SS 2023, 'Pathogen and Antibody Identification in Children with Encephalitis in Myanmar', Annals of neurology, vol. 93, no. 3, pp. 615-628. https://doi.org/10.1002/ana.26560

TY - JOUR

T1 - Pathogen and Antibody Identification in Children with Encephalitis in Myanmar

AU - Galardi, Maria M.

AU - Sowa, Gavin M.

AU - Crockett, Cameron D.

AU - Rudock, Robert

AU - Smith, Alyssa E.

AU - Shwe, Ei E.

AU - San, Thidar

AU - Linn, Kyaw

AU - Aye, Aye Mya M.

AU - Ramachandran, Prashanth S.

AU - Zia, Maham

AU - Wapniarski, Anne E.

AU - Hawes, Isobel A.

AU - Hlaing, Chaw S.

AU - Kyu, Ei H.

AU - Thair, Cho

AU - Mar, Yi Y.

AU - Nway, Nway

AU - Storch, Gregory A.

AU - Wylie, Kristine M.

AU - Wylie, Todd N.

AU - Dalmau, Josep

AU - Wilson, Michael R.

AU - Mar, Soe S.

PY - 2023/3

Y1 - 2023/3

N2 - Objective: Prospective studies of encephalitis are rare in regions where encephalitis is prevalent, such as low middle-income Southeast Asian countries. We compared the diagnostic yield of local and advanced tests in cases of pediatric encephalitis in Myanmar. Methods: Children with suspected subacute or acute encephalitis at Yangon Children's Hospital, Yangon, Myanmar, were prospectively recruited from 2016–2018. Cohort 1 (n = 65) had locally available diagnostic testing, whereas cohort 2 (n = 38) had advanced tests for autoantibodies (ie, cell-based assays, tissue immunostaining, studies with cultured neurons) and infections (ie, BioFire FilmArray multiplex Meningitis/Encephalitis multiplex PCR panel, metagenomic sequencing, and pan-viral serologic testing [VirScan] of cerebrospinal fluid). Results: A total of 20 cases (13 in cohort 1 and 7 in cohort 2) were found to have illnesses other than encephalitis. Of the 52 remaining cases in cohort 1, 43 (83%) had presumed infectious encephalitis, of which 2 cases (4%) had a confirmed infectious etiology. Nine cases (17%) had presumed autoimmune encephalitis. Of the 31 cases in cohort 2, 23 (74%) had presumed infectious encephalitis, of which one (3%) had confirmed infectious etiology using local tests only, whereas 8 (26%) had presumed autoimmune encephalitis. Advanced tests confirmed an additional 10 (32%) infections, 4 (13%) possible infections, and 5 (16%) cases of N-methyl-D-aspartate receptor antibody encephalitis. Interpretation: Pediatric encephalitis is prevalent in Myanmar, and advanced technologies increase identification of treatable infectious and autoimmune causes. Developing affordable advanced tests to use globally represents a high clinical and research priority to improve the diagnosis and prognosis of encephalitis. ANN NEUROL 2023;93:615–628.

AB - Objective: Prospective studies of encephalitis are rare in regions where encephalitis is prevalent, such as low middle-income Southeast Asian countries. We compared the diagnostic yield of local and advanced tests in cases of pediatric encephalitis in Myanmar. Methods: Children with suspected subacute or acute encephalitis at Yangon Children's Hospital, Yangon, Myanmar, were prospectively recruited from 2016–2018. Cohort 1 (n = 65) had locally available diagnostic testing, whereas cohort 2 (n = 38) had advanced tests for autoantibodies (ie, cell-based assays, tissue immunostaining, studies with cultured neurons) and infections (ie, BioFire FilmArray multiplex Meningitis/Encephalitis multiplex PCR panel, metagenomic sequencing, and pan-viral serologic testing [VirScan] of cerebrospinal fluid). Results: A total of 20 cases (13 in cohort 1 and 7 in cohort 2) were found to have illnesses other than encephalitis. Of the 52 remaining cases in cohort 1, 43 (83%) had presumed infectious encephalitis, of which 2 cases (4%) had a confirmed infectious etiology. Nine cases (17%) had presumed autoimmune encephalitis. Of the 31 cases in cohort 2, 23 (74%) had presumed infectious encephalitis, of which one (3%) had confirmed infectious etiology using local tests only, whereas 8 (26%) had presumed autoimmune encephalitis. Advanced tests confirmed an additional 10 (32%) infections, 4 (13%) possible infections, and 5 (16%) cases of N-methyl-D-aspartate receptor antibody encephalitis. Interpretation: Pediatric encephalitis is prevalent in Myanmar, and advanced technologies increase identification of treatable infectious and autoimmune causes. Developing affordable advanced tests to use globally represents a high clinical and research priority to improve the diagnosis and prognosis of encephalitis. ANN NEUROL 2023;93:615–628.

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U2 - 10.1002/ana.26560

DO - 10.1002/ana.26560

M3 - Article

C2 - 36443898

AN - SCOPUS:85144051339

SN - 0364-5134

VL - 93

SP - 615

EP - 628

JO - Annals of neurology

JF - Annals of neurology

IS - 3

ER -

Pathogen and Antibody Identification in Children with Encephalitis in Myanmar

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