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Volume 21, Number 2—February 2015

Infectious Causes of Encephalitis and Meningoencephalitis in Thailand, 2003–2005

Sonja J. Olsen1Comments to Author , Angela P. Campbell1, Krongkaew Supawat, Sahas Liamsuwan, Tawee Chotpitayasunondh, Somsak Laptikulthum, Akravudh Viriyavejakul, Tasanee Tantirittisak, Supoch Tunlayadechanont, Anannit Visudtibhan, Punnee Vasiknanonte, Supachai Janjindamai, Pairoj Boonluksiri, Kiatsak Rajborirug, Veerachai Watanaveeradej, Nino Khetsuriani, Scott F. Dowell, and Thailand Encephalitis Surveillance Team
Author affiliations: Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell); Thailand Ministry of Health, Nonthaburi (K. Supawat); Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh); Rajvithi Hospital, Bangkok (S. Laptikulthum); Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak); Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan); Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai); Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug); Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)

Main Article

Table 3

Final classification of cases of encephalitis into etiologic category Thailand, 2003–2005*

Etiologic classification category Total
Adenovirus 0 0 7† 7
Bartonella henselae 0 0 0 0
Chikungunya virus 0 0 0 0
Cryptococcus spp. 3 0 0 3
Dengue virus 2 0 0 2
Epstein-Barr virus 0 3 0 3
Enteroviruses 6‡ 0 24§ 30
Escherichia coli 1 0 0 1
Herpes simplex virus 1/2 1 0 0 1
Human herpesvirus 6 0 0 0 0
Human herpesvirus 7 0 0 1 1
Haemophilus influenzae 3 0 0 3
HIV 0 0 8 8
Influenza viruses 0 1 5 6
Japanese encephalitis virus# 15 6 0 21
Malaria 0 0 0 0
Measles virus 0 0 10 10
Mumps virus 0 0 8 8
Mycoplasma pneumoniae 0 3 1 4
Nipah virus 0 0 0 0
Neisseria meningitidis 1 0 0 1
Other bacteria 0 0 21** 21
Orientia tsutsugamushi (scrub typhus) 0 6 0 6
Parainfluenza viruses 1,2,3 0 0 5 5
Parasites, other 0 0 0 0
Rabies virus 0 0 1†† 1
Rickettsia conorii (spotted fever) 0 3 0 3
Rubella 0 0 4 4
Salmonella group D 1 0 0 1
Streptococcus pneumoniae 3 0 0 3
Treponema pallidum 0 1‡‡ 0 1
Varicella-zoster virus 2 0 0 2
West Nile virus 0 0 0 0
Total no. pathogens detected 38 23 95 156
Total no. patients 37 17 44 98

*Strategy used is same as that shown in Table 1. Pathogen categories are not mutually exclusive.
†Only 1 in a cerebrospinal fluid sample was positive by PCR and it was adenovirus type 40.
‡Echovirus 9 (n = 3); echovirus 27 (n = 2); echovirus 30 (1).
§Enterovirus 71 (n = 3); enterovirus, untyped (n = 21).
Not typed.
#This number is 1 less confirmed Japanese encephalitis case than previously published (29). The excluded patient had onset of neurologic symptoms 18 d after hospital admission.
**See Table 2 for organisms, excludes coagulase-negative Staphylococcus.
††Record says never vaccinated.
‡‡Serum Venereal Disease Research Laboratory testing only.

Main Article

  1. Glaser  CA, Gilliam  S, Schnurr  D. Forghani B, Honarmand S, Khetsuriani N, et al. In search of encephalitis etiologies: diagnostic challenges in the California Encephalitis Project, 1998–2000. Clin Infect Dis. 2003;36:731–42. PMID: 12627357
  2. Lewis  P, Glaser  CA. Encephalitis. Pediatr Rev. 2005;26:35363. DOIPubMedGoogle Scholar
  3. Roos  KL. Encephalitis. Neurol Clin. 1999;17:81333. DOIPubMedGoogle Scholar
  4. Solomon  T. Exotic and emerging viral encephalitides. Curr Opin Neurol. 2003;16:4118 . DOIPubMedGoogle Scholar
  5. Whitley  RJ, Gnann  JW. Viral encephalitis: familiar infections and emerging pathogens. Lancet. 2002;359:50713. DOIPubMedGoogle Scholar
  6. Mailles  A, Stahl  JP. Infectious encephalitis in France in 2007: a national prospective study. Clin Infect Dis. 2009;49:183847. DOIPubMedGoogle Scholar
  7. Granerod  J, Ambrose  HE, Davies  NW. Clewley JP, Walsh AL, Morgan D, et al. Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis. 2010;10:835–44.
  8. Tan  LV, Phan  TQ, Do  QH. Nguyen BH, Lam QB, Bach V, et al. Viral etiology of encephalitis in children in southern Vietnam: results of a one-year prospective descriptive study. PLoS Negl Trop Dis. 2010;4:e854.
  9. Ho Dang Trung  N, Le Thi Phuong  T, Wolbers  M. Nguyen Van Minh H, Nguyen Thanh V, Van MP, et al. Aetiologies of central nervous system infection in Viet Nam: a prospective provincial hospital-based descriptive surveillance study. PLoS ONE. 2012;7:e37825.
  10. Chokephaibulkit  K, Kankirawatana  P, Apintanapong  S. Pongthapisit V, Yoksan S, Kositanont U, et al. Viral etiologies of encephalitis in Thai children. Pediatr Infect Dis J. 2001;20:216–8.
  11. Lee  TC, Tsai  CP, Yuan  CL. Wei CY, Tsao WL, Lee RJ, et al. Encephalitis in Taiwan: a prospective hospital-based study. Jpn J Infect Dis. 2003;56:193–9.
  12. Srey  VH, Sadones  H, Ong  S. Mam M, Yim C, Sor S, et al. Etiology of encephalitis syndrome among hospitalized children and adults in Takeo, Cambodia, 1999–2000. Am J Trop Med Hyg. 2002;66:200–7.
  13. Cam  BV, Fonsmark  L, Hue  NB, Phuong  NT, Poulsen  A, Heegaard  ED. Prospective case–control study of encephalopathy in children with dengue hemorrhagic fever. Am J Trop Med Hyg. 2001;65:84851 .PubMedGoogle Scholar
  14. Kankirawatana  P, Chokephaibulkit  K, Puthavathana  P, Yoksan  S, Apintanapong  S, Pongthapisit  V. Dengue infection presenting with central nervous system manifestation. J Child Neurol. 2000;15:5447. DOIPubMedGoogle Scholar
  15. Solomon  T, Dung  NM, Vaughn  DW. Kneen R, Thao LT, Raengsakulrach B, et al. Neurological manifestations of dengue infection. Lancet. 2000;355:1053–9.
  16. Ho  M, Chen  ER, Hsu  KH. Twu SJ, Chen KT, Tsai SF, et al. An epidemic of enterovirus 71 infection in Taiwan. Taiwan Enterovirus Epidemic Working Group. N Engl J Med. 1999;341:929–35.
  17. Lam  SK, Chua  KB. Nipah virus encephalitis outbreak in Malaysia. Clin Infect Dis. 2002;34(Suppl 2):S4851. DOIPubMedGoogle Scholar
  18. Chan  KP, Goh  KT, Chong  CY, Teo  ES, Lau  G, Ling  AE. Epidemic hand, foot and mouth disease caused by human enterovirus 71, Singapore. Emerg Infect Dis. 2003;9:7885. DOIPubMedGoogle Scholar
  19. Rao  BL, Basu  A, Wairagkar  NS. Gore MM, Arankalle VA, Thakare JP, et al. A large outbreak of acute encephalitis with high fatality rate in children in Andhra Pradesh, India, in 2003, associated with Chandipura virus. Lancet. 2004;364:869–74.
  20. Hsu  VP, Hossain  MJ, Parashar  UD. Ali MM, Ksiazek TG, Kuzmin I, et al. Nipah virus encephalitis reemergence, Bangladesh. Emerg Infect Dis. 2004;10:2082–7.
  21. Ho  M. Enterovirus 71: the virus, its infections and outbreaks. J Microbiol Immunol Infect. 2000;33:20516 .PubMedGoogle Scholar
  22. Tu  PV, Thao  NT, Perera  D. Huu TK, Tien NT, Thuong TC, et al. Epidemiologic and virologic investigation of hand, foot, and mouth disease, southern Vietnam, 2005. Emerg Infect Dis. 2007;13:1733–41.
  23. Zhang  Y, Tan  XJ, Wang  HY. Yan DM, Zhu SL, Wang DY, et al. An outbreak of hand, foot, and mouth disease associated with subgenotype C4 of human enterovirus 71 in Shandong, China. J Clin Viro.l 2009; 44:262–7. PMID: 19269888 DOIGoogle Scholar
  24. Venkatesan  A, Tunkel  AR, Bloch  KC. Lauring AS, Sejvar J, Bitnun A, et al. Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the International Encephalitis Consortium. Clin Infect Dis. 2013;57:1114–28. PMID: 23861361 DOIGoogle Scholar
  25. Tunkel  AR, Glaser  CA, Bloch  KC. Sejvar JJ, Marra CM, Roos KL, et al. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2008;47:303–27. PMID:18582201 DOIGoogle Scholar
  26. Khetsuriani  N, Holman  RC, Anderson  LJ. Burden of encephalitis-associated hospitalizations in the United States, 1988–1997. Clin Infect Dis. 2002;35:17582. DOIPubMedGoogle Scholar
  27. Khetsuriani  N, Tong  S, Lu  X. Reed S, Erdman D, Campbell A, et al. Systemic infection with enteric adenovirus in immunocompetent child with Haemophilus influenzae disease. Emerg Infect Dis. 2009;15:355–7.
  28. Chunsuttiwat  S, Warachit  P. Japanese encephalitis in Thailand. Southeast Asian J Trop Med Public Health. 1995;26(Suppl 3):436.PubMedGoogle Scholar
  29. Olsen  SJ, Supawat  K, Campbell  AP. Anantapreecha S, Liamsuwan S, Tunlayadechanont S, et al. Japanese encephalitis virus remains an important cause of encephalitis in Thailand. Int J Infect Dis. 2010;14:e888–92.
  30. Saisongkorh  W, Rolain  JM, Suputtamongkol  Y, Raoult  D. Emerging Bartonella in humans and animals in Asia and Australia. J Med Assoc Thai. 2009;92:70731 .PubMedGoogle Scholar
  31. Na-Bangchang  K, Congpuong  K. Current malaria status and distribution of drug resistance in East and Southeast Asia with special focus to Thailand. Tohoku J Exp Med. 2007;211:99113. DOIPubMedGoogle Scholar
  32. Luby  SP, Gurley  ES, Hossain  MJ. Transmission of human infection with Nipah virus. Clin Infect Dis. 2009;49:17438 .DOIPubMedGoogle Scholar
  33. Wacharapluesadee  S, Boongird  K, Wanghongsa  S. Ratanasetyuth N, Supavonwong P, Saengsen D, et al. A longitudinal study of the prevalence of Nipah virus in Pteropus lylei bats in Thailand: evidence for seasonal preference in disease transmission. Vector Borne Zoonotic Dis. 2010;10:183–90.
  34. Palacios  G, Oberste  MS. Enteroviruses as agents of emerging infectious diseases. J Neurovirol. 2005;11:42433 and. DOIPubMedGoogle Scholar
  35. Lum  LC, Lam  SK, Choy  YS, George  R, Harun  F. Dengue encephalitis: a true entity? Am J Trop Med Hyg. 1996;54:2569 .PubMedGoogle Scholar
  36. Rajapakse  S, Rodrigo  C, Fernando  D. Scrub typhus: pathophysiology, clinical manifestations and prognosis. Asian Pac J Trop Med. 2012;5:261–4.
  37. 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;191:2347. DOIPubMedGoogle Scholar
  38. Bitnun  A, Ford-Jones  EL, Petric  M. MacGregor D, Heurter H, Nelson S, et al. Acute childhood encephalitis and Mycoplasma pneumoniae. Clin Infect Dis. 2001;32:1674–84. PMID: 11360206
  39. Christie  LJ, Honarmand  S, Talkington  DF. Gavali SS, Preas C, Pan CY, et al. Pediatric encephalitis: what is the role of Mycoplasma pneumoniae? Pediatrics. 2007;120:305–13.
  40. 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;54:899904 .DOIPubMedGoogle Scholar

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1These authors contributed equally to this article.

2Members are listed at the end of this article.

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