Characteristics and therapy of enteroviral encephalitis: case report and systematic literature review

• Published in: International journal of infectious diseases 2021-12, Vol.113, p.93-102
• Main Authors: Wagner, Judith N., Leibetseder, Annette, Troescher, Anna, Panholzer, Juergen, von Oertzen, Tim J.
• Format: Article
• Language: English
• Subjects: Critical care; Encephalitis; Encephalitis, Viral - drug therapy; Enterovirus; Enterovirus Infections - drug therapy; Humans; Immunoglobulins; Immunoglobulins, Intravenous - therapeutic use; Retrospective Studies; Viral infections
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2021.10.002

•Enteroviruses are an important cause of encephalitis in the immunocompromised.•Intravenous immunoglobulin (IVIG) treatment may be considered in these patients.•Serious adverse events seem to be rare with IVIG treatment.•Some data support a high-dose approach (2 g/kg).•Studies should investigate the optimal regimen of IVIG therapy in enteroviral encephalitis. Enterovirus (EV) is a frequent cause of encephalitis. The optimal therapeutic approach remains a matter of debate. We present the case of an immunosuppressed patient with EV encephalitis treated successfully with intravenous immunoglobulin (IVIG) and report the results of a systematic review on the characteristics of EV encephalitis, as well as the safety and efficacy of IVIG therapy. A systematic review was conducted using the PubMed, Cochrane Database, BIOSIS Previews, and ClinicalTrials.gov databases to identify all reports on patients with EV encephalitis as of December 31, 2020. The main outcomes assessed were the efficacy and safety of the respective therapeutic approach. A total of 73 articles were included: one prospective trial, one retrospective and prospective case series, one purely retrospective case series, and 70 case reports. The case reports included a total of 101 patients. Immunosuppressed patients were at higher risk of contracting EV encephalitis and experiencing a fatal course. Hypogammaglobulinaemia particularly predisposes to EV disease, even with a moderate reduction in serum IgG levels. IVIG therapy in the immunosuppressed may confer a survival advantage. IVIG therapy is rarely associated with severe adverse events and may be considered in immunosuppressed patients with EV encephalitis. Future trials should investigate the optimal IVIG dosing and route of application, the benefit of antibody-enriched IVIG preparations, and the serum immunoglobulin level that should trigger prophylactic replacement.