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- Title
Neuronal infection is a major pathogenetic mechanism and cause of fatalities in human acute Nipah virus encephalitis.
- Authors
Ong, Kien Chai; Ng, Khong Ying; Ng, Chiu Wan; Tan, Soon Hao; Teo, Woon Li; Karim, Norain; Kumar, Shalini; Wong, Kum Thong
- Abstract
Objectives: Acute Nipah (NiV) encephalitis is characterised by a dual pathogenetic mechanism of neuroglial infection and ischaemia–microinfarction associated with vasculitis‐induced thrombotic occlusion. We investigated the contributions of these two mechanisms in fatal cases. Materials and methods: We analysed brain tissues (cerebrum, brainstem and cerebellum) from 15 autopsies using light microscopy, immunohistochemistry (IHC), in situ hybridisation and quantitative methods. Results: Three types of discrete plaque‐like parenchymal lesions were identified: Type 1 with neuroglial IHC positivity for viral antigens and minimal or no necrosis; Type 2 with neuroglial immunopositivity and necrosis; and Type 3 with necrosis but no viral antigens. Most viral antigen/RNA‐positive cells were neurons. Cerebral glial immunopositivity was rare, suggesting that microinfarction played a more important role in white matter injury. Type 1 lesions were also detected in the brainstem and cerebellum, but the differences between cerebral cortex and these two regions were not statistically significant. In the cerebral cortex, Type 1 lesions overwhelmingly predominated, and only 14% Type 1 vs 69% Type 2 lesions were associated with thrombosis. This suggests that neuronal infection as a mechanism of pathogenesis was more important than microinfarction, both in general and in Type 1 lesions in particular. Between the 'early' group (<8‐day fever) and the 'late' group (≥8‐day fever), there was a decrease of Type 1 and Type 2 lesions with a concomitant increase of Type 3 lesions, suggesting the latter possibly represented late‐stage microinfarction and/or neuronal infection. Conclusion: Neuronal infection appears to play a more important role than vasculopathy‐induced microinfarction in acute NiV encephalitis.
- Subjects
ENCEPHALITIS viruses; NIPAH virus; VIRAL antigens; CEREBRAL cortex; WHITE matter (Nerve tissue); JAPANESE encephalitis viruses; BRAIN stem
- Publication
Neuropathology & Applied Neurobiology, 2022, Vol 48, Issue 6, p1
- ISSN
0305-1846
- Publication type
Article
- DOI
10.1111/nan.12828