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Practical progression in the clinical management of neuroinfections and related diseases in Japan
Author(s) -
Kamei Satoshi
Publication year - 2021
Publication title -
neurology and clinical neuroscience
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.125
0ISSN - 2049-4173
DOI - 10.1111/ncn3.12442
Subject(s) - medicine , foscarnet , aciclovir , encephalitis , gold standard (test) , meningitis , disease , intensive care medicine , herpes simplex virus , immunology , virus , virology , pathology , pediatrics , viral disease , herpesviridae
Neuroinfections and related diseases are a life‐threatening disease. The practical progression of the clinical management in these diseases in Japan was reviewed. The guidelines for the clinical management of bacterial meningitis in Japan were published in 2014 which were established based on the current knowledge of microbiological evidence in Japan. The guidelines for the clinical management of herpes simplex virus encephalitis (HSVE) in Japan were also published in 2017. Aciclovir should be initiated in all patients with suspected encephalitis. Polymerase chain reaction (PCR) for HSVE has high sensitivity and specificity and is the gold standard diagnostic tool. However, when the negative result of PCR is obtained at the acute stage with the highly suspicious patients with HSVE, our clinical guidelines recommend to continuing aciclovir and repeating PCR. The viral resistance to aciclovir has been reported. In the case of aciclovir‐nonresponding and treatment‐resistant patients, an alternative treatment with foscarnet is recommended. Autoimmune encephalitis (AIE) is considered one of the most common causes of noninfectious acute encephalitis. As a series of anti‐neuronal surface antibodies (NSAs) were found, the diagnostic approach to AIE has undergone a paradigm shift. Different techniques are currently available to detect NSAs: tissue‐based assays (TBAs) with rodent brain sections, cell‐based assays (CBAs), and assays for primary cultured neurons of rodent. The diagnosis of AIE in Japan could previously be delayed owing to limited access to specialized laboratory; the assay system used by TBAs and CBAs for AIE was established and started to use in Japan since 2019.