May early intervention with high dose intravenous immunoglobulin pose a potentially successful treatment for severe cases of tick-borne encephalitis?

BMC Infectious Diseases

Hans Helmut Niller²  Gerhard Dobler¹  Daniel Růžek³ 

[1] Department of Microbiology of the German Armed Forces, Neuherbergstr. 11, D-80937 Munich, Germany;Institute for Medical Microbiology and Hygiene, University of Regensburg, Franz-Josef-Strauss Allee: 11, 93053 Regensburg, Germany;Department of Virology, Veterinary Research Institute, Hudcova: 70, CZ-62100 Brno, Czech Republic

关键词: T2-weighted hyper intensity;    Tick-borne encephalitis;    TBE;    Neopterin;    Macrophage;    MRI;    Inflammation;    T-cell;    Arboviruses;   

Others  :  1147176
DOI  :  10.1186/1471-2334-13-306

 received in 2013-03-05, accepted in 2013-07-02,  发布年份 2013

【 摘 要 】

Background

Arthropod-borne viral encephalitis of diverse origins shows similar clinical symptoms, histopathology and magnetic resonance imaging, indicating that the patho mechanisms may be similar. There is no specific therapy to date. However, vaccination remains the best prophylaxis against a selected few. Regardless of these shortcomings, there are an increasing number of case reports that successfully treat arboviral encephalitis with high doses of intravenous immunoglobulins.

Discussion

To our knowledge, high dose intravenous immunoglobulin has not been tested systematically for treating severe cases of tick-borne encephalitis. Antibody-dependent enhancement has been suspected, but not proven, in several juvenile cases of tick-borne encephalitis. Although antibody-dependent enhancement during secondary infection with dengue virus has been documented, no adverse effects were noticed in a controlled study of high dose intravenous immunoglobulin therapy for dengue-associated thrombocytopenia. The inflammation-dampening therapeutic effects of generic high dose intravenous immunoglobulins may override the antibody-dependent enhancement effects that are potentially induced by cross-reactive antibodies or by virus-specific antibodies at sub-neutralizing levels.

Summary

Analogous to the increasing number of case reports on the successful treatment of other arboviral encephalitides with high dose intravenous immunoglobulins, we postulate whether it may be possible to also treat severe cases of tick-borne encephalitis with high dose intravenous immunoglobulins as early in the course of the disease as possible.

【 授权许可】

   
2013 Růžek et al.; licensee BioMed Central Ltd.

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