• Investigative Magnetic Resonance Imaging
• /
• v.23 no.1
• /
• pp.65-69
• /
• 2019

Ramsay Hunt syndrome with the complication of encephalitis or meningoencephalitis is rarely reported and uncommon in immunocompetent patients. The radiological manifestations of such cases usually involve the cerebellum and brainstem or exhibit the absence of any abnormality. We report a case of a 78-year-old immunocompetent man hospitalized with Ramsay Hunt syndrome, who later developed meningoencephalitis. The cerebrospinal fluid-study excluded other causes of meningoencephalitis, and the clinical diagnosis indicated varicella zoster virus meningoencephalitis. Magnetic resonance imaging revealed increased signal intensities in the bilateral temporal lobe, midbrain, and pons on T2-weighted imaging, and T2 fluid attenuated inversion recovery and contralateral asymmetric pachymeningeal enhancement. Contrast-enhanced T1-weighted imaging revealed ipsilateral facial nerve enhancement.

• Journal of Medicine and Life Science
• /
• v.17 no.3
• /
• pp.98-102
• /
• 2020

Influenza is a common disease that causes epidemics yearly due to the influenza virus. If patients with influenza present with rare symptoms, the diagnosis may be delayed and the condition is difficult to treat. A 5-year-old boy presented to the emergency room with fever and cramps. Brain computed tomography showed low attenuation in the thalamus and brain stem, which was suggestive of encephalopathy caused by influenza virus. Another 5-year-old girl visited the emergency room with mild fever and painful calf edema. She was diagnosed with myositis caused by influenza and treated accordingly.

• Pediatric Infection and Vaccine
• /
• v.8 no.2
• /
• pp.150-159
• /
• 2001

Purpose : We need to reconsider booster vaccination schedule of Japanese encephalitis vaccination. To do that we evaluate the long-term immunogenicity and the incidence of adverse events with inactivated mouse brain derived Nakayama Japanese encephalitis vaccine. Methods : We tested neutalizing antibody for 311 elementary school students by plaque reduction neutralizing test(PRNT) at USAMC-AFRIMS(United States Armed Forces Research Institute of Medical Science/Department of Virology). We evaluated vaccine related adverse events by spontaneous reporting prospectively among 15,487 vaccinees who were vaccinated at public health center and 2,277 elementary school students who were immunized previously by a questionnaire and school health record. Results : According to the time interval from the last booster injection of 311 children, PRNT antibody titers gradually decreased as the interval increased; 239 mIU/mL, 188 mIU/mL, 134 mIU/mL, 49 mIU/mL each at 6, 18, 30, 42 months after the last booster injection. The seropositivity rates were 98%, 99%, 95.6%, 71.4% each at 6, 18, 30, 42 months after the last booster injection. There were 21(0.13%) cases with systemic reactions among 15,487 vaccinees who had visited the hospital by prospective passive reporting system at public health center. According to the questionnaires and school health records in elementary school students, local induration and pain were 17.4% and 14.8%, respectively. Systemic reactions including fever, vomiting, rash were reported in few cases. Conclusion : Biannual booster vaccination that has been recommended so far should not be necessary. Surveillance for adverse events with inactivated mouse brain derived Nakayama vaccine should be strengthened to better assess the number of cases and reactions associated with immunization.

• Pediatric Infection and Vaccine
• /
• v.4 no.1
• /
• pp.116-125
• /
• 1997

Purpose : Studies on the duration of immune response against Japanese encephalitis virus from recipients with JE vaccine (Nakayama-NIH strain) in Korea. Methods : To determinate the immune response and the duration of antibody against JE vaccine, 213 students were examined since 1994 using hemmaglutination inhibition test and plaque reduction neutralization test (PRNT). Results : 24 months after the first vaccination, haemmaglutination inhibition and neutralizing antibody maintained from the recipients 63.4% (>1:20) and 100% (>1:20), respectively. In April 1996, one dose booster to the same recipients those who were vaccinated in 1994, the GMT antibody for HI and PRNT titer were both increased from 1:11.6 to 1:13.2 and 1:275.7 to 1:348.1, respectively, after 6 months booster (after 30 months from the initial vaccination). This results showed that the antibody from the active immunity could be maintained more than 12 months after the initial vaccination. On the basis of these results, inactivated killed JE vaccine (Nakayama-NIH strain) using for preventing against JE purpose seems to produce antibody enough to protect against JE at present. Conclusions : Along with the results of this study demonstrating duration of antibody, the active immunization could be maintained as long as by initial vaccination of 2 doses, a single dose of booster vaccination made during a period of 1 month to 12 months and the successive booster vaccination by 2 or 3 year intervals. However, the immunization schedule should be concerned with both epidemiology of disease and the immune response of vaccinated individuals.

• Clinical and Experimental Pediatrics
• /
• v.45 no.11
• /
• pp.1373-1380
• /
• 2002

Purpose : Acute measles encephalitis(ME) is characterized by an abrupt onset of fever and obtundation, frequently accompanied by seizures and multifocal neurological signs. The aim of this study was to clarify the clinical manifestation, progression and the brain SPECT patterns in patients with acute ME. Methods : This study included 11 children with acute ME admitted to Chonbuk National University Hospital. Ten patients received a first dose of measles vaccine, one patient did not receive a first dose, and no patients received a second dose. ME was diagnosed based on characteristic clinical pictures, measles antibodies by ELISA and abnormal CSF findings. Brain MRI and brain SPECT were performed in 11 patients with acute ME. Results : There were four males and seven females whose ages at onset ranged between 18 months and 14 years(mean : 10.5 years). The main clinical neurologic pictures were loss of consciousness( 10) and seizure(five). The titer of IgG and IgM antimeasles antibodies in serum were positive in 10 patients. In CSF, nine patients had IgG antibodies and one patient had IgM antibodies. The concentration of protein(mean : $124{\pm}60mg/dL$) and WBC counts(mean : $158{\pm}157/{\mu}L$) in CSF were elevated in all patients. In electroencephalographic examination, nine patients showed increased slow waves. Seven of 11 patients(63.6%) revealed high signal intensity on the brain MRI. In contrast, all patients showed hypoperfusion in brain SPECT examination. According to brain SPECT, the perfusion deficits were frequently observed in the frontal lobe(nine), temporal (nine), parietal(eight) and thalamus(eight). Conclusion : Brain SPECT is more sensitive than MRI for the evaluation of brain damage in early stages of acute ME.

• Pediatric Infection and Vaccine
• /
• v.16 no.2
• /
• pp.183-190
• /
• 2009

Purpose : To evaluate the number and severity of adverse reactions after Japanese Encephalitis (JE) vaccination in children using different vaccines (inactivated vaccine or live attenuated vaccine) and to determine the ability and safety of the vaccines to provide effective immunization for JE. Methods : From August 2006 to February 2007, we conducted a prospective cohort study of the adverse reactions associated with JE immunization in Korea. We investigated common adverse reactions during the 4 days following immunization using telephone collaborations with four public health centers and nine pediatric clinics. Results : The mean age of children receiving the inactivated vaccines and live attenuated vaccines, respectively, were 1.4 y (range: 1 to 8.5) and 1.7 y (range: 1 to 8.3). The number of children that received the inactivated vaccines was 425 (64.6%). A total of 233 (35.4%) received the live attenuated vaccines. Fourteen children (3.3%) had more than one localized adverse event with the inactivated vaccine, and six (2.6%) had more than one event with the live attenuated vaccine (P =0.607). Systemic adverse reactions occurred in 5.2% vs. 8.2%, respectively, of these groups (P =0.131). Fever was more common in the live attenuated vaccine group than in the inactivated vaccine group on the day of vaccination (P =0.026). Conclusions : The rate of adverse events in our study was even lower than that previously reported. No significant difference in outcomes between inactivated vaccine and live attenuated vaccine was found in JE-immunized children. Fever was more common in the live attenuated vaccine group than in the inactivated vaccine group on the day of vaccination.

• Korean journal of applied entomology
• /
• v.58 no.2
• /
• pp.89-99
• /
• 2019

In total, 654,362 adult mosquitoes were captured using black light traps in Gangwon-do Province of the Republic of Korea from 2012 to 2017. The collected mosquitoes were identified to the species level, placed in pools of up to 50 mosquitoes each, by species and date of collection, and screened for flaviviruses using a reverse transcription-polymerase chain reaction assay. A total of 276,224 adult mosquitoes were grouped in 7,721 pools for virus testing, and 68 flavivirus positive pools (0.9%) were detected. Flavivirus-positive products were confirmed by DNA sequencing. Japanese encephalitis viruses were detected in single pools collected from Chuncheon (2012, 2017: Culex pipiens, 2,728 and 1,111 mosquitoes, respectively), Hoengseong (2013: Culex orientalis, 19), and Gangneung (2017: C. pipiens, 724). All the Japanese encephalitis viruses detected were revealed as genotype V. Chaoyang viruses were detected in 63 pools of 5,055 Aedes vexans nipponii and a single pool of 585 C. pipiens collected in Gangwon-do Province from 2012 to 2017. Chuncheon was the region with the highest minimum infection rates (MIR, 0.32) and maximum likehood estimate (MLE, 0.33; confidence interval (CI) 95%, 0.23-0.46) of A. vexans nipponii for Chaoyang virus, followed by Hoengseong (MIR 0.30, MLE 0.30, CI 0.16-0.52) and Gangneung (MIR 0.21, MLE 0.21, CI 0.13-0.31). Monthly MIR and MLE values of A. vexans nipponii for Chaoyang virus were the highest in October (MIR 0.38, MLE 0.38, CI 0.07-1.25).

• Journal of Microbiology
• /
• v.42 no.1
• /
• pp.25-31
• /
• 2004

Sf9 cells have obvious advantages for the conventional production technology of vaccine. They are useful tools for high concentration and large-scale cultures. Sf9 cells were grown to maximal concentration, 8${\times}$l0$\^$6/ cells/$m\ell$ in a 500$m\ell$ spinner flask, with a doubling time at the exponentially growing phase of 24.5 hours, using serum-free media. To explore the ability of Sf9 cells to be infected by the Japanese encephalitis (JE) virus Beijing-l strain, Sf9 cells were infected with the virus. By 4-5 days post-infection, 10-15 % of the Sf9 cells showed cytopathic effect (CPE), from granularity to the formation of syncytia and multinucleated giant cells continuously observed over a period of 35 days. Positive fluorescent reactions were detected in 30-40% of cells infected with the JE virus Beijing-l strain, and the uninfected Sf9 cells were completely negative. Virus particles, propagated in Sf9 and Vero cells, were concentrated by sedimentation on 40% trehalose cushions by ultracentrifugation, and showed identical patterns of viral morphogenesis. Complete virus particles, 40 to 50 nm in diameter, were observed, and JE virus envelope (E) proteins, at 53 kDa, were found in the western blot analysis to the anti-JE virus E protein monoclonal antibody and reacted as a magenta band in the same position to the glycoprotein staining. To evaluate whether the infectious virus was produced in Sf9 cells inoculated with the JE virus Beijing-l stain, Sf9 cells were inoculated with the virus, and sample harvested every 5 days. The titers of the JE virus Beijing-l strain rose from 1.0${\times}$l0$\^$5/ to 1.5${\times}$l0$\^$6/ pfu/$m\ell$. The infected Sf9 cells could be subcultured in serum-free medium, with no change in the plaque sizes formed by the JE virus Beijing-l strain in the plaque assay. It is suggested that the ability of the JE virus Beijing-l strain to infect Sf9 cells in serum-free media will provide a useful insect cell system, where the JE virus replication, cytopathogenicity and vaccine immunogen can be studied.

• Journal of Preventive Medicine and Public Health
• /
• v.7 no.2
• /
• pp.403-415
• /
• 1974

The author has investigated epidemiological features of human cases of epidemic encephalitis (E. E.) in the Republic of Korea and the status of antibody requisition in pre-and post-epidemic time. And virological and serological studies with regarding the relationship of E. E. infection between human and piglet, and field survey against its vector by means of virus isolation from mosquitoes were carried out. Finally, vaccine field trial against human population has also been evaluated in order to confirm its effectiveness. The results of the studies are summarized as follows : 1. The annual incidence of reported cases during the past 25 years (1949-1973) in the Republic of Korea has shown two patterns, one was typical cyclic incidence and the other one was irregular. Annual average morbidity and mortality rate per 100,000 population were 5.7 and 2.1 and fatality rate was 34.6% in typical cyclic years. 2. With regard to the geographical distribution of E. E., the province of Jeolla-Bug-Do illustrated the highest incidence regardless of the epidemic size. 3. The main epidemic period was between mid-August and mid-September (above 90% of the total number of cases). The first case was reported in middle of July and the epidemic ceased in late of October. 4. An analysis of the age distribution of cases of E. E., has shown that above 90% of the total cases occurred in the age groups under 14 years and it was noted that about its 54% were occurred in the age groups between 5-9 years group. 5. Through the Haemagglutination Inhibition (H-I) test for the laboratory diagnosis of E. E., it was found that higher H-I antibody titer was usually detected in the convalescent phase, 15 days after onset. 6. The H-I antibody survey against 563 healthy population by age groups during the pre-epidemic season showed that 422(75%) were less than H-I titer, 1:20 and 122(21.7%) were positive H-I titer, 1:20. Among the 94 American in Seoul who had not been in E. E. endemic area previously only one person had appeared sero-conversion as a H-I titer of 1:80 after post-epidemic season. 7. The E. E. virus could be isolated from the mosquitos pools-C, tritaeniorhyncus which were caught between late July and middle August. 8. E.E. Virus was also isolated from piglet blood on early August and H-I antibody conversion was occurred mostly on middle of August. 9. H-I antibody sero-conversion rate reached to high level when vaccine purified by mouse brain tissue inoculated, showing 98.9%. Higher antibody titer was acquired when booster inoculation was performed, Four fold rise of H-I add N-T antibodies was confirmed with 93.2% and 82.1% respectively.

• IMMUNE NETWORK
• /
• v.7 no.2
• /
• pp.66-74
• /
• 2007

Background: The genus Flavivirus consists of many emerging arboviruses, including Dengue virus (DV), Japanese encephalitis virus (JEV) and West Nile virus (WNV). Effective preventive vaccines remain elusive for these diseases. Mice are being increasingly used as the animal model for vaccine studies. However, the pathogenic mechanisms of these viruses are not clearly understood. Here, we investigated the interaction of DV and JEV with murine bone marrow-derived dendritic cells (bmDC). Methods: ELISA and FACS analysis were employed to investigate cytokine production and phenotypic changes of DCs obtained from bone marrow following flavivirus infection. Results: We observed that these viruses altered the cytokine profile and phenotypic markers. Although both viruses belong to the same family, JEV-infected bmDC produced anti-inflammatory cytokine (IL-10) along with pro-inflammatory cytokines, whereas DV infection induced production of large amounts of pro-inflammatory cytokines (IL-6 and TNF-${\alpha}$) and no IL-10 from murine bmDCs. Both flaviviruses also up-regulated the expression of co-stimulatory molecules such as CD40, CD80 and CD86. JEV infection led to down-regulation of MHC II expression on infected bmDCs. We also found that cytokine production induced by JEV and DV is MyD88-dependent. This dependence was complete for DV, as cytokine production was completely abolished in the absence of MyD88. With regard to JEV, the absence of MyD88 led to a partial reduction in cytokine levels. Conclusion: Here, we demonstrate that MyD88 plays an important role in the pathogenesis of flaviviruses. Our study provides insight into the pathogenesis of JEV and DV in the murine model.