The Effect of a Combined Ganciclovir, Methylprednisolone, and Immunoglobulin Regimen on Survival and Functional Outcomes in Patients With Japanese Encephalitis

Wang Miao; Junshuang Guo; Shuyu Zhang; Nannan Shen; Xiaoping Shang; Furong Liu; Warren Lu; Jianghai Xu; Junfang Teng

doi:10.3389/fneur.2021.711674

The Effect of a Combined Ganciclovir, Methylprednisolone, and Immunoglobulin Regimen on Survival and Functional Outcomes in Patients With Japanese Encephalitis

Front Neurol. 2021 Nov 4:12:711674. doi: 10.3389/fneur.2021.711674. eCollection 2021.

Authors

Wang Miao¹, Junshuang Guo¹, Shuyu Zhang¹, Nannan Shen¹, Xiaoping Shang², Furong Liu², Warren Lu³, Jianghai Xu⁴, Junfang Teng¹

Affiliations

¹ Neuro-Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
² Department of Medical Records Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
³ Department of Biology, New York University, New York, NY, United States.
⁴ Third Department of Infectious Diseases, Anyang Fifth People's Hospital, Anyang, China.

Abstract

Objective: There is currently no effective treatment for Japanese encephalitis, which has a high rate of morbidity and mortality. This study assessed the effectiveness of a ganciclovir, methylprednisolone, and immunoglobulin combination (TAGMIC) therapy in decreasing cognitive impairment and mortality among patients with Japanese encephalitis. Methods: We retrospectively assessed the clinical data of 31 patients diagnosed with Japanese encephalitis, who were admitted to an intensive care unit. Patients were divided into the TAGMIC and non-TAGMIC group according to their treatment regime. We compared the 60-day, 6-month, and overall mortality and survival curves between groups. We also compared Barthel Index scores, Montreal Cognitive Assessment (MoCA) scores, and diffusion tensor imaging (DTI) results. Results: There was no significant difference in the 30-day mortality rate or Kaplan-Meier survival curve between groups. The 60-day, 6-month, and overall mortality rates in the TAGMIC group were significantly reduced (P = 0.043, P = 0.018, and P = 0.018, respectively) compared with the non-TAGMIC group (0, 0, 0 vs. 31.25, 37.5, 37.5%, respectively). The 60-day, 6-month, and overall Kaplan-Meier survival curves were significantly different between groups (P = 0.020, P = 0.009, P = 0.009, respectively). There was no significant difference in the Barthel Index scores of surviving patients. Among the five patients who underwent MoCA and DTI, four had a score of 0/5 for delayed recall (no cue), while the remaining patient had a score of 2/5. All five patients were able to achieve a score of 5/5 with classification and multiple-choice prompts, and had sparse or broken corpus callosum (or other) fibre bundles. Conclusion: TAGMIC treatment can reduce mortality due to severe Japanese encephalitis. The memory loss of surviving patients is mainly due to a disorder of the memory retrieval process, which may be related to the breakage of related fibre bundles.

Keywords: Japanese encephalitis; combined regimen; ganciclovir; immunoglobulin; methylprednisolone.