Japanese Encephalitis Differential Diagnoses

  • Author: Asim A Jani, MD, MPH, FACP; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 6, 2012
 
 

Diagnostic Considerations

Serologic cross-reactivity among other viruses, specifically dengue and West Nile virus, may lead to confusion in the diagnostic evaluation of Japanese encephalitis (especially in tropical Asian regions).

Noninfectious conditions to consider in the differential diagnosis of Japanese encephalitis include the following:

  • CNS lupus erythematosus
  • CNS tumors (nonmetastatic)
  • Cerebrovascular diseases

Bacterial infections to consider in the differential diagnosis of Japanese encephalitis include the following:

  • Pyogenic focal brain abscess
  • Tuberculous meningitis
  • Mycoplasma meningitis
  • Ehrlichiosis
  • Typhoid fever
  • Tuberculosis
  • Rocky Mountain spotted fever

Viral infections to consider in the differential diagnosis of Japanese encephalitis include the following:

Fungal infections, toxoplasmosis, and malaria should also be considered in the differential diagnosis.

See the following for more information:

Differential Diagnoses

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Contributor Information and Disclosures
Author

Asim A Jani, MD, MPH, FACP  Clinician-Educator and Epidemiologist, Consultant and Senior Physician, Florida Department of Health; Diplomate, Infectious Diseases, Internal Medicine and Preventive Medicine

Asim A Jani, MD, MPH, FACP is a member of the following medical societies: American Association of Public Health Physicians, American College of Physicians, American College of Preventive Medicine, American Medical Association, American Public Health Association, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Joseph F John Jr, MD, FACP, FIDSA, FSHEA Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Alexander J Kallen, MD Instructor of Medicine, Department of Internal Medicine, Division of Outcomes Research, Dartmouth Medical School, Veterans Affairs Medical Center of White River Junction, VT

Alexander J Kallen, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, California Medical Association, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Klaus-Dieter Lessnau, MD, FCCP Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Sepracor None None

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

  1. Vazquez A, Jimenez-Clavero M, Franco L, et al. Usutu virus: potential risk of human disease in Europe. Euro Surveill. Aug 4 2011;16(31):[Medline].

  2. Ravi V, Taly AB, Shankar SK, Shenoy PK, Desai A, Nagaraja D, et al. Association of Japanese encephalitis virus infection with Guillain-Barré syndrome in endemic areas of south India. Acta Neurol Scand. Jul 1994;90(1):67-72. [Medline].

  3. Kuwayama M, Ito M, Takao S, Shimazu Y, Fukuda S, Miyazaki K, et al. Japanese encephalitis virus in meningitis patients, Japan. Emerg Infect Dis. Mar 2005;11(3):471-3. [Medline].

  4. Unni SK, Ružek D, Chhatbar C, Mishra R, Johri MK, Singh SK. Japanese encephalitis virus: from genome to infectome. Microbes Infect. Apr 2011;13(4):312-21. [Medline].

  5. Hanna JN, Ritchie SA, Phillips DA, Shield J, Bailey MC, Mackenzie JS, et al. An outbreak of Japanese encephalitis in the Torres Strait, Australia, 1995. Med J Aust. Sep 2 1996;165(5):256-60. [Medline].

  6. Kumar R, Tripathi P, Singh S, Bannerji G. Clinical features in children hospitalized during the 2005 epidemic of Japanese encephalitis in Uttar Pradesh, India. Clin Infect Dis. Jul 15 2006;43(2):123-31. [Medline].

  7. Richman DD, Whitley RJ, Hayden FG. Clinical Virology. New York, NY: Churchill Livingstone; 1997.

  8. Solomon T, Thao LT, Dung NM, Kneen R, Hung NT, Nisalak A, et al. Rapid diagnosis of Japanese encephalitis by using an immunoglobulin M dot enzyme immunoassay. J Clin Microbiol. Jul 1998;36(7):2030-4. [Medline]. [Full Text].

  9. Hoke CH Jr, Vaughn DW, Nisalak A, Intralawan P, Poolsuppasit S, Jongsawas V, et al. Effect of high-dose dexamethasone on the outcome of acute encephalitis due to Japanese encephalitis virus. J Infect Dis. Apr 1992;165(4):631-7. [Medline].

  10. Harinasuta C, Nimmanitya S, Titsyakorn U. The effect of interferon-alpha A on two cases of Japanese encephalitis in Thailand. Southeast Asian J Trop Med Public Health. Jun 1985;16(2):332-6. [Medline].

  11. Solomon T, Dung NM, Wills B, Kneen R, Gainsborough M, Diet TV, et al. Interferon alfa-2a in Japanese encephalitis: a randomised double-blind placebo-controlled trial. Lancet. Mar 8 2003;361(9360):821-6. [Medline].

  12. Lee E, Pavy M, Young N, Freeman C, Lobigs M. Antiviral effect of the heparan sulfate mimetic, PI-88, against dengue and encephalitic flaviviruses. Antiviral Res. Jan 2006;69(1):31-8. [Medline].

  13. Saxena SK, Mathur A, Srivastava RC. Inhibition of Japanese encephalitis virus infection by diethyldithiocarbamate is independent of its antioxidant potential. Antivir Chem Chemother. Mar 2003;14(2):91-8. [Medline].

  14. Swarup V, Ghosh J, Mishra MK, Basu A. Novel strategy for treatment of Japanese encephalitis using arctigenin, a plant lignan. J Antimicrob Chemother. Mar 2008;61(3):679-88. [Medline].

  15. Yang SE, Pan MJ, Tseng HF, Liau MY. The efficacy of mouse-brain inactivated Nakayama strain Japanese encephalitis vaccine--results from 30 years experience in Taiwan. Vaccine. Mar 24 2006;24(14):2669-73. [Medline].

  16. Harakuni T, Kohama H, Tadano M, et al. Mucosal vaccination approach against mosquito-borne Japanese encephalitis virus. Jpn J Infect Dis. Jan 2009;62(1):37-45. [Medline].

  17. Yang DK, Kweon CH, Kim BH, Hwang IJ, Kang MI, So BJ, et al. The seroprevalence of Japanese encephalitis virus in goats raised in Korea. J Vet Sci. Jun 2007;8(2):197-9. [Medline]. [Full Text].

  18. Solomon T, Thao TT, Lewthwaite P, Ooi MH, Kneen R, Dung NM, et al. A cohort study to assess the new WHO Japanese encephalitis surveillance standards. Bull World Health Organ. Mar 2008;86(3):178-86. [Medline]. [Full Text].

  19. Schiøler KL, Samuel M, Wai KL. Vaccines for preventing Japanese encephalitis. Cochrane Database Syst Rev. Jul 18 2007;CD004263. [Medline].

  20. Thongtan T, Cheepsunthorn P, Chaiworakul V, Rattanarungsan C, Wikan N, Smith DR. Highly permissive infection of microglial cells by Japanese encephalitis virus: a possible role as a viral reservoir. Microbes Infect. Jan 2010;12(1):37-45. [Medline].

 
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Geographic distribution of Japanese encephalitis. Courtesy of the CDC.
Japanese encephalitis, 2006. Courtesy of the WHO.
 
 
 
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