Objective

Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS), the second most common encephalopathy syndrome in Japan, is most often associated with viral infection. Bacterial MERS has been rarely reported but is mostly associated with acute focal bacterial nephritis (AFBN) for an unknown reason. We examined cytokines and chemokines in four MERS patients with AFBN to determine if they play an important role in the pathogenesis.

Methods

We examined the clinical charts and MRI results in four MERS patients with AFBN, and measured 10 cytokines and chemokines in serum and cerebrospinal fluid in the acute phase. These were analyzed using the Mann-Whitney U test, compared with the control group (cases with a non-inflammatory neurological disease). Longitudinal changes in the serum cytokine and chemokine levels were evaluated in two patients.

Results

Hyponatremia was observed in all four patients with MERS associated with AFBN (128–134 mEq/L). CSF analysis revealed increased cytokines/chemokines associated with Th1 (CXCL10, TNF-α, IFN-γ), T reg (IL-10), Th17 (IL-6), and neutrophil (IL-8 and CXCL1). In serum, upregulation was observed in those associated with Th1 (CXCL10, TNF-α, IFN-γ), Th17 (IL-6), and inflammasome (IL-1ß). The increased serum cytokines/chemokines in the acute stage normalized within 2 weeks in patients 1 and 2, so examined, in accordance with their clinical improvement.

Conclusion

Increased cytokines/chemokines and hyponatremia may be factors that explain why AFBN is likely to cause MERS.

中文翻译：

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增加的细胞因子/趋化因子和低钠血症是临床轻度脑炎/脑病的可能原因，伴有与急性局灶性细菌性肾炎相关的可逆脾损伤

客观的

临床轻度脑炎/伴有可逆性脾损伤 (MERS) 的脑病是日本第二常见的脑病综合征，最常与病毒感染有关。细菌性 MERS 很少见报道，但主要与急性​​局灶性细菌性肾炎 (AFBN) 相关，原因不明。我们检查了四名患有 AFBN 的 MERS 患者的细胞因子和趋化因子，以确定它们是否在发病机制中起重要作用。

方法

我们检查了 4 名患有 AFBN 的 MERS 患者的临床图表和 MRI 结果，并在急性期测量了血清和脑脊液中的 10 种细胞因子和趋化因子。与对照组（患有非炎症性神经系统疾病的病例）相比，这些使用 Mann-Whitney U检验进行了分析。在两名患者中评估了血清细胞因子和趋化因子水平的纵向变化。

结果

在所有 4 名与 AFBN 相关的 MERS (128–134 mEq/L) 患者中均观察到低钠血症。CSF 分析显示与 Th1（CXCL10、TNF-α、IFN-γ）、T reg (IL-10)、Th17 (IL-6) 和中性粒细胞（IL-8 和 CXCL1）相关的细胞因子/趋化因子增加。在血清中，在与 Th1（CXCL10、TNF-α、IFN-γ）、Th17（IL-6）和炎性体（IL-1ß）相关的那些中观察到上调。患者 1 和 2 在急性期增加的血清细胞因子/趋化因子在 2 周内恢复正常，因此根据其临床改善情况进行了检查。

结论

增加的细胞因子/趋化因子和低钠血症可能是解释为什么 AFBN 可能导致 MERS 的因素。