Abstract
Pseudorabies virus (PRV) is known to cause severe encephalitis in juvenile pigs and various non-native hosts; recent evidences suggest that PRV might cause encephalitis in humans. In a multicenter cohort study in China, next-generation sequencing of cerebrospinal fluid (CSF) was performed to detect pathogens in all patients with clinically suspected central nervous system infections. This study involved all the patients whose CSF samples were positive for PRV-DNA; their clinical features were evaluated, and species-specific PCR and serological tests were sequentially applied for validation. Among the 472 patients tested from June 1, 2016, to December 1, 2018, six were positive for PRV-DNA, which were partially validated by PCR and serological tests. Additionally, we retrospectively examined another case with similar clinical and neuroimaging appearance and detected the presence of PRV-DNA. These patients had similar clinical manifestations, including a rapid progression of panencephalitis, and similar neuroimaging features of symmetric lesions in the basal ganglia and bilateral hemispheres. Six of the patients were engaged in occupations connected with swine production. PRV infection should be suspected in patients with rapidly progressive panencephalitis and characteristic neuroimaging features, especially with exposure to swine.
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Acknowledgments
The authors thank the patients for participating in this study.
Funding
This study was funded by the National Key Research and Development Program of China (Grant No. 2016YFC0901502) and National Science and Technology Major Project of China (Grant No.2018ZX10305409–001-001).
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Contributions
HG and SF contributed to the study conception design. SF, HY, LL, HL, SW, WZ, YW, YF, YL, XQ, GL, DW, HR, YZ, BP, LC, PW, JW, and HG collected the clinical data. LL, JW, and DW examined and treated Case 4 in 2011. HW, YG, and YL performed NGS, bioinformatics analysis, and PCR. YL, JH, WZ, and PC performed pseudorabies virus antibody detection. SF, LL, JW, and HG analyzed the clinical data. SF wrote the first draft of the manuscript after discussions with HG. HW, YG, and YL wrote portions of the methods section. All authors contributed to manuscript revision and have read and approved the submitted version.
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This study was approved by the Institutional Review Board of Peking Union Medical College Hospital (PUMCH) (IRB no. JS-890). The use of the patients’ clinical data and CSF samples was approved by the Ethics Committee of PUMCH. Written informed consent was obtained from each patient or their legal surrogate in accordance with the Declaration of Helsinki.
Conflict of interest
Authors Honglong Wu, Yanping Gong, and Zhenzi Ma were employed by company BGI-Tianjin and BGI-Shenzhen. Author Yongjun Li was employed by company BGI-Shenzhen and Vision Medical. All other authors declare no competing interests.
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Fan, S., Yuan, H., Liu, L. et al. Pseudorabies virus encephalitis in humans: a case series study. J. Neurovirol. 26, 556–564 (2020). https://doi.org/10.1007/s13365-020-00855-y
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DOI: https://doi.org/10.1007/s13365-020-00855-y