Clinical features of COVID-19-related encephalitis: comparison with the features of herpes virus encephalitis and autoimmune encephalitis

Yue Cui; Zhongyun Chen; Yu Kong; Yingtao Wang; Yihao Wang; Jing Zhang; Lin Wang; Jiatang Zhang; Wei Sun; Liyong Wu

doi:10.1007/s10072-024-07587-5

Clinical features of COVID-19-related encephalitis: comparison with the features of herpes virus encephalitis and autoimmune encephalitis

Neurol Sci. 2024 May 22. doi: 10.1007/s10072-024-07587-5. Online ahead of print.

Authors

Yue Cui¹, Zhongyun Chen¹, Yu Kong¹, Yingtao Wang¹, Yihao Wang¹, Jing Zhang¹, Lin Wang¹, Jiatang Zhang², Wei Sun^#³, Liyong Wu^#⁴

Affiliations

¹ Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
² Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China.
³ Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China. bmusunnyw@163.com.
⁴ Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China. wmywly@hotmail.com.

^# Contributed equally.

PMID: 38772979
DOI: 10.1007/s10072-024-07587-5

Abstract

Introduction: Identifying coronavirus disease 2019 (COVID-19)-related encephalitis without clear etiological evidence is clinically challenging. The distinctions between this condition and other prevalent encephalitis types remain unknown. Therefore, we aimed to explore the similarities and differences in the clinical characteristics of COVID-19-related encephalitis and other encephalitis types.

Methods: Adult patients with encephalitis admitted to the neurology department at Xuanwu Hospital were enrolled and categorized into the following six groups based on the results of metagenomic next-generation sequencing and autoimmune antibody detection in cerebrospinal fluid (CSF): COVID-19-related encephalitis (n = 36), herpes simplex virus type 1 encephalitis (HSV-1 encephalitis; n = 28), human herpesvirus 3 encephalitis (HHV-3 encephalitis; n = 10), NMDAR-antibody encephalitis (n = 18), LGI1-antibody encephalitis (n = 12), and GABAB-antibody encephalitis (n = 8).

Results: The predominant characteristics of COVID-19-related encephalitis include a low incidence of seizures (38.9%), cognitive defects (30.6%), and meningeal irritation signs (8.3%). Compared with HSV-1 and HHV-3 encephalitis, COVID-19-related encephalitis exhibited lower white blood cell count (2.5 count/mm³), protein (32.2 mg/dL), and immunoglobulin M, G, and A levels (0.09, 3.2, and 0.46 mg/dL, respectively) in the CSF tests. Abnormal imaging findings were present in only 36.1% of COVID-19-related encephalitis cases, mostly showing diffuse inflammation scattered in various parts, which differed from HSV-1 encephalitis. Additionally, COVID-19-related encephalitis exhibited significant differences in clinical symptoms and CSF white blood cell counts compared with NMDAR-antibody encephalitis; however, it showed limited differences compared with LGI1-antibody and GABAB-antibody encephalitis.

Discussion: COVID-19-related encephalitis and herpes virus or autoimmune encephalitis differ clinically. Symptoms and auxiliary examinations can be used as distinguishing tools.

Keywords: COVID-19-related encephalitis; Intracranial inflammation; SARS-CoV-2 infection.