Encephalitis and aseptic meningitis: short-term and long-term outcome, quality of life and neuropsychological functioning

Abstract

For those surviving encephalitis, the influence on daily life of patients and their relatives may be substantial. In contrast, the prognosis after aseptic meningitis (ASM) is considered good. In this prospective study in patients with encephalitis (n = 20) and ASM (n = 46), we show that both groups experienced reduced Health Related Quality of Life (HRQoL) at two months after discharge, and that workability was reduced in 37% of the patients with ASM. However, 12 months after discharge no neuropsychological deficits were detected in the ASM group, whereas patients with encephalitis had lower scores on tests of fine motor and psychomotor skills as well as on learning and memory. We also found that for patients with encephalitis, neopterin, as a marker of Th1 cell induced macrophage activation, and a putatively neurotoxic ratio of the kynurenine pathway (KP) measured during the acute phase was associated with lower HRQoL. Our data show that not only encephalitis, but also ASM has substantial short-term influence on HRQoL and workability. For patients with encephalitis we suggest a link between immune activation and activation of the KP during the acute phase with impaired HRQoL.

Figure 1

Flowchart showing inclusion of patients. SF-36: Survey Short Form, HAD: Hospital Anxiety and Depression Scale, GOSE: Glasgow Outcome Scale Extended.

Figure 2

Mean scores of SF-36 subscales, PCS and MCS of patients with aseptic meningitis and encephalitis compared to the estimated population mean at follow-up at two months. Asterisks denotes significant difference vs estimated population mean; *p < 0.05, **p ≤ 0.001. For encephalitis both PCS (p = 0.005) and MCS (p = 0.014) were below the population mean, while for ASM, only PCS was below (p = 0.042). PF: Physical functioning, RP: Role physical, RE: Role emotional, BP: Bodily pain, GH: General health, VT: Vitality, SF: Social functioning, MH: Mental health, PCS: Physical Component Summary score, MCS: Mental Component Summary score.

Figure 3

Neopterin, KYN/TRP ratio and KYNA/(3-HK + QA) for patients with encephalitis (n = 7) and ASM (n = 10) measured at admission in comparison with a previously reported control group consisting of patients with no pleocytosis in the CSF. Data shown are medians with IQR. Asterisks above patients groups indicate significant difference vs controls (Mann Whitney U test); **p < 0.01, ***p < 0.001. ^aKYN/TRP ratio as a measure of IDO activity. KYN: kynurenine, TRP: tryptophan, KYNA: kynurenic acid, 3-HK: 3-hydroxykynurenine, QA: quinolinic acid.