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In endemic areas and epidemic season, the patients
                                                              considered as CNS infection with bilateral thalamic
                                                              involvement should be highly suspected as JE.

                                                              REFERENCES


           a                       b                          1.   Solomon T. Control of Japanese encephalitis – within our grasp? N
                                                                  Engl J Med 2006;355:869‑71.
                                                              2.   Erlanger TE, Weiss S, Keiser J, Utzinger J, Wiedenmayer K. Past,
                                                                  present, and future of Japanese encephalitis.  Emerg Infect Dis
                                                                  2009;15:1‑7.
                                                              3.   Gao X, Nasci R, Liang G. The neglected arboviral infections in
                                                                  mainland China. PLoS Negl Trop Dis 2010;4:e624.
                                                              4.   Basumatary LJ, Raja D, Bhuyan D, Das M, Goswami M, Kayal AK.
                                                                  Clinical and radiological spectrum of Japanese encephalitis. J Neurol
           c                       d                              Sci 2013;325:15‑21.
          Figure 2:  May–Grünwald–Giemsa  staining  results  (×1000)  of  the   5.   Ghosh D, Basu A. Japanese encephalitis‑a pathological and clinical
          cerebral  spinal  fluid  in  Japanese  encephalitis  patient  at  different  phases:   perspective. PLoS Negl Trop Dis 2009;3:e437.
          (a) Initial phase – Neutrophils (black arrows) are the main inflammatory cells in   6.   Solomon T, Dung NM, Kneen R, Gainsborough M, Vaughn DW,
          the background; (b) Acute phase – A decrease in the number of neutrophils and   Khanh VT. Japanese encephalitis. J Neurol Neurosurg Psychiatry
          an increase in the number of lymphocytes were noted. Furthermore, activated
          monocytes  (black  arrows)  are  apparent;  (c)  Acute  phase  –  Plasmocytes   2000;68:405‑15.
          developed in the acute phase (black arrows); (d) Convalescence – Cytology   7.   Zheng  Y,  Li  M,  Wang  H,  Liang  G. Japanese  encephalitis  and
          mainly shows the lymphocyte reaction (black arrows)     Japanese encephalitis virus in mainland China.  Rev Med Virol
                                                                  2012;22:301‑22.
                                                              8.   Kalita J, Misra UK. Comparison of CT scan and MRI findings in the
          of neutrophils dramatically declined to 5.82%, while    diagnosis of Japanese encephalitis. J Neurol Sci 2000;174:3‑8.
          lymphocytes significantly increased. Monocytes and   9.   Misra UK, Kalita J, Phadke RV, Wadwekar V, Boruah DK, Srivastava A,
          activated monocytes gradually decreased, but plasma     Maurya PK, Bhattacharyya A. Usefulness of various MRI sequences
          cells peaked. At convalescence, mainly lymphocyte       in the diagnosis of viral encephalitis. Acta Trop 2010;116:206‑11.
          reaction or typical lymphocyte reaction were observed   10.  Dung NM, Turtle L, Chong WK, Mai NT, Thao TT, Thuy TT, Kneen R,
                                                                  Phu NH, Wills B, Farrar J, Das K, Solomon T. An evaluation of
          on CSF cytological examination. Neutrophils,            the usefulness of neuroimaging for the diagnosis of Japanese
          monocytes, activated monocytes, and plasma cells all    encephalitis. J Neurol 2009;256:2052‑60.
          rapidly decreased or even disappeared [Figure 2]. In   11.  Sawlani  V. Diffusion‑weighted imaging and apparent diffusion
          addition to typical cytological characteristics of viral   coefficient evaluation of herpes simplex encephalitis and Japanese
                                                                  encephalitis. J Neurol Sci 2009;287:221‑6.
          encephalitis, CSF cytological examination of JE patients   12.  Misra UK, Kalita J. Overview: Japanese encephalitis. Prog Neurobiol
          also showed that the mixed-cell reaction existed for long   2010;91:108‑20.
          periods of time, and we observed neutrophils existed for   13.  Singh P, Kalra N, Ratho RK, Shankar S, Khandelwal N, Suri S.
          longer than one week. The rates of neutrophils decrease   Coexistent neurocysticercosis and Japanese B encephalitis: MR
                                                                  imaging correlation. AJNR Am J Neuroradiol 2001;22:1131‑6.
          and lymphocyte increase are fast during treatment,   14.  Handique SK, Das RR, Barman K, Medhi N, Saharia B, Saikia P,
          and this may facilitate the differential diagnosis of JE.   Ahmed SA. Temporal lobe involvement in Japanese encephalitis:
          Misra and Kalita [26]  have reported that the 3-month   problems in differential diagnosis.  AJNR Am J Neuroradiol
                                                                  2006;27:1027‑31.
          clinical outcomes were not significantly related to CSF   15.  Handique  SK. Viral infections of the central nervous system.
          abnormalities. Further studies are required.            Neuroimaging Clin N Am 2011;21:777‑94, vii.
                                                              16.  Agid R, Ducreux D, Halliday WC, Kucharczyk W, terBrugge KG,
          Based on the results of routine biochemical examinations   Mikulis DJ. MR diffusion‑weighted imaging in a case of West Nile
                                                                  virus encephalitis. Neurology 2003;61:1821‑3.
          of CSF, white blood cell and protein content slightly   17.  Prakash M, Kumar S, Gupta RK. Diffusion‑weighted MR imaging in
          increased while glucose and chloride content remained   Japanese encephalitis. J Comput Assist Tomogr 2004;28:756‑61.
          normal in most JE patients. The mixed-cell reaction   18.  Handique SK, Das RR, Saharia B, Das P, Buragohain R, Saikia P.
          was noted in the early phase of JE and existed longer   Coinfection of Japanese encephalitis with neurocysticercosis: an
                                                                  imaging study. AJNR Am J Neuroradiol 2008;29:170‑5.
          than in general viral encephalitis. At convalescence,   19.  Jia M, Xiong N, Huang J, Wang Y, Zhang X, Zhang Z, Cao X, Lin Z,
          cytological examinations of CSF demonstrated mainly     Wang T. Japanese encephalitis accompanied by cerebral venous
          lymphocyte reaction or typical lymphocyte reaction.     sinus thrombosis: a case report. BMC Neurol 2012;12:43.
          The mixed-cell reaction in JE lasts longer than in   20.  Sips GJ, Wilschut J, Smit JM. Neuroinvasive flavivirus infections.
                                                                  Rev Med Virol 2012;22:69‑87.
          general viral encephalitis. JE imaging is characterized   21.  Ghoshal A, Das S, Ghosh S, Mishra MK, Sharma V, Koli P, Sen E,
          by bilateral thalamic involvement, and involvement of   Basu A. Proinflammatory mediators released by activated microglia
          the basal ganglia and hippocampus are also common.      induces neuronal death in Japanese encephalitis. Glia 2007;55:483‑96.



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