{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T23:21:46Z","timestamp":1767914506238,"version":"3.49.0"},"reference-count":41,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,8,2]]},"abstract":"<jats:p>Japanese encephalitis (JE) virus is a major cause of devastating viral encephalitis, especially in Asia. Although a successful vaccination program led to its near-elimination over three decades in South Korea, the incidence of JE has increased since 2010. The present study investigated the clinical manifestations, laboratory findings, and factors affecting neurological outcomes of reemerging JE. We retrospectively reviewed medical records of laboratory-confirmed JE patients who presented with acute encephalitis syndrome at three tertiary hospitals between 2010 and 2015. A total of 17 patients with JE were identified. Their median age was 51 years, and 10 (58.5%) were men. The most common symptoms and signs were fever (94.1%), altered consciousness (94.1%), and headache (80.2%). Hyporeflexia (47.1%), seizures (35.2%), abnormal brainstem reflex (23.5%), and flaccid weakness (17.6%) were also noted. Brain imaging revealed thalamic lesions in all patients, with the hippocampus, midbrain, basal ganglia, and cerebral cortex affected to varying degrees. Sixteen patients (94.1%) required management in the intensive care unit with mechanical ventilation due to neurological deterioration. At the time of discharge, 11 (64.7%) had poor recovery, defined as Glasgow coma scale scores of less than 8, and remained ventilator dependent. Comparison between the two outcome groups indicated that midbrain involvement (<jats:italic>P<\/jats:italic> = 0.028) and rapid deterioration (<jats:italic>P<\/jats:italic> = 0.005) were associated with severe neurological sequelae. Given that JE is a vaccine-preventable disease, vaccination for adults should be considered in response to the reemergence of JE.<\/jats:p>","DOI":"10.4269\/ajtmh.17-0054","type":"journal-article","created":{"date-parts":[[2017,5,9]],"date-time":"2017-05-09T07:00:14Z","timestamp":1494313214000},"page":"369-375","source":"Crossref","is-referenced-by-count":24,"title":["Clinical Characteristics of Severe Japanese Encephalitis: A Case Series from South Korea"],"prefix":"10.4269","volume":"97","author":[{"given":"Jun-Sang","family":"Sunwoo","sequence":"first","affiliation":[{"name":"Department of Neurology, Soonchunhyang University School of Medicine, Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soon-Tae","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea"},{"name":"Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keun-Hwa","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea"},{"name":"Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyung-Il","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jangsup","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea"},{"name":"Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ki-Young","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea"},{"name":"Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manho","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea"},{"name":"Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea"},{"name":"Protein Metabolism Medical Research Center, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sang Kun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea"},{"name":"Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kon","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea"},{"name":"Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"ref1","series-title":"Annu Rev Entomol","first-page":"17","article-title":"Ecology and geographical expansion of Japanese encephalitis virus","volume":"54","author":"van den Hurk","year":"2009"},{"issue":"766\u2013774","key":"ref2","series-title":"Bull World Health Organ","first-page":"774A","article-title":"Estimated global incidence of Japanese encephalitis: a systematic review","volume":"89","author":"Campbell","year":"2011"},{"key":"ref3","series-title":"J Glob Infect Dis","first-page":"3","article-title":"The emergence of zika virus as a global health security threat: a review and a consensus statement of the INDUSEM Joint working Group (JWG)","volume":"8","author":"Sikka","year":"2016"},{"key":"ref4","series-title":"Handbook of Clinical Neurology","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/B978-0-444-53488-0.00026-2","article-title":"Chapter 26\u2014Japanese encephalitis virus infection","author":"Griffiths","year":"2014"},{"key":"ref5","series-title":"Brain","first-page":"1084","article-title":"Seizures and raised intracranial pressure in Vietnamese patients with Japanese encephalitis","volume":"125","author":"Solomon","year":"2002"},{"key":"ref6","series-title":"J Neurol","first-page":"47","article-title":"Japanese encephalitis (JE). Part I: clinical profile of 1,282 adult acute cases of four epidemics","volume":"259","author":"Sarkari","year":"2012"},{"key":"ref7","series-title":"N Engl J Med","first-page":"370","article-title":"Flavivirus encephalitis","volume":"351","author":"Solomon","year":"2004"},{"key":"ref8","series-title":"Epidemiol Infect","first-page":"1292","article-title":"Risk factors for Japanese encephalitis: a case-control study","volume":"138","author":"Liu","year":"2010"},{"key":"ref9","series-title":"Emerg Infect Dis","first-page":"17","article-title":"Japanese encephalitis immunization in South Korea: past, present, and future","volume":"6","author":"Sohn","year":"2000"},{"key":"ref10","series-title":"Jpn J Infect Dis","first-page":"333","article-title":"Japanese encephalitis: surveillance and elimination effort in Japan from 1982 to 2004","volume":"61","author":"Arai","year":"2008"},{"key":"ref11","series-title":"Infectious Disease Surveillance Yearbook","year":"2015"},{"key":"ref12","series-title":"PLoS One","first-page":"e0147841","article-title":"Prevalence of neutralizing antibodies to Japanese encephalitis virus among high-risk age groups in South Korea, 2010","volume":"11","author":"Lee","year":"2016"},{"key":"ref13","series-title":"Infectious Disease Statistics System","year":"2016"},{"key":"ref14","series-title":"Emerg Infect Dis","first-page":"1841","article-title":"Reemergence of Japanese Encephalitis in South Korea, 2010\u20132015","volume":"22","author":"Sunwoo","year":"2016"},{"key":"ref15","series-title":"Bull World Health Organ","first-page":"178","article-title":"A cohort study to assess the new WHO Japanese encephalitis surveillance standards","volume":"86","author":"Solomon","year":"2008"},{"key":"ref16","series-title":"Int J Infect Dis","first-page":"e448","article-title":"Epidemiology of Japanese encephalitis in South Korea, 2007\u20132010","volume":"16","author":"Lee","year":"2012"},{"key":"ref17","series-title":"Osong Public Health Res Perspect","first-page":"286","article-title":"Comparison of four serological tests for detecting antibodies to Japanese encephalitis virus after vaccination in children","volume":"5","author":"Cha","year":"2014"},{"key":"ref18","series-title":"J Neurol Neurosurg Psychiatry","first-page":"405","article-title":"Japanese encephalitis","volume":"68","author":"Solomon","year":"2000"},{"key":"ref19","series-title":"Emerg Infect Dis","first-page":"1525","article-title":"Dengue fever in South Korea, 2006\u20132010","volume":"18","author":"Park","year":"2012"},{"key":"ref20","series-title":"J Korean Med Sci","first-page":"343","article-title":"The first reported case of West Nile encephalitis in Korea","volume":"30","author":"Hwang","year":"2015"},{"key":"ref21","series-title":"Am J Trop Med Hyg","first-page":"78","article-title":"The epidemiology of Japanese encephalitis on Taiwan during 1966\u20131997","volume":"61","author":"Wu","year":"1999"},{"key":"ref22","series-title":"Bull World Health Organ","first-page":"625","article-title":"Japanese encephalitis: current worldwide status","volume":"63","author":"Umenai","year":"1985"},{"key":"ref23","series-title":"J Clin Virol","first-page":"45","article-title":"A comparison of clinical features of Japanese encephalitis virus infection in the adult and pediatric age group with acute encephalitis syndrome","volume":"52","author":"Borah","year":"2011"},{"key":"ref24","series-title":"Lancet","first-page":"1094","article-title":"Poliomyelitis-like illness due to Japanese encephalitis virus","volume":"351","author":"Solomon","year":"1998"},{"key":"ref25","series-title":"J Neurol Sci","first-page":"143","article-title":"Prognosis of Japanese encephalitis: a multivariate analysis","volume":"161","author":"Misra","year":"1998"},{"key":"ref26","series-title":"Curr Opin Infect Dis","first-page":"375","article-title":"Infectious causes of acute flaccid paralysis","volume":"16","author":"Solomon","year":"2003"},{"key":"ref27","series-title":"BioMed Res Int","first-page":"152656","article-title":"Clinical profile and outcome of Japanese encephalitis in children admitted with acute encephalitis syndrome","volume":"2013","author":"Kakoti","year":"2013"},{"key":"ref28","series-title":"Clin Infect Dis","first-page":"458","article-title":"The epidemiology, clinical features, and long-term prognosis of Japanese encephalitis in central Sarawak, Malaysia, 1997\u20132005","volume":"47","author":"Ooi","year":"2008"},{"key":"ref29","series-title":"J Neurol Sci","first-page":"15","article-title":"Clinical and radiological spectrum of Japanese encephalitis","volume":"325","author":"Basumatary","year":"2013"},{"key":"ref30","series-title":"J Neurol Sci","first-page":"3","article-title":"Comparison of CT scan and MRI findings in the diagnosis of Japanese encephalitis","volume":"174","author":"Kalita","year":"2000"},{"key":"ref31","series-title":"J Neurol","first-page":"255","article-title":"Japanese encephalitis in the Kurume region of Japan: CT and MRI findings","volume":"236","author":"Shoji","year":"1989"},{"key":"ref32","series-title":"Arch Neurol","first-page":"1760","article-title":"A comparison of clinical and radiological findings in adults and children with Japanese encephalitis","volume":"60","author":"Kalita","year":"2003"},{"key":"ref33","series-title":"AJNR Am J Neuroradiol","first-page":"1027","article-title":"Temporal lobe involvement in Japanese encephalitis: problems in differential diagnosis","volume":"27","author":"Handique","year":"2006"},{"key":"ref34","series-title":"J Virol","first-page":"5602","article-title":"Viral infection of the central nervous system and neuroinflammation precede blood-brain barrier disruption during Japanese encephalitis virus infection","volume":"89","author":"Li","year":"2015"},{"key":"ref35","series-title":"Pract Neurol","first-page":"150","article-title":"The hippocampus: modern imaging of its anatomy and pathology","volume":"5","author":"Thammaroj","year":"2005"},{"key":"ref36","series-title":"Surg Neurol","first-page":"339","article-title":"Microvascular anatomy of the hippocampal formation","volume":"37","author":"Marinkovic","year":"1992"},{"key":"ref37","series-title":"Acta Radiol","first-page":"827","article-title":"The prognostic role of magnetic resonance imaging and single-photon emission computed tomography in viral encephalitis","volume":"49","author":"Misra","year":"2008"},{"key":"ref38","series-title":"PLoS Negl Trop Dis","first-page":"e437","article-title":"Japanese encephalitis-a pathological and clinical perspective","volume":"3","author":"Ghosh","year":"2009"},{"key":"ref39","series-title":"J Neurol Sci","first-page":"57","article-title":"Seizures in Japanese encephalitis","volume":"190","author":"Misra","year":"2001"},{"key":"ref40","series-title":"J Neurovirol","first-page":"412","article-title":"Status epilepticus in encephalitis: a study of clinical findings, magnetic resonance imaging, and response to antiepileptic drugs","volume":"14","author":"Kalita","year":"2008"},{"key":"ref41","series-title":"Epilepsia","first-page":"177","article-title":"Nonconvulsive status epilepticus and coma","volume":"51","author":"Bauer","year":"2010"}],"container-title":["The American Society of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/97\/2\/article-p369.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/97\/2\/article-p369.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/97\/2\/article-p369.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T22:21:49Z","timestamp":1723069309000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/97\/2\/article-p369.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,8,2]]},"references-count":41,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.17-0054","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,8,2]]}}}