Research Article| Volume 160, ISSUE 1, P92-95, September 18, 1998

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Cerebrospinal fluid atypical lymphocytes in Japanese encephalitis


      Among atypical lymphocytes (AL) examined morphologically and immunohistochemically in the cerebrospinal fluid (CSF) of adult patients with encephalitis, we distinguished a CD4+ `type I' AL, with a multilobulated nucleus resembling those of the abnormal cells in adult T-cell leukemia (ATL), from a CD8+ `type II' AL, a large lymphocyte with basophilic cytoplasm and a nucleus containing coarse chromatin. Type I AL were detected in 7 of 8 patients with Japanese encephalitis (JE), but in none of 11 patients with herpes simplex encephalitis (HSE) and none of 19 patients with unspecified acute viral encephalitis. Type II AL were seen frequently in all three groups. The observation of type I AL in CSF strongly suggests JE, which warrants careful follow-up without antiherpetic drugs. In identifying type I AL, which presumably are virally transformed lymphocytes, care must be taken to distinguish them from leukemic involvement by ATL cells, which frequently includes the meninges. Both type I and type II AL also must be differentiated from lymphoma cells.


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        • Baker R.C.
        • Lenane A.M.
        The predictive value of cerebrospinal fluid differential cytology in meningitis.
        Pediatr Infect Dis J. 1989; 8: 329-330
        • Bigner S.H.
        Cerebrospinal fluid (CSF) cytology: Current status and diagnostic applications.
        J Neuropathol Exp Neurol. 1992; 51: 235-245
        • Davies S.F.
        • Gormus B.J.
        • Yarchoan R.
        • Kaplan M.E.
        Cryptococcal meningitis with false-positive cytology in the CSF. Use of T-cell rosetting to exclude meningeal lymphoma.
        JAMA. 1978; 239: 2369-2370
        • Griffith J.F.
        • Chien L.T.
        Herpes simplex virus encephalitis.
        Med Clin North Am. 1983; 21: 67-70
        • Hoke C.H.
        • Nisalak A.
        • Sangawhipa N.
        • et al.
        Protection against Japanese encephalitis by inactivated vaccines.
        N Engl J Med. 1988; 319: 608-614
        • Johnson R.T.
        • Intralawan P.
        • Puapanwatton P.
        Japanese encephalitis: Identification of inflammatory cells in cerebrospinal fluid.
        Ann Neurol. 1986; 20: 691-695
        • Ketel W.B.
        • Ognibebne A.J.
        Japanese B encephalitis in Vietnam.
        Am J Med Sci. 1971; 261: 271-275
        • Meiyu F.
        • Huosheng C.
        • Cuihua C.
        • et al.
        Detection of flaviviruses by reverse transcriptase-polymerase chain reaction with the universal primer set.
        Microbiol Immunol. 1997; 41: 209-213
        • Monath T.P.
        Japanese encephalitis. A plague of orient.
        N Engl J Med. 1988; 319: 641-643
        • Sato Y.
        • Natori H.
        • Egami K.
        • Tanaka K.
        • Kaji M.
        Meningeal involvement in adult T-cell leukemia-lymphoma.
        Neurol Med (Tokyo). 1983; 19: 166-169
        • Sato Y.
        • Matunami M.
        • Maruoka H.
        • et al.
        A seroepidemiological study of hepatitis C virus (HCV) in an area with a high prevalence of chronic liver disease in the Kyushu district of Japan.
        Kurume Med J. 1993; 41: 41-50
      1. Sato Y, Ohta Y, Honda Y, Kaji M, Oizumi K. Diagnostic value of atypical lymphocytes in cerebrospinal fluid from adults with enteroviral meningitis. J Neurol 1998, in press.

        • Schlesinger Y.
        • Sawyer M.H.
        • Storch G.A.
        Enteroviral meningitis in infancy: Potential role for polymerase chain reaction in patient management.
        Pediatrics. 1994; 94: 157-162
        • Shoji H.
        • Hiraki Y.
        • Kuwasaki N.
        • Toyomasu T.
        • Kaji M.
        • Okudera T.
        Japanese encephalitis in the Kurume region of Japan. CT and MRI findings.
        J Neurol. 1989; 236: 255-259
        • Tanaka M.
        Rapid identification of flavivirus using the polymerase chain reaction.
        J Virol Methods. 1993; 41: 311-322