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Japanese encephalitis — SCE Neurology MCQ

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HardCNS InfectionsJapanese encephalitisSCE Neurology

A 34-year-old returns from six weeks working near irrigated rice fields in rural Thailand. He develops fever, confusion, asymmetric parkinsonism and seizures; MRI shows bilateral thalamic and substantia-nigra T2 hyperintensity. On illness day 7, which test most specifically attributes the encephalitis to Japanese encephalitis virus?

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Correct answer: C — Japanese encephalitis virus-specific IgM in cerebrospinal fluid by capture assay

Explanation lettering: E = shown as A · D = shown as B · A = shown as C · B = shown as D · C = shown as E

A is correct: JEV-specific IgM in CSF provides evidence of CNS infection and is the most reliable routine confirmatory test. B is insensitive because viraemia is usually low or absent by neurological presentation. C cannot distinguish remote exposure, vaccination or cross-reactivity. D is not pathogen-specific. E is not a validated diagnostic specimen or routine method.

Reference: WHO standards for Japanese encephalitis surveillance: https://pmc.ncbi.nlm.nih.gov/articles/PMC2809064/