Abstract Details

Title Etiologies Associated with Hypoglycorrhachia in Adults with Encephalitis

Topic Autoimmune Neurology

Presentation(s) P6 - Poster Session 6 (11:45 AM-12:45 PM)

Poster/Presentation
Number 8-005

Objective

To determine the proportions and etiologies associated with hypoglycorrhachia in adults with encephalitis.

Background Encephalitis, an inflammation of the brain, is due to infectious or non-infectious etiologies (i.e. autoimmune) that can result in severe neurological complications and death. Hypoglycorrhachia [defined as a cerebrospinal fluid (CSF) glucose level <45mg/dl] occurs in adults with encephalitis but there is limited data on the etiologies.

Design/Methods We conducted a retrospective cohort study of patients from the Greater Houston and Baltimore regions between 2005-2022 diagnosed with encephalitis as per the International Encephalitis Consortium guidelines. Thirty-seven patients without a CSF glucose level were excluded from this study. A Cross-Tabulation analysis with Pearson Chi Square and Fisher Exact Test values were used for analysis.

Results Of the 610 patients enrolled, 287 had an infectious etiology (47%), 177 had autoimmune (29%), and 146 were unknown (23.9%). The leading infectious etiology was HSV (n=83) and the leading autoimmune etiology was seronegative limbic encephalitis (n=58). Overall, 114 (18.7%) patients had hypoglycorrhachia, with the majority having an infectious etiology (81/114, 71.1%, p<.0001). Within the infectious group, 58.1% of patients with bacterial and 84.2% of patients with fungal/parasitic etiologies had hypoglycorrhachia upon admission (p<.0001). Of the remaining patients with hypoglycorrhachia, 24 (21.1%) had an unknown etiology and only 9 (7.9%) had an autoimmune cause (antibody-mediated (n=5), seronegative limbic (n=3), and Hashimoto encephalopathy (n=1)). Thirty-three patients presented with severe hypoglycorrhachia, defined as a CSF glucose level <30mg/dl. Twenty-eight (84.8%) of them had an infectious cause, while the remaining had either unknown (n=4) or autoimmune (Hashimoto encephalopathy (n=1)) etiologies.

Conclusions

Hypoglycorrhachia occurs in approximately one fifth of encephalitis cases and is seen more frequently with infectious etiologies such as bacterial, fungal, and parasitic causes.

Authors/Disclosures
Sienna Wu PRESENTER	Ms. Wu has nothing to disclose.
Rodrigo Hasbun	Rodrigo Hasbun has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biomeriaux. The institution of Rodrigo Hasbun has received research support from Biomeriaux.
Ralph Habis, MD (Johns Hopkins School of Medicine)	Dr. Habis has nothing to disclose.
Jordan Benderoth	Miss Benderoth has nothing to disclose.
Ivany V. Patel, BA	Ms. Patel has nothing to disclose.
Arun Venkatesan, MD, PhD (Johns Hopkins Hospital)	Dr. Venkatesan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen Pharmaceuticals. The institution of Dr. Venkatesan has received research support from NIH. The institution of Dr. Venkatesan has received research support from U.S. DOD.
John Probasco, MD, FAAN (The Johns Hopkins Hospital)	Dr. Probasco has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NEJM Clinician. The institution of Dr. Probasco has received research support from Roche/Genentech.
Laya Rao (Villas at Hermann Park)	Ms. Rao has nothing to disclose.
Rajesh K. Gupta, MBBS (UTHealth)	Dr. Gupta has nothing to disclose.

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