A variety
of encephalitic syndromes can mimic those attributed
to vaccination. The possible causes are numerous and
include, but are not limited to, Epstein-Barr Virus
(EBV), herpes viruses, enteroviruses, measles, mumps,
Mycoplasma pneumoniae, varicella-zoster virus, and arboviruses.
In addition a variety of encephalopathies can produce
identical symptoms.
Studies should be undertaken to rule out other causes,
as this diagnosis is ultimately one of exclusion. Polymerase
chain reaction (PCR) testing of spinal fluid for a range
of agents normally causing meningo-encephalitis should
be performed. Bacterial infection should also be ruled
out by examination of the cerebrospinal fluid, and other
appropriate cultures. The peripheral white blood cell
count and in the CSF are non-specific, showing an increase
in mononuclear cells. Cerebrospinal fluid protein and
glucose may be slightly elevated.
Typically, temporal association with vaccination (10-14
days to onset on the average) and meningo-encephalitic
symptoms suggest this entity.
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