Evidence map›Paper›PMID 33172962›Full record

Observational studyNeurology(R) neuroimmunology & neuroinflammation2021

Eastern equine encephalitis and use of IV immunoglobulin therapy and high-dose steroids.

Douglas R Wilcox, Sarah I Collens, Isaac H Solomon, Farrah J Mateen, Shibani S Mukerji

Open access · goldAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Neurology(R) neuroimmunology & neuroinflammation, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
0.7field-weighted citation impact, top 24% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 18 citations in OpenAlex.

  1. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026
    Article
  2. Review
  3. Neuroinvasive eastern equine encephalitis in a previously healthy 56-year-old woman.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026
    Article
  4. Review
  5. Reemerging Infectious Diseases and Neuroimmunologic Complications.Neurology(R) neuroimmunology & neuroinflammation · 2025
    Review
  6. Article
  7. Review
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 1 institution in 1 country.

Douglas R WilcoxFrom the Division of Neuroimmunology and Neuro-Infectious Diseases (D.R.W., S.I.C., F.J.M., S.S.M.), Department of Neurology, Massachusetts General Hospital; Department of Neurology (D.R.W.), Brigham and Women's Hospital; Department of Pathology (I.H.S.), Brigham and Women's Hospital; and Department of Neurology (D.R.W., F.J.M., S.S.M.), Harvard Medical School, Boston, MA. drwilcox@bwh.harvard.edu.
Sarah I CollensFrom the Division of Neuroimmunology and Neuro-Infectious Diseases (D.R.W., S.I.C., F.J.M., S.S.M.), Department of Neurology, Massachusetts General Hospital; Department of Neurology (D.R.W.), Brigham and Women's Hospital; Department of Pathology (I.H.S.), Brigham and Women's Hospital; and Department of Neurology (D.R.W., F.J.M., S.S.M.), Harvard Medical School, Boston, MA.
Isaac H SolomonFrom the Division of Neuroimmunology and Neuro-Infectious Diseases (D.R.W., S.I.C., F.J.M., S.S.M.), Department of Neurology, Massachusetts General Hospital; Department of Neurology (D.R.W.), Brigham and Women's Hospital; Department of Pathology (I.H.S.), Brigham and Women's Hospital; and Department of Neurology (D.R.W., F.J.M., S.S.M.), Harvard Medical School, Boston, MA.
Farrah J MateenFrom the Division of Neuroimmunology and Neuro-Infectious Diseases (D.R.W., S.I.C., F.J.M., S.S.M.), Department of Neurology, Massachusetts General Hospital; Department of Neurology (D.R.W.), Brigham and Women's Hospital; Department of Pathology (I.H.S.), Brigham and Women's Hospital; and Department of Neurology (D.R.W., F.J.M., S.S.M.), Harvard Medical School, Boston, MA.
Shibani S MukerjiFrom the Division of Neuroimmunology and Neuro-Infectious Diseases (D.R.W., S.I.C., F.J.M., S.S.M.), Department of Neurology, Massachusetts General Hospital; Department of Neurology (D.R.W.), Brigham and Women's Hospital; Department of Pathology (I.H.S.), Brigham and Women's Hospital; and Department of Neurology (D.R.W., F.J.M., S.S.M.), Harvard Medical School, Boston, MA.
Brigham and Women's Hospital · US

Funding

Immune Activation, Cerebral Metabolic Activity and Depression in Treated HIV-InfectionK23MH115812 · NIMH · MASSACHUSETTS GENERAL HOSPITAL · PI MUKERJI, SHIBANI SHARON · 2018 to 2022
$926k
NIMH NIH HHS K23 MH115812
6 · The paper itself

Abstract

objectiveTo determine the clinical presentation and patient outcomes after treatment with IV immunoglobulin (IVIG), high-dose steroids, or standard of care alone in Eastern equine encephalitis (EEE), a mosquito-borne viral infection with significant neurologic morbidity and mortality.

methodsA retrospective observational study of patients admitted to 2 tertiary academic medical centers in Boston, Massachusetts, with EEE from 2005 to 2019.

resultsOf 17 patients (median [IQR] age, 63 [36-70] years; 10 (59%) male, and 16 (94%) White race), 17 patients had fever (100%), 15 had encephalopathy (88%), and 12 had headache (71%). Eleven of 14 patients with CSF cell count differential had a neutrophil predominance (mean = 60.6% of white blood cells) with an elevated protein level (median [IQR], 100 mg/dL [75-145]). Affected neuroanatomic regions included the basal ganglia (n = 9/17), thalamus (n = 7/17), and mesial temporal lobe (n = 7/17). A total of 11 patients (65%) received IVIG; 8 (47%) received steroids. Of the patients who received IVIG, increased time from hospital admission to IVIG administration correlated with worse long-term disability as assessed by the modified Rankin Scale (mRS) (

conclusionsClinicians should suspect EEE in immunocompetent patients with early subcortical neuroimaging abnormalities and CSF neutrophilic predominance. This study suggests a lower mortality than previously reported, but a high morbidity rate in EEE. IVIG as an adjunctive to standard of care may be considered early during hospitalization.

Indexed as

Adrenal Cortex HormonesAdultAgedEncephalomyelitis, Eastern EquineFemaleHumansImmunoglobulins, IntravenousMaleMiddle AgedRetrospective StudiesAdrenal Cortex HormonesImmunoglobulins, Intravenous

Identifiers

PMID33172962
PMCPMC7713729
OpenAlexW3102130553

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.