Authors: Shailendra K Saxena (King George’s Medical University, India)
Take a look behind the scenes of a recent Future Microbiology review, entitled: ‘Pathogen-associated acute encephalitis syndrome: therapeutics and management’, as we ask the authors about the challenges facing this field, the use of complementary and alternative medicine and what research needs to be done.
What inspired you to write this piece?
Despite the false perception that viral neurological infections deal with untreatable conditions, viro-neurological practice is constantly undergoing vivid changes, and numerous drugs and other forms of therapy continue to emerge. By their integration into common practice our group is associated with ‘Definite, Distinct, and Discrete’ (3D) innovations and future trends in therapy.
Our inspiration came from the research we have performed in the pathogen-associated acute encephalitis syndrome (PA-AES). The results emanating from our studies are useful to develop neurotherapeutic drugs or agents that could attenuate or prevent the neuropathogenesis associated with viral CNS infections and to design novel strategies to develop preventive and therapeutic strategies for 3D specialty pharmaceuticals for viral neurotherapeutics. Worldwide prevalence of pathogen-associated acute encephalitis syndrome (PA-AES) and challenges surrounding perfect diagnosis, effective treatment and prevention instigated us to comprehensively write about this. The currently available poor diagnostic schemes, limited drugs and vaccines are unable to effectively control PA-AES. The complex aetiology of PA-AES needs to be understood in order to effectively control or prevent the disease progression.
What are the main challenges in treating and diagnosing PA-AES?
The enormous diversity in etiological agents capable of causing PA-AES may result in intricate perfect diagnosis. In clinical practices, most cases are diagnosed based on clinical manifestation, lab reports, neuroimaging and electrophysiologic findings. Effective treatment of PA-AES is based on the perfect diagnosis. Nevertheless, precise diagnosis is difficult to achieve due to the enormous range of etiological agents that lead to similar clinical manifestations. With regards to treatment, some drugs have been shown to be effectively control some associated pathogens. Broad spectrum antimicrobial agents targeting multiple pathogens are effective for developing ideal therapeutics for PA-AES. However, our work exhibits the use of complementary and alternative medicine (CAM) as an unconventional approach might be advantageous.
What is ‘CAM’ and how can it be used for acute encephalitis?
According to the WHO, CAM is progressively being used globally. The US National Institute of Health (MD, USA) defines complementary medicine as non-mainstream, non-western practice used together with conventional medicine, whereas alternative medicine is defined as the same used instead of conventional medicine. As per the WHO, CAM is: “a broad set of health care practices that may not be part of conventional medicine and are not fully integrated into the dominant health care system. They are used interchangeably with traditional medicine which includes the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness.”
In order to manage PA-AES, the use of CAM as an alternative approach might be advantageous. CAM has been shown to be effective not only as therapeutics but also for preventive strategies in some of the PA-AES. Globally, CAM is more easily accessible and affordable to patients compared with conventional medicine. Therefore, the WHO strategy includes evidence-based research in CAM as well as education and training for their practice.
However, in recent years several western countries have become fascinated with the popularity of CAM and have become willing to adopt the same. Integration of CAM into national health systems may allow them to be regulated and practiced safely along with conventional medicine for the better outcomes. We are highly engaged towards popularization and development of evidence-based complementary and alternative medicine in alliance with conventional medicine for therapeutics and prevention of various communicable and non-communicable diseases globally.
Are there any current preventative strategies?
Preventive strategies of PA-AES depend on etiological complexity and the nature of the pathogen. The current vaccination programs are focusing on single pathogens, with little success in significantly reducing the prevalence of disease in endemic areas. Apart from vaccination, personal protective measures are always considered as paramount for avoiding infection. However, CAM has been shown to be effective for preventive strategies in various PA-AES, but needs more efficient evidence-based data.
What work are you hoping to do/ what do you think needs to be done in this area?
The treatment of PA-AES should rely on its etiology, which is indispensable for its overall management. The results emanating from our studies are useful to develop neurotherapeutic drugs or agents that could attenuate or prevent the neuropathogenesis associated with CNS infections and design novel strategies to develop preventive and therapeutic strategies for 3D specialty pharmaceuticals for viral neurotherapeutics.
The area of CAM medicines provides great opportunity for developing potential treatments for PA-AES with better affordability and accessibility with least side effects. We are currently working on some of the well documented communicable and non-communicable diseases and trying to popularize and develop evidence-based CAM in alliance with conventional medicine for therapeutics and preventive strategies for them. Prevention of PA-AES may be managed through the development of a peptide-based vaccine, based on consensus peptide sequences; development of such a multivalent vaccine is not easy to accomplish. We are engaged in developing these preventive/therapeutic strategies.
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