Use of Intravenous Immunoglobulins in Paediatric Viral Meningoencephalitis

By Aliya Yu, PharmD Candidate

Introduction

Despite advances in molecular diagnostics that have greatly improved clinicians’ ability to identify the viruses responsible for these infections, treatment options have not progressed at the same pace. For many viral causes of encephalitis, management remains largely supportive, as effective antiviral medications are available for only a limited number of pathogens. This therapeutic gap has led clinicians to explore the use of intravenous immunoglobulin (IVIG), a blood product containing antibodies collected from healthy donors that may help modulate the immune response and, in some cases, provide antiviral activity. However, evidence supporting its routine use in viral meningoencephalitis remains limited.

In this retrospective observational study, Lazzareschi and colleagues sought to determine whether IVIG administration was associated with improved neurological outcomes in children with molecularly confirmed viral meningoencephalitis caused by enterovirus, human parechovirus, or human herpesvirus 6 (HHV-6).

What is viral meningoencephalitis? 

Viral meningoencephalitis is a serious infection of the central nervous system (CNS) that causes inflammation of both the brain (encephalitis) and the thin protective layers of tissue surrounding the brain and spinal cord (meningitis). Together, these structures form the body’s control center.

The brain is responsible for functions such as memory, emotions, behavior, movement, speech, and thought, while the spinal cord serves as the primary communication pathway between the brain and the rest of the body, allowing us to move, feel sensations, and regulate many automatic functions, including breathing. The protective tissues surrounding the brain and spinal cord cushion these delicate structures and help defend them against injury and infection.

When inflammation affects both the brain and its protective tissues (a condition known as meningoencephalitis) communication throughout the nervous system can become disrupted, leading to symptoms such as severe headache, neck stiffness, seizures, confusion, changes in behavior, weakness, or loss of consciousness. In infants and young children, the illness may instead present with more subtle signs, including poor feeding, lethargy, or apnea.

The research

The study included 29 pediatric patients admitted between 2016 and 2025, with enterovirus identified as the most common cause of infection, accounting for 50% of cases. Although most children experienced favorable neurological outcomes, all unfavorable outcomes (including neurodevelopment delay and epilepsy) occurred in patients with enteroviral infections. IVIG was administered to approximately 25% of patients, primarily younger infants who presented with more severe symptoms (particularly apnea).

While none of the children who received IVIG developed long-term neurological complications, the difference was not statistically significant, and the authors concluded that IVIG administration appeared to reflect disease severity and physician judgment rather than a demonstrated improvement in neurological outcomes.

Conclusion and future directions

Overall, this study contributes meaningful real-world evidence to an area where treatment options remain limited. While IVIG was not associated with significantly improved neurological outcomes, its use appeared to reflect clinicians’ attempts to treat younger patients with more severe presentations rather than a standardized therapeutic approach.

Also, the study reinforces that enteroviral meningoencephalitis can lead to lasting neurological complications despite most children experiencing favorable recoveries. These findings underscore the need for larger, prospective, multicenter studies to better define which patients may benefit from immunomodulatory therapies such as IVIG, as well as standardized treatment protocols and long-term neurological follow-up.

As diagnostic technologies continue to improve, future efforts must focus on developing evidence-based therapies that not only identify viral meningoencephalitis earlier but also improve long-term outcomes for children affected by this potentially devastating disease.

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To view the original paper, click here.