西尼罗河病毒脑炎：临床特征以及与其他传染性脑炎的比较。

IF 3.6 3区医学 Q1 CLINICAL NEUROLOGY

Journal of the Neurological Sciences Pub Date : 2024-11-04 DOI:10.1016/j.jns.2024.123286

Gadi Maayan Eshed , Tal Levinson , Yair Mina , Adi Ashkenazi , Michal Dekel , Ronit Cohen-Poradosu , Yifat Alcalay , Ora Halutz , Orna Aizenstein , Yael Paran , Avi Gadoth

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引用次数: 0

摘要

目的：以西尼罗河病毒性脑炎（WNVE）为重点，比较成人急性感染性脑炎的功能预后并帮助区分重要致病因子：在特拉维夫医疗中心的电子数据库中筛选了 2010-2020 年间入院的急性脑炎患者。此外，还对同期患者的实验室结果进行了筛查，以确定是否有脑脊液样本对导致脑炎的常见病原体呈阳性反应。对主要患者组的临床特征和功能结果进行了比较：结果：共发现 105 名传染性脑炎患者。WNVE患者（31人）和VZV脑炎患者（31人）的年龄大于HSV1脑炎患者（15人）（中位年龄分别为73岁、76岁和51岁）。WNVE患者的炎症特征更为突出。各组间的 CSF 特征存在明显差异，VZVE 患者的单核白细胞占绝大多数（中位数为 98%）。与HSV1E患者（分别为2.5分和1分）和VZVE患者（分别为1.5分和1分）相比，WNVE患者出院时的功能预后明显较差（出院时改良Rankin量表评分中位数为4分，最后一次随访时为2.5分）：结论：与之前的报道不同，本研究中 WNVE 和 VZVE 的发病率远高于 HSV1E。临床特征的差异可能会在脑炎早期证明对临床有用，包括 WNVE 与相对突出的炎症特征（有点类似细菌感染）有关，而 VZVE 则以极度单核白细胞为主。WNVE的有害结果强调了推进WNV感染研究的必要性。

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West Nile virus encephalitis: Clinical characteristics and a comparison to other infectious encephalitides

Purpose

To compare functional outcomes and help differentiate between important causative agents of acute infectious encephalitis in adults, focusing on West Nile virus encephalitis (WNVE).

Methods

The electronic database of Tel Aviv Medical Center was screened for patients admitted during 2010–2020 with acute encephalitis. Additionally, patient laboratory results during the same period were screened for CSF samples positive for common pathogens causing encephalitis. The main patient groups were compared in terms of clinical characteristics and functional outcomes.

Results

One hundred and five infectious encephalitis patients were identified. WNVE patients (n = 31) and VZV encephalitis (VZVE) patients (n = 31) were older than HSV1 encephalitis (HSV1E) patients (n = 15) (median ages 73, 76, 51, respectively). WNVE patients had a more prominent inflammatory profile. CSF characteristics significantly differed between groups, with an extreme mononuclear white blood cell predominance in VZVE patients (median 98%).

Functional outcomes at discharge were significantly worse in WNVE patients (median modified Rankin Scale score 4 at hospital discharge, 2.5 at last follow-up) when compared with HSV1E patients (2.5, 1, respectively) and VZVE patients (1.5, 1, respectively).

Conclusion

In odds with previous reports, WNVE and VZVE in this study were far more prevalent than HSV1E. Differences in clinical characteristics could prove clinically useful early in encephalitis, including an association of WNVE with a relatively prominent inflammatory profile (somewhat resembling a bacterial infection) and an extreme mononuclear white blood cell predominance in VZVE. The detrimental outcome of WNVE emphasizes the need to advance research on WNV infection.

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来源期刊

Journal of the Neurological Sciences 医学-临床神经学

CiteScore

7.60

自引率

2.30%

发文量

313

审稿时长

22 days

期刊介绍： The Journal of the Neurological Sciences provides a medium for the prompt publication of original articles in neurology and neuroscience from around the world. JNS places special emphasis on articles that: 1) provide guidance to clinicians around the world (Best Practices, Global Neurology); 2) report cutting-edge science related to neurology (Basic and Translational Sciences); 3) educate readers about relevant and practical clinical outcomes in neurology (Outcomes Research); and 4) summarize or editorialize the current state of the literature (Reviews, Commentaries, and Editorials). JNS accepts most types of manuscripts for consideration including original research papers, short communications, reviews, book reviews, letters to the Editor, opinions and editorials. Topics considered will be from neurology-related fields that are of interest to practicing physicians around the world. Examples include neuromuscular diseases, demyelination, atrophies, dementia, neoplasms, infections, epilepsies, disturbances of consciousness, stroke and cerebral circulation, growth and development, plasticity and intermediary metabolism.