Relapsed and late-onset Nipah encephalitis
Relapsed and late-onset Nipah encephalitis
复制标题
DOI：
10.1002/ana.10212
复制
发表时间：
2002-06-01
影响因子：
11.2
通讯作者：
Jusoh, MR
中科院分区：
文献类型：
--
作者：
Tan, CT;Goh, KJ;Jusoh, MR
1998年9月至1999年6月，马来西亚发生了一起新的副粘病毒--尼帕病毒的暴发感染，涉及265名患者和105人死亡。这是疫情爆发24个月后的一项跟踪研究。12名急性脑炎幸存者(7.5%)有反复神经系统疾病(复发性脑炎)。在最初患有急性非脑炎或无症状感染的患者中，10名患者(3.4%)为迟发性脑炎。首次发病至首次感染时间的平均间隔时间为8.4个月。三名患者出现了第二次神经性发作。复发性或迟发性脑炎的发病通常是急性的。常见的临床特征是发热、头痛、癫痫发作和局灶性神经体征。在22名复发和迟发性脑炎患者中，有4人(18%)死亡。磁共振成像典型地显示融合的皮质病变的斑片状区域。系列单光子发射计算机断层扫描显示相应区域的局灶性高灌注区向低灌注区演变。2例尸检显示局灶性脑炎改变，Nipah病毒抗原免疫定位阳性，但无静脉周围脱髓鞘迹象。我们的结论是，一种独特的复发和缓解性脑炎或迟发性脑炎可能是中枢神经系统持续尼帕病毒感染的并发症所致。
An outbreak of infection with the Nipah virus, a novel paramyxovirus, occurred among pig farmers between September 1998 and June 1999 in Malaysia, involving 265 patients with 105 fatalities. This is a follow-up study 24 months after the outbreak. Twelve survivors (7.5%) of acute encephalitis had recurrent neurological disease (relapsed encephalitis). Of those who initially had acute nonencephalitic or asymptomatic infection, 10 patients (3.4%) had late-onset encephalitis. The mean interval between the first neurological episode and the time of initial infection was 8.4 months. Three patients had a second neurological episode. The onset of the relapsed or late-onset encephalitis was usually acute. Common clinical features were fever, headache, seizures, and focal neurological signs. Four of the 22 relapsed and late-onset encephalitis patients (18%) died. Magnetic resonance imaging typically showed patchy areas of confluent cortical lesions. Serial single-photon emission computed tomography showed the evolution of focal hyperperfusion to hypoperfusion in the corresponding areas. Necropsy of 2 patients showed changes of focal encephalitis with positive immunolocalization for Nipah virus antigens but no evidence of perivenous demyelination. We concluded that a unique relapsing and remitting encephalitis or late-onset encephalitis may result as a complication of persistent Nipah virus infection in the central nervous system.