Eastern equine encephalitis and use of IV immunoglobulin therapy and high-dose steroids.
Eastern equine encephalitis and use of IV immunoglobulin therapy and high-dose steroids.
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DOI：
10.1212/nxi.0000000000000917
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发表时间：
2021-01
期刊：
影响因子：
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通讯作者：
Mukerji SS
中科院分区：
文献类型：
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作者：
Wilcox DR;Collens SI;Solomon IH;Mateen FJ;Mukerji SS
目的是确定东部马脑炎 (EEE) 经静脉注射免疫球蛋白 (IVIG)、高剂量类固醇或单独标准护理治疗后的临床表现和患者结局，这是一种蚊媒病毒感染，具有显着的神经系统发病率和死亡率。对 2005 年至 2019 年入住马萨诸塞州波士顿 2 个三级学术医疗中心的 EEE 患者进行的一项回顾性观察研究。在 17 名患者中（中位 [IQR] 年龄为 63 [36–70] 岁；10 名 (59%) 男性，16 名 (94%) 白人），17 名患者发烧 (100%)，15 名患者患有脑病(88%)，12 人有头痛 (71%)。 14 名存在脑脊液细胞计数差异的患者中，有 11 名患者以中性粒细胞为主（平均值 = 白细胞的 60.6%），且蛋白质水平升高（中位值 [IQR]，100 mg/dL [75–145]）。受影响的神经解剖区域包括基底神经节（n = 9/17）、丘脑（n = 7/17）和内侧颞叶（n = 7/17）。共有11名患者（65%）接受了IVIG； 8 人（47%）接受了类固醇治疗。根据改良Rankin量表（mRS）评估，在接受IVIG的患者中，从入院到IVIG给药的时间增加与长期残疾程度恶化相关（r = 0.72，p = 0.02）；类固醇的使用与 mRS 评分无关。死亡率为12%。对于早期皮质下神经影像学异常且脑脊液中性粒细胞占优势的免疫功能正常的患者，临床医生应怀疑 EEE。这项研究表明 EEE 的死亡率比以前报道的要低，但发病率很高。 IVIG 作为标准护理的辅助手段可以在住院期间早期考虑。
To 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. A retrospective observational study of patients admitted to 2 tertiary academic medical centers in Boston, Massachusetts, with EEE from 2005 to 2019. Of 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) (r = 0.72, p = 0.02); steroid use was not associated with the mRS score. The mortality was 12%. Clinicians 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.