Fatal fulminant pan-meningo-polioencephalitis due to West Nile virus
Fatal fulminant pan-meningo-polioencephalitis due to West Nile virus
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DOI：
10.1111/j.1750-3639.2003.tb00477.x
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发表时间：
2003-10-01
期刊：
影响因子：
6.4
通讯作者：
Wiley, CA
中科院分区：
文献类型：
--
作者：
Omalu, BI;Shakir, AA;Wiley, CA
我们报告了一例致命的暴发性西尼罗河病毒(WNV)脑膜脑炎，患者为87岁的白人男性园丁。这名宾夕法尼亚州患者出现了3天的流感样症状。他的住院过程非常危险，在入院后10天内出现昏迷、呼吸机依赖、皮质和脑干功能丧失。急性血清和脑脊液样本显示WNV IgM抗体水平升高，脑脊液白细胞、蛋白质和血糖也升高。完整的尸检显示为多灶性淋巴细胞性心肌炎和严重的慢性肾小管间质肾炎。对死后的脾、肾和脑标本进行病毒培养和PCR分析，均为WNV阳性。大脑和脊髓所有区域的组织学切片显示为严重的非坏死性亚急性脊髓灰质炎脑膜脑炎。虽然灰质和白质都发炎了，但灰质受累要严重得多。许多灰质核团表现为严重的神经元丢失，残留的死亡神经元被激活的小胶质细胞包围。免疫组织化学染色显示CD8T淋巴细胞和血管周围B淋巴细胞大量渗入脑膜和脑实质。电子显微镜可见弥漫性细胞内和细胞外水肿，但未发现病毒颗粒。免疫组织化学和免疫荧光染色显示残留神经元胞浆内充满西尼罗河病毒。西尼罗河病毒直接感染神经元，继发于以脊髓灰质炎为主的脑炎。
We report a case of fatal fulminant West Nile virus (WNV) meningoencephalitis in an 87-year-old white male gardener. The Pennsylvania patient presented with a 3-day history of flu-like symptoms. His hospital course was gravely precipitous with onset of coma, ventilator dependence, loss of cortical and brainstem functions within ten days of admission. Acute serum and cerebrospinal fluid samples revealed elevated levels of WNV IgM antibodies by ELISA as well as elevated CSF white blood cells, protein and glucose. A complete autopsy revealed a multifocal lymphocytic myocarditis and severe chronic tubulointerstitial nephritis. Viral culture and PCR analysis of post-mortem samples of the spleen, kidney and brain were positive for WNV. Histological sections from all regions of the brain and spinal cord demonstrated a severe, non-necrotizing, subacute, polio-meningoencephalitis. While both gray and white matter were inflamed, gray matter was much more severely involved. Many gray matter nuclei showed severe neuronal loss with residual dying neurons surrounded by activated microglia. Immunohistochemical stains revealed profuse infiltration of the meninges and cerebral parenchyma by CD8 T-lymphocytes and perivascular B-lymphocytes. Electron micrographs revealed diffuse intracellular and extracellular edema but no viral particles were identified. Immunohistochemical and immunofluorescent staining for WNV filled the cytoplasm of residual neurons. West Nile virus mediates a predominantly polioencephalitis secondary to direct infection of neurons.