Neurologic manifestations and outcome of West Nile virus infection
Neurologic manifestations and outcome of West Nile virus infection
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DOI：
10.1001/jama.290.4.511
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发表时间：
2003-07-23
影响因子：
120.7
通讯作者：
Petersen, LR
中科院分区：
文献类型：
--
作者：
Sejvar, JJ;Haddad, MB;Petersen, LR
背景西尼罗河病毒（WNV）感染患者的神经系统表现、实验室检查结果和预后尚未得到前瞻性描述。目的前瞻性描述WNV感染神经系统表现患者的临床和实验室特征以及长期预后。设计、设置和参与者从2002年8月1日至9月2日，一个以社区为基础的，前瞻性病例系列研究在路易斯安那州圣坦慕尼教区进行。收集疑似西尼罗河病毒感染患者的标准化临床数据。确认WNV血清阳性患者进行了重新评估，在8 months.Main结果测量临床，神经，和实验室功能在最初的介绍，和长期的神经outcome.Results十六（37%）的39例疑似病例有抗体对WNV; 5脑膜炎，8脑炎，和3例脊髓灰质炎样急性弛缓性麻痹。运动障碍，包括震颤（15例[94%]）、肌阵挛（5例[31%]）和帕金森综合征（11例[69%]），在WNV血清阳性患者中很常见。1例患者死亡。8个月随访时，疲劳、头痛和肌痛是持续症状; 6名患者持续存在步态和运动障碍。西尼罗河病毒脑膜炎或脑炎患者有良好的结果，虽然急性弛缓性麻痹患者没有恢复肢体strength.Conclusions运动障碍，包括震颤，肌阵挛，帕金森综合征，可能存在于急性疾病与西尼罗河病毒感染。一些患有西尼罗河病毒感染和脑膜炎或脑炎的患者最终可能有良好的长期结局，尽管可能导致不可逆的脊髓灰质炎样综合征。
Context The neurologic manifestations, laboratory findings, and outcome of patients with West Nile virus (WNV) infection have not been prospectively characterized.Objective To describe prospectively the clinical and laboratory features and long-term outcome of patients with neurologic manifestations of WNV infection.Design, Setting, and Participants From August 1 to September 2, 2002, a community-based, prospective case series was conducted in St Tammany Parish, La. Standardized clinical data were collected on patients with suspected WNV infection. Confirmed WNV-seropositive patients were reassessed at 8 months.Main Outcome Measures Clinical, neurologic, and laboratory features at initial presentation, and long-term neurologic outcome.Results Sixteen (37%) of 39 suspected cases had antibodies against WNV; 5 had meningitis, 8 had encephalitis, and 3 had poliomyelitis-like acute flaccid paralysis. Movement disorders, including tremor (15 [94%]), myoclonus (5 [31%]) and parkinsonism (11 [69%]), were common among WNV-seropositive patients. One patient died. At 8-month followup, fatigue, headache, and myalgias were persistent symptoms; gait and movement disorders persisted in 6 patients. Patients with WNV meningitis or encephalitis had favorable outcomes, although patients with acute flaccid paralysis did not recover limb strength.Conclusions Movement disorders, including tremor, myoclonus, and parkinsonism, may be present during acute illness with WNV infection. Some patients with WNV infection and meningitis or encephalitis ultimately may have good long-term outcome, although an irreversible poliomyelitis-like syndrome may result.