Long-Term Neurological Outcomes in West Nile Virus-Infected Patients: An Observational Study
Long-Term Neurological Outcomes in West Nile Virus-Infected Patients: An Observational Study
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DOI：
10.4269/ajtmh.14-0616
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发表时间：
2015-05-01
影响因子：
3.3
通讯作者：
Murray, Kristy O.
中科院分区：
文献类型：
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作者：
Weatherhead, Jill E.;Miller, Vicki E.;Murray, Kristy O.
休斯顿西尼罗队列研究（HWNC）成立于2002年，当时西尼罗病毒（WNV）传播到德克萨斯州休斯顿。西尼罗病毒感染后的长期结果大部分仍然未知，尽管有记录显示感染后1年的神经异常。我们报道了一项观察性研究，在HWNC感染西尼罗河病毒后1-3年和8-11年的神经异常。我们在两个不同的时间点进行了标准的神经系统检查，以评估神经系统状态随时间的变化。与单纯发热（27%,3/11）和脑膜炎（36%,5/14）病例相比，大多数脑炎患者（86%,30/35）在首次评估时有异常的神经系统检查结果。在第二次评估时，57%（4/7）的西尼罗热（WNF）、33%（2/6）的西尼罗脑膜炎（WNM）和36%（5/14）的西尼罗脑炎（WNE）出现新的神经系统并发症。最常见的异常是串联步态、听力损失、异常反射和肌肉无力。长期神经系统异常最常见于原发性西尼罗河病毒脑炎患者。无论最初的临床感染如何，新的异常可能随着时间的推移而发展。未来的研究应旨在区分西尼罗河病毒神经侵入性感染引起的神经系统后果和与合并症相关的神经功能下降。
The Houston West Nile Cohort (HWNC) was founded in 2002 when West Nile virus (WNV) reached Houston, TX. The long-term outcomes following WNV infection are still mostly unknown, though neurological abnormalities up to 1 year postinfection have been documented. We report an observational study of neurological abnormalities at 1-3 and 8-11 years following WNV infection in the HWNC. We conducted standard neurological examinations at two separate time points to assess changes in neurological status over time. The majority of patients (86%, 30/35) with encephalitis had abnormal neurological exam findings at the time of the first assessment compared with uncomplicated fever (27%, 3/11) and meningitis (36%, 5/14) cases. At the time of the second assessment, 57% (4/7) of West Nile fever (WNF), 33% (2/6) of West Nile meningitis (WNM), and 36% (5/14) of West Nile encephalitis (WNE) had developed new neurological complications. The most common abnormalities noted were tandem gait, hearing loss, abnormal reflexes, and muscle weakness. Long-term neurological abnormalities were most commonly found in patients who experienced primary WNV encephalitis. New abnormalities may develop over time regardless of initial clinical infection. Future studies should aim to differentiate neurological consequences due to WNV neuroinvasive infection versus neurological decline related to comorbid conditions.