McJunkin J E, de los Reyes E C, Irazuzta J E, Caceres M J, Khan R R, Minnich L L, Fu K D, Lovett G D, Tsai T, Thompson A
Charleston Division, Robert C. Byrd Health Sciences Center of West Virginia University, Charleston, USA.
N Engl J Med. 2001 Mar 15;344(11):801-7. doi: 10.1056/NEJM200103153441103.
La Crosse encephalitis is a mosquito-borne disease that can be mistaken for herpes simplex encephalitis. It has been reported in 28 states but may be underrecognized.
We investigated the manifestations and clinical course of La Crosse encephalitis in 127 patients hospitalized from 1987 through 1996. The diagnosis was established by serologic testing for IgM and IgG antibodies to La Crosse virus. Data were collected by chart review.
Most of the patients were school-aged children (mean [+/-SD] age, 7.8+/-3.5 years; range, 0.5 to 15.0). Symptoms included headache, fever, and vomiting (each in 70 percent or more of the patients), seizures (in 46 percent), and disorientation (in 42 percent). Thirteen percent had aseptic meningitis. Hyponatremia developed in 21 percent, and there were signs of increased intracranial pressure in 13 percent. Six patients, including three with cerebral herniation, underwent intracranial-pressure monitoring. The 13 patients (11 percent) whose condition deteriorated in the hospital had decreases in serum sodium levels (P=0.007), and increases in body temperature (P=0.003) at the time of deterioration. At admission, these patients more often had a history of vomiting (P=0.047) and a score of 12 or lower on the Glasgow Coma Scale (P=0.02) than the others; a trend toward a greater prevalence of seizures at admission was also evident in this group (P=0.07). All the patients survived, but 15 of them (12 percent) had neurologic deficits at discharge. Follow-up assessments, performed in 28 children, suggested an increase in cognitive and behavioral deficits 10 to 18 months after the episode of encephalitis.
La Crosse virus infection should be considered in children who present with aseptic meningitis or encephalitis. Hyponatremia and increasing body temperature may be related to clinical deterioration.
拉科罗斯脑炎是一种由蚊子传播的疾病，可能被误诊为单纯疱疹性脑炎。美国28个州均有该病报告，但可能未得到充分认识。
我们调查了1987年至1996年期间住院的127例拉科罗斯脑炎患者的临床表现和临床病程。通过检测抗拉科罗斯病毒的IgM和IgG抗体进行血清学诊断。通过查阅病历收集数据。
大多数患者为学龄儿童（平均[±标准差]年龄为7.8±3.5岁；范围为0.5至15.0岁）。症状包括头痛、发热和呕吐（各占患者的70%或更多）、癫痫发作（46%）和定向障碍（42%）。13%的患者患有无菌性脑膜炎。21%的患者出现低钠血症，13%的患者有颅内压升高的迹象。6例患者，包括3例脑疝患者，接受了颅内压监测。13例（11%）病情在医院恶化的患者在病情恶化时血清钠水平下降（P=0.007），体温升高（P=0.003）。入院时，这些患者比其他患者更常有呕吐史（P=0.047），格拉斯哥昏迷量表评分≤12分（P=0.02）；该组入院时癫痫发作患病率较高的趋势也很明显（P=0.07）。所有患者均存活，但其中15例（12%）出院时有神经功能缺损。对28名儿童进行的随访评估表明，脑炎发作10至18个月后认知和行为缺损增加。
出现无菌性脑膜炎或脑炎的儿童应考虑拉科罗斯病毒感染。低钠血症和体温升高可能与临床病情恶化有关。
