Solomon Tom, Willison Hugh
Department of Neurological Science, and Medical Microbiology, University of Liverpool, Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
Curr Opin Infect Dis. 2003 Oct;16(5):375-81. doi: 10.1097/00001432-200310000-00002.
Although acute flaccid paralysis (AFP) is more frequently seen in the tropics than in temperate regions, recent outbreaks of West Nile virus (WNV) in North America have drawn attention to this important presentation. Starting with anatomical and neurophysiological considerations, this article examines data on AFP caused by WNV, and considers recent data on paralysis caused by enteroviruses, and Guillain-Barré syndrome (GBS).
Neurophysiological, radiological and pathological studies suggest WNV causes AFP by damaging anterior horn cells in the spinal cord. The clinical presentation is probably best described as a 'poliomyelitis-like illness', and the disease as 'WNV myelitis'. Other findings during the recent outbreaks include increasing recognition of a Parkinson's-disease like presentation, and descriptions of virus transmission in blood transfusions and transplanted organs. GBS is now recognized as several disorders characterized by immune-mediated attack on peripheral nerves: in acute inflammatory demyelinating polyneuropathy the myelin sheath and Schwann cell of sensory and motor nerves are targeted; acute motor axonal and acute motor and sensory axonal neuropathy often follow Campylobacter jejuni enteritis and are associated with antibodies against the ganglioside component of the nerve axolemmal membrane. In Asia-Pacific, enterovirus 71 has caused outbreaks of neurological diseases with AFP and encephalitis, but no single genogroup of virus appears responsible for severe disease.
Despite the near eradication of poliomyelitis, AFP caused by viruses remains an important clinical presentation. Distinguishing direct viral causes from GBS is important for public health reasons, and to avoid inappropriate therapies.
尽管急性弛缓性麻痹（AFP）在热带地区比温带地区更为常见，但北美最近爆发的西尼罗河病毒（WNV）疫情已引起人们对这一重要表现的关注。本文从解剖学和神经生理学角度出发，研究了WNV所致AFP的数据，并考虑了肠道病毒和吉兰 - 巴雷综合征（GBS）所致麻痹的最新数据。
神经生理学、放射学和病理学研究表明，WNV通过损害脊髓前角细胞导致AFP。临床表现或许最好描述为“脊髓灰质炎样疾病”，而该疾病称为“WNV脊髓炎”。最近疫情期间的其他发现包括越来越多地认识到类似帕金森病的表现，以及关于输血和移植器官中病毒传播的描述。GBS现在被认为是几种以外周神经免疫介导攻击为特征的疾病：在急性炎症性脱髓鞘性多发性神经病中，感觉和运动神经的髓鞘和施万细胞是攻击目标；急性运动轴索性和急性运动和感觉轴索性神经病常继发于空肠弯曲菌肠炎，并与针对神经轴膜神经节苷脂成分的抗体有关。在亚太地区，肠道病毒71已引发伴有AFP和脑炎的神经系统疾病疫情，但似乎没有单一病毒基因组导致严重疾病。
尽管脊髓灰质炎已近乎根除，但病毒所致AFP仍然是一种重要的临床表现。出于公共卫生原因以及避免不适当治疗，区分病毒直接病因与GBS很重要。
