Omalu Bennet I, Shakir Abdulrazek A, Wang Guoji, Lipkin W Ian, Wiley Clayton A
Department of Pathology, University of Pittsburgh, PA 15213, USA.
Brain Pathol. 2003 Oct;13(4):465-72. doi: 10.1111/j.1750-3639.2003.tb00477.x.
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.
我们报告了一例87岁白人男性园丁患致命性暴发性西尼罗河病毒（WNV）脑膜脑炎的病例。这位宾夕法尼亚州的患者出现了3天的流感样症状。他的住院病程极其危急，入院十天内就出现昏迷、依赖呼吸机、皮质和脑干功能丧失。急性血清和脑脊液样本通过酶联免疫吸附测定（ELISA）显示WNV IgM抗体水平升高，同时脑脊液白细胞、蛋白质和葡萄糖水平也升高。完整的尸检显示有多灶性淋巴细胞性心肌炎和严重的慢性肾小管间质性肾炎。对脾脏、肾脏和大脑的死后样本进行病毒培养和聚合酶链反应（PCR）分析，结果显示WNV呈阳性。来自大脑和脊髓所有区域的组织学切片显示为严重的、非坏死性的、亚急性的脊髓灰质炎脑膜脑炎。虽然灰质和白质均有炎症，但灰质受累更为严重。许多灰质核显示严重的神经元丧失，残留的濒死神经元被活化的小胶质细胞包围。免疫组织化学染色显示脑膜和脑实质有大量CD8 T淋巴细胞和血管周围B淋巴细胞浸润。电子显微镜照片显示弥漫性细胞内和细胞外水肿，但未发现病毒颗粒。对WNV进行免疫组织化学和免疫荧光染色显示残留神经元的细胞质内有阳性反应。西尼罗河病毒主要通过直接感染神经元介导脊髓灰质炎脑炎。
