Kleinschmidt-DeMasters B K, Marder Brad A, Levi Marilyn E, Laird Stephen P, McNutt J Trevor, Escott Edward J, Everson Gregory T, Tyler Kenneth L
Department of Pathology, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
Arch Neurol. 2004 Aug;61(8):1210-20. doi: 10.1001/archneur.61.8.1210.
In the 2003 West Nile virus (WNV) epidemic, Colorado reported more WNV cases than any other state, including an unprecedented number in organ transplant recipients.
Physicians caring for transplant recipients hospitalized with naturally acquired WNV encephalitis provided data to characterize the clinical symptoms, results of diagnostic studies, and outcomes.
Eleven transplant recipients were identified (4 kidney, 2 stem cell, 2 liver, 1 lung, and 2 kidney/pancreas). Seven were directly admitted to 1 of the 2 hospitals in the study, and 4 were referred to 1 of these centers from regional hospitals. All but 1 patient had a prodrome typical of WNV encephalitis in nonimmunosuppressed patients. Ten patients developed meningoencephalitis, which in 3 cases was associated with acute flaccid paralysis. One patient developed acute flaccid paralysis without encephalitis. Six patients had significant movement disorders including tremor, myoclonus, or parkinsonism. All patients had cerebrospinal fluid pleocytosis and WNV-specific IgM in the cerebrospinal fluid and/or serum. Cerebrospinal fluid cytologic studies (n = 5) showed atypical lymphocytes, some resembling plasma cells; however, flow cytometry (n = 3) showed that cells were almost exclusively of T-cell (not B-cell or plasma cell) lineage. Magnetic resonance images of the brain were abnormal in 7 of 8 tested patients, and electroencephalograms were abnormal in 7 of 7, with 2 showing periodic lateralized epileptiform discharges. Nine of 11 patients survived infection, but 3 had significant residual deficits. One patient died 17 days after admission, and autopsy findings revealed severe panencephalitic changes with multifocal areas of necrosis in the cerebral deep gray nuclei, brainstem, and spinal cord as well as diffuse macrophage influx in the periventricular white matter. A second patient died of complications of WNV encephalitis 6 months after hospital admission.
Naturally acquired WNV encephalitis in transplant recipients shows diagnostic, clinical, and laboratory features similar to those reported in nonimmunocompromised individuals, but neuroimaging, electroencephalography, and autopsy results verify that these patients develop neurological damage at the severe end of the spectrum.
在2003年西尼罗河病毒（WNV）疫情中，科罗拉多州报告的WNV病例比其他任何州都多，包括器官移植受者中出现了前所未有的病例数。
负责照顾因自然感染WNV脑炎住院的移植受者的医生提供了数据，以描述临床症状、诊断研究结果和预后情况。
共确定了11名移植受者（4例肾移植、2例干细胞移植、2例肝移植、1例肺移植和2例肾/胰腺移植）。其中7例直接入住研究中的两家医院之一，4例从地区医院转诊至这些中心之一。除1例患者外，所有患者都有非免疫抑制患者典型的WNV脑炎前驱症状。10例患者发展为脑膜脑炎，其中3例伴有急性弛缓性麻痹。1例患者出现急性弛缓性麻痹但无脑炎。6例患者有明显的运动障碍，包括震颤、肌阵挛或帕金森综合征。所有患者脑脊液均有细胞增多，脑脊液和/或血清中有WNV特异性IgM。脑脊液细胞学检查（n = 5）显示非典型淋巴细胞，有些类似浆细胞；然而，流式细胞术（n = 3）显示细胞几乎均为T细胞谱系（而非B细胞或浆细胞谱系）。8例接受检测的患者中7例脑部磁共振成像异常，7例脑电图异常，其中2例显示周期性一侧性癫痫样放电。11例患者中有9例感染后存活，但3例有明显的残留缺陷。1例患者入院17天后死亡，尸检结果显示严重全脑炎改变，脑深部灰质核、脑干和脊髓有多灶性坏死区域，以及脑室周围白质有弥漫性巨噬细胞浸润。第二例患者在入院6个月后死于WNV脑炎并发症。
移植受者自然感染WNV脑炎的诊断、临床和实验室特征与非免疫功能低下个体中报告的相似，但神经影像学、脑电图和尸检结果证实这些患者在疾病严重程度谱的严重端出现神经损伤。
