Feki Imed, Marrakchi Chakib, Ben Hmida Mohamed, Belahsen Faozi, Ben Jemaa Mounir, Maaloul Imed, Kanoun Fakher, Ben Hamed Sonia, Mhiri Chokri
Department of Neurology, Habib Bourguiba University Hospital, Hédi Chaker University Hospital, Sfax, Tunisia.
Neuroepidemiology. 2005;24(1-2):1-7. doi: 10.1159/000081042. Epub 2004 Sep 23.
West Nile fever (WNF) is a mosquito-borne flavivirus infection. It is epidemic in Africa and Asia. In autumn 1997, a WNF epidemic occurred in the Sfax area (southeastern Tunisia). Fifty-seven patients were hospitalized with aseptic meningitis and/or encephalitis. Search for specific anti-West Nile virus (WNV) antibodies in serum and cerebrospinal fluid (CSF) was performed using an ELISA test. Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to detect the WNV genome in CSF and brain specimens. Recent central nervous system (CNS) infection by WNV was confirmed in 30 patients, probable infection in 17 and it was excluded in 10. In the confirmed subgroup, patients with encephalitis were older than those with meningitis. CSF showed pleocytosis, high protein (47%) and normal glucose levels. Brain computed tomography-scan (CT-scan) and magnetic resonance imaging (MRI) were normal. RT-PCR disclosed WNV genome in the CSF in two cases and in a brain specimen in one. Three patients died rapidly, the remaining cases had favorable prognosis. Autopsy was performed in two cases and showed nonspecific lesions of encephalitis. No viral inclusions were seen with light microscopy. Seropositivity rate in patients' proxies for WNV was 23.4%. Prognosis of CNS involvement during WNF seemed to be poor in older patients. This is the first WNV encephalitis epidemic report in the Sfax area of Tunisia.
西尼罗河热（WNF）是一种由蚊子传播的黄病毒感染。它在非洲和亚洲流行。1997年秋季，突尼斯东南部的斯法克斯地区发生了西尼罗河热疫情。57名患者因无菌性脑膜炎和/或脑炎住院。使用酶联免疫吸附测定（ELISA）试验检测血清和脑脊液（CSF）中的特异性抗西尼罗河病毒（WNV）抗体。逆转录聚合酶链反应（RT-PCR）用于检测脑脊液和脑标本中的WNV基因组。30例患者确诊近期有WNV中枢神经系统（CNS）感染，17例可能感染，10例排除感染。在确诊亚组中，脑炎患者比脑膜炎患者年龄大。脑脊液显示细胞增多症、高蛋白（47%）和正常葡萄糖水平。脑部计算机断层扫描（CT扫描）和磁共振成像（MRI）正常。RT-PCR在2例脑脊液和1例脑标本中检测到WNV基因组。3例患者迅速死亡，其余病例预后良好。对2例进行了尸检，显示为非特异性脑炎病变。光学显微镜下未见病毒包涵体。患者家属中WNV血清阳性率为23.4%。西尼罗河热期间中枢神经系统受累的预后在老年患者中似乎较差。这是突尼斯斯法克斯地区首例WNV脑炎疫情报告。
