急性弛缓性麻痹：西尼罗河病毒感染一种新认识的并发症的范围

Acute flaccid paralysis: the spectrum of a newly recognized complication of West Nile virus infection.

作者信息

Saad Mustafa, Youssef Souad, Kirschke David, Shubair Mohammed, Haddadin Dafer, Myers James, Moorman Jonathan

机构信息

Department of Internal Medicine, James H. Quillen College of Medicine, East Tennessee State University, Medical Service, James H. Quillen VAMC, Mountainhome, Box 70622, Johnson City, TN 37614, USA.

出版信息

J Infect. 2005 Aug;51(2):120-7. doi: 10.1016/j.jinf.2004.10.005. Epub 2004 Nov 6.

DOI:10.1016/j.jinf.2004.10.005

PMID:16038762

Abstract

OBJECTIVES

Acute flaccid paralysis (AFP) has recently emerged as a major central nervous system complication associated with West Nile virus (WNV) infection. The spectrum of clinical presentations of AFP in WNV infection and its sequelae have not been well-studied.

METHODS

We describe three patients with AFP due to WNV infection and review the clinical presentations of 56 patients with this complication derived from published studies.

RESULTS

Patients with AFP and WNV presented with a spectrum of illness ranging from single extremity paralysis to quadriparalysis with cranial nerve involvement. Patients commonly developed respiratory failure (54%) and bladder dysfunction (22%). While fever was nearly universal (92%), signs of meningismus were less common (17%). Cerebrospinal fluid (CSF) analysis generally revealed a modest pleocytosis, and imaging studies were not diagnositic. Persistent neurologic impairment occurred in all survivors; overall mortality rate was high (22%) and was associated with both the extent of paralysis and advanced age.

CONCLUSION

AFP in the setting of WNV is associated with significant mortality and long-term morbidity.

摘要

目的

急性弛缓性麻痹（AFP）最近已成为与西尼罗河病毒（WNV）感染相关的一种主要中枢神经系统并发症。WNV感染中AFP的临床表现谱及其后遗症尚未得到充分研究。

方法

我们描述了3例因WNV感染导致AFP的患者，并回顾了已发表研究中56例有此并发症患者的临床表现。

结果

AFP合并WNV感染的患者表现出一系列病症，从单肢麻痹到伴有颅神经受累的四肢麻痹。患者常出现呼吸衰竭（54%）和膀胱功能障碍（22%）。虽然发热几乎普遍存在（92%），但脑膜刺激征则较少见（17%）。脑脊液（CSF）分析通常显示有轻度细胞增多，影像学检查无诊断意义。所有幸存者均出现持续性神经功能损害；总体死亡率较高（22%），且与麻痹程度和高龄相关。