Rayamajhi Ajit, Singh Rupa, Prasad Rajniti, Khanal Basudha, Singhi Sunit
Department of Pediatrics and Adolescent Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal.
Pediatr Int. 2007 Dec;49(6):978-84. doi: 10.1111/j.1442-200X.2007.02495.x.
A hospital-based prospective cross-sectional study was conducted in children aged 1 month-14 years to identify the proportion of viral encephalitis due to Japanese encephalitis (JE) and compare the clinico-laboratory profile and outcome of JE with that of other viral encephalitis (non-JE).
All probable cases of viral encephalitis on clinical and laboratory evaluation were confirmed as JE on anti-JE IgM in cerebrospinal fluid (CSF) and/or serum. Patients not having anti-JE IgM in CSF and/or serum were diagnosed as having non-JE.
Of 94 cases, 58 were JE and 36 non-JE. Although practice of rearing pigs at home was associated with JE (P = 0.0001), significantly higher serum creatinine, protein, aspartate aminotransferase and CSF protein levels were observed in non-JE. Longer duration of fever was associated with complete recovery in JE whereas shorter duration of fever was associated with recovery in non-JE. Risk of neurological sequelae (P = 0.01), especially hemiparesis (P = 0.03) was significantly more in JE. Sequelae were observed at 6 weeks follow up in 18.8% of JE and 13.9% of non-JE.
JE was the most common cause of viral encephalitis in eastern Nepal and should be suspected in encephalitic patients having pig rearing at home and neurological sequelae. Although duration of hospitalization and complication were higher in JE, final outcome was similar to non-JE. Longer duration of fever in JE and shorter duration of fever in non-JE correlated with recovery, while altered sensorium and focal neurological deficit were independent predictors of sequelae at 6 weeks only in JE and not in non-JE.
在1个月至14岁的儿童中开展了一项基于医院的前瞻性横断面研究，以确定日本脑炎（乙脑）所致病毒性脑炎的比例，并比较乙脑与其他病毒性脑炎（非乙脑）的临床实验室特征及转归。
所有经临床和实验室评估的疑似病毒性脑炎病例，通过脑脊液（CSF）和/或血清中的抗乙脑IgM确诊为乙脑。脑脊液和/或血清中未检测到抗乙脑IgM的患者被诊断为非乙脑。
94例病例中，58例为乙脑，36例为非乙脑。虽然家中养猪的行为与乙脑相关（P = 0.0001），但在非乙脑中观察到血清肌酐、蛋白质、天冬氨酸转氨酶和脑脊液蛋白水平显著更高。发热持续时间较长与乙脑的完全康复相关，而发热持续时间较短与非乙脑的康复相关。乙脑患者发生神经后遗症的风险（P = 0.01）显著更高，尤其是偏瘫（P = 0.03）。在6周随访时，18.8%的乙脑患者和13.9%的非乙脑患者出现了后遗症。
乙脑是尼泊尔东部病毒性脑炎最常见的病因，对于家中养猪且有神经后遗症的脑炎患者应怀疑为乙脑。虽然乙脑患者的住院时间和并发症更多，但最终转归与非乙脑相似。乙脑发热持续时间较长和非乙脑发热持续时间较短与康复相关，而意识改变和局灶性神经功能缺损仅在乙脑中是6周时后遗症的独立预测因素，在非乙脑中并非如此。
