Ooi Mong How, Lewthwaite Penny, Lai Boon Foo, Mohan Anand, Clear Daniela, Lim Lina, Krishnan Shekhar, Preston Teresa, Chieng Chae Hee, Tio Phaik Hooi, Wong See Chang, Cardosa Jane, Solomon Tom
Department of Paediatrics, Sibu Hospital, Sibu, Malaysia.
Clin Infect Dis. 2008 Aug 15;47(4):458-68. doi: 10.1086/590008.
Japanese encephalitis is a major public health problem in Asia. However, there is little data on the long-term outcome of Japanese encephalitis survivors.
We prospectively evaluated children with serologically confirmed Japanese encephalitis over an 8.3-year period. The patients were assessed and their outcomes were graded with a functional outcome score at hospital discharge and at follow-up appointments. We examined how patient outcome at hospital discharge compared with that at long-term follow-up visits, when changes in outcome occurred, and the prognostic indicators of the eventual outcome.
One hundred and eighteen patients were recruited into the study, and 10 (8%) died during the acute phase of illness. At hospital discharge, 44 (41%) of the 108 patients who survived had apparent full recovery; 3 (3%) had mild, 28 (26%) had moderate, and 33 (31%) had severe neurological sequelae. Eighty six of the 108 patients were followed up for a median duration of 52.9 months (range, 0.9-114.9 months). During follow-up, 31 patients experienced improvement, but 15 patients experienced deterioration in their outcome grade. In most cases, assessment during the first 3-6 months after hospital discharge was predictive of the long-term outcome. More than one-half of the patients continued to experience neuropsychological sequelae and behavioral disorders. A combination of poor perfusion, Glasgow coma score < or =8, and > or =2 witnessed seizures predicted a poor long-term outcome with 65% sensitivity and 92% specificity.
Neurological assessment of Japanese encephalitis survivors at hospital discharge does not predict long-term outcome. Seizures and shock are treatable risk factors for a poor outcome at hospital discharge and at long-term follow-up visits.
日本脑炎是亚洲一个主要的公共卫生问题。然而，关于日本脑炎幸存者的长期预后的数据很少。
我们对血清学确诊为日本脑炎的儿童进行了为期8.3年的前瞻性评估。在患者出院时及随访预约时对其进行评估，并使用功能预后评分对其预后进行分级。我们研究了出院时患者的预后与长期随访时的预后相比情况如何、何时出现预后变化以及最终预后的预测指标。
118名患者被纳入研究，10名（8%）在疾病急性期死亡。在出院时，108名存活患者中有44名（41%）明显完全康复；3名（3%）有轻度、28名（26%）有中度、33名（31%）有重度神经后遗症。108名患者中的86名接受了随访，中位随访时间为52.9个月（范围为0.9 - 114.9个月）。在随访期间，31名患者病情好转，但15名患者的预后等级恶化。在大多数情况下，出院后前3 - 6个月的评估可预测长期预后。超过一半的患者继续存在神经心理后遗症和行为障碍。灌注不良、格拉斯哥昏迷评分≤8分以及≥2次目击发作共同预测长期预后不良，敏感性为65%，特异性为92%。
日本脑炎幸存者出院时的神经学评估不能预测长期预后。癫痫发作和休克是出院时及长期随访时预后不良的可治疗危险因素。
