López Horacio, Neira Jorge, Morales María Alejandra, Fabbri Cintia, D'Agostino María Laura, Zitto Teresa
Centro de Infectología, Institución Afiliada a la Facultad de Medicina de la Universidad de Buenos Aires, Argentina.
Medicina (B Aires). 2011;71(3):247-50.
We report the case of a male, 80-year-old resident in the City of Buenos Aires, with a diagnosis of St. Louis encephalitis (SLE) during a countrywide dengue outbreak, from January to May 2009. The patient had a chronic lymphocytic leukemia treated with chlorambucil, prostate cancer (hormone therapy and radiotherapy) and images consistent with bone metastases. Cerebrospinal fluid examination showed pleocytosis with a predominance of mononuclear cells and high protein concentration. Bacteria, fungi and mycobacteria cultures, as well as the PCR for herpes virus, HSV, CMV and EBV, were negative. We confirmed the diagnosis of SLE by detection of IgM antibodies in both CSF and serum sample with IgG seroconversion by neutralization in cell cultures and negative results for other flaviviruses with known circulation in Argentina. We review the evidence for the presence of the St. Louis virus in our country and point to the importance of the diagnosis and the search of other Flavivirus in suspected dengue cases with severe or atypical presentation. This work emphasizes the need to strengthen both the epidemiological surveillance of SLE, and vector control to prevent different infections transmitted by mosquitoes and to understand their true impact on public health in Argentina.
我们报告了一例居住在布宜诺斯艾利斯市的80岁男性病例，该患者在2009年1月至5月全国登革热疫情期间被诊断为圣路易斯脑炎（SLE）。患者患有慢性淋巴细胞白血病，接受苯丁酸氮芥治疗，还患有前列腺癌（激素治疗和放射治疗），影像学检查显示有骨转移。脑脊液检查显示细胞增多，以单核细胞为主，蛋白质浓度升高。细菌、真菌和分枝杆菌培养，以及针对疱疹病毒、单纯疱疹病毒、巨细胞病毒和EB病毒的聚合酶链反应（PCR）均为阴性。我们通过检测脑脊液和血清样本中的IgM抗体，以及细胞培养中IgG血清转化中和试验确诊为SLE，并且针对阿根廷已知传播的其他黄病毒检测结果为阴性。我们回顾了我国存在圣路易斯病毒的证据，并指出在出现严重或非典型表现的疑似登革热病例中诊断及查找其他黄病毒的重要性。这项工作强调了加强圣路易斯脑炎的流行病学监测以及病媒控制的必要性，以预防蚊子传播的不同感染，并了解它们对阿根廷公共卫生的实际影响。
