Levi Marilyn E
Transplant Infectious Diseases, University of Colorado Denver, Denver, CO, USA,
Curr Infect Dis Rep. 2013 Nov 15. doi: 10.1007/s11908-013-0367-8.
West Nile virus infection has become the predominant cause of flavivirus-associated encephalitis in the US. While 80 % of infected individuals are asymptomatic, 20 % develop symptoms including fever, headache, transient rash and gastrointestinal symptoms. Among the immunocompetent population, 1 in 150 develop neuroinvasive disease characterized by acute flaccid paralysis, Parkinsonian cogwheel rigidity, meningitis, encephalitis, meningoencephalitis and asymmetric muscle weakness (Mostashari et al. in Lancet 358:261-264, 2001). In the immunocompromised population such as transplant recipients and HIV-infected and chemotherapy patients, the incidence of neuroinvasive disease may be increased. The largest population studied is recipients of solid organ transplants, with data on both donor-derived and naturally occurring transmissions. The risk of neuroinvasive disease in donor-derived infection is estimated to be between 50 % and 75 % while in those with mosquito-borne transmission the risk is estimated at 40 % of those infected (Kumar et al. in Am J Transplant 4:1883-1888, 2004). With significant morbidity associated with donor transmission, specific pretransplant screening recommendations are reviewed. Treatment includes supportive care and consideration for the use of intravenous immunoglobulin.
西尼罗河病毒感染已成为美国黄病毒相关脑炎的主要病因。虽然80%的感染者无症状，但20%会出现症状，包括发热、头痛、短暂皮疹和胃肠道症状。在免疫功能正常的人群中，150人中有1人会发生神经侵袭性疾病，其特征为急性弛缓性麻痹、帕金森齿轮样强直、脑膜炎、脑炎、脑膜脑炎和不对称性肌无力（Mostashari等人，《柳叶刀》358:261 - 264，2001年）。在免疫功能低下的人群中，如移植受者、HIV感染者和化疗患者，神经侵袭性疾病的发病率可能会增加。研究最多的人群是实体器官移植受者，有关于供体来源和自然发生传播的数据。供体来源感染中神经侵袭性疾病的风险估计在50%至75%之间，而在蚊媒传播感染的人群中，风险估计为感染者的40%（Kumar等人，《美国移植杂志》4:1883 - 1888，2004年）。鉴于供体传播会带来显著的发病率，本文对具体的移植前筛查建议进行了综述。治疗包括支持性护理以及考虑使用静脉注射免疫球蛋白。
