Urošević Aleksandar, Dulović Olga, Milošević Branko, Maksić Nebojša, Popović Nataša, Milošević Ivana, Delić Dragan, Jevtović Djordje, Poluga Jasmina, Jordović Jelena, Peruničić Sanja, Stevanović Goran
Medical Faculty, University of Belgrade, Belgrade, Serbia.
Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia.
J Med Biochem. 2016 Nov 2;35(4):451-457. doi: 10.1515/jomb-2016-0022. eCollection 2016 Oct.
West Nile virus neuroinvasive disease (WNND) occurs in less than 1% of infected people. Leukocytosis with lymphocytopenia, mild anaemia, thrombocytopenia, elevated liver and muscle enzymes and hyponatremia are occasionally present in patients with WNND. Cerebrospinal fluid (CSF) findings resemble other viral neuroinfections. The purpose of this study is to pre sent some of the most important laboratory findings of our patients with WNND and to evaluate their correlation with fatal outcome.
The study included 161 patients with WNND. Their blood and CSF samples were cytobiochemically analysed and the obtained variables were then tested for predictive significance of the disease outcome, or used for differentiation between two clinical syndromes (encephalitis vs meningitis).
West Nile encephalitis was present in 127 (78.9%) patients and West Nile meningitis was diagnosed in 34 (21.1%) cases. Leukocytosis was found in 45.9% patients. CRP level higher than 100 mg/L was registered only in those with encephalitis (p=0.020). CSF leukocyte count was 146±171 per microlitre, with slight lymphocytic predominance (mean 52%). Hypoglycorrhachia was registered in 9.3% of our patients with WNND. Twenty-eight (17.4%) patients died and all of them had encephalitis. Independent predictors of fatal outcome in WNND were serum CRP > 100 mg/L (p=0.011) and CSF proteins > 1 g/L (p=0.002).
WNND usually affects older males. Prolonged neutrophilic predominance in CSF can occasionally be present, as well as hypoglycorrhachia. Patients with encephalitis, high serum CRP and high CSF protein level have a higher risk of fatal outcome.
西尼罗河病毒神经侵袭性疾病（WNND）在不到1%的感染者中发生。WNND患者偶尔会出现白细胞增多伴淋巴细胞减少、轻度贫血、血小板减少、肝酶和肌酶升高以及低钠血症。脑脊液（CSF）检查结果与其他病毒性神经感染相似。本研究的目的是展示我们的WNND患者的一些最重要的实验室检查结果，并评估它们与致命结局的相关性。
该研究纳入了161例WNND患者。对他们的血液和脑脊液样本进行细胞生化分析，然后对获得的变量进行疾病结局预测意义的测试，或用于区分两种临床综合征（脑炎与脑膜炎）。
127例（78.9%）患者为西尼罗河脑炎，34例（21.1%）诊断为西尼罗河脑膜炎。45.9%的患者出现白细胞增多。仅在脑炎患者中CRP水平高于100mg/L（p=0.020）。脑脊液白细胞计数为每微升146±171，以淋巴细胞轻度占优势（平均52%）。9.3%的WNND患者出现脑脊液低糖。28例（17.4%）患者死亡，且均为脑炎患者。WNND致命结局的独立预测因素是血清CRP>100mg/L（p=0.011）和脑脊液蛋白>1g/L（p=0.002）。
WNND通常影响老年男性。脑脊液中偶尔会出现长时间的中性粒细胞占优势，以及脑脊液低糖。脑炎患者、血清CRP高和脑脊液蛋白水平高的患者有更高的致命结局风险。
