Schwermer Benedikt, Eschle Daniel, Bloch-Infanger Constantine
Dtsch Med Wochenschr. 2017 Jul;142(14):1063-1066. doi: 10.1055/s-0043-106282. Epub 2017 Jul 20.
50 year-old man with fever and headache starting one week after returning from his vacation in Thailand. His general practitioner prescribed amoxicillin/clavulanic acid, without further analyses to pinpoint the infection. The examination of cerebro-spinal fluid was crucial for the final diagnosis. Lumbar puncture demonstrated a predominantly mononuclear pleocytosis of 80 cells/µl (< 5) with an elevated protein of 782 mg/l (< 450); glucose and lactate were within normal limits. Initially we tried to treat a broad range of organisms potentially causing meningitis or encephalitis. Typical bacteria and viruses endemic to Switzerland were not found, thus anti-infective treatment was stopped. Also the search for malaria, HIV, Chikungunya and Dengue infections yielded negative results. After 10 days we received a positive serologic test for Japanese encephalitis virus (JEV). The Japanese encephalitis virus is transmitted by mosquitoes and is epidemiologically one of the most important transmissible neurologic diseases in Asia. Although only a minority of infected patients are gravely ill, their sequelae and death toll are considerable. Since 2009 a well-tolerated vaccine is available.
一名50岁男性，在泰国度假归来一周后开始出现发热和头痛症状。他的全科医生开了阿莫西林/克拉维酸，未进行进一步分析以明确感染病因。脑脊液检查对最终诊断至关重要。腰椎穿刺显示以单核细胞为主的细胞增多，每微升80个细胞（<5个），蛋白升高至782毫克/升（<450毫克/升）；葡萄糖和乳酸水平正常。起初，我们试图治疗一系列可能导致脑膜炎或脑炎的病原体。未发现瑞士本地的典型细菌和病毒，因此停止了抗感染治疗。对疟疾、艾滋病毒、基孔肯雅热和登革热感染的检测也均为阴性。10天后，我们收到日本脑炎病毒（JEV）血清学检测呈阳性的结果。日本脑炎病毒通过蚊子传播，在流行病学上是亚洲最重要的可传播神经系统疾病之一。虽然只有少数感染患者病情严重，但其后遗症和死亡人数相当可观。自2009年以来，有一种耐受性良好的疫苗可供使用。
