Khan Erum, Barr Kelli L, Farooqi Joveria Qais, Prakoso Dhani, Abbas Alizeh, Khan Zain Yar, Ashi Shanze, Imtiaz Kehkashan, Aziz Z, Malik Faisal, Lednicky John A, Long Maureen T
Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan.
Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States.
Front Public Health. 2018 Feb 27;6:20. doi: 10.3389/fpubh.2018.00020. eCollection 2018.
Like most of the world, Pakistan has seen an increase in mosquito-transmitted diseases in recent years. The magnitude and distribution of these diseases are poorly understood as Pakistan does not have a nation-wide system for reporting disease. A cross-sectional study to determine which flaviviruses were causing of arboviral disease in Pakistan was instituted. West Nile virus (WNV) is a cause of seasonal fever with neurotropic findings in countries that share borders with Pakistan. Here, we describe the active and persistent circulation of WNV in humans in the southern region of Pakistan. This is the first report of WNV causing neurological disease in human patients in this country. Of 997 enrolled patients presenting with clinical features suggestive of arboviral disease, 105 were positive for WNV IgM antibodies, and 71 of these patients possessed WNV-specific neutralizing antibodies. Cross-reactivity of WNV IgM antibodies with Japanese encephalitis virus (JEV) occurred in 75 of these 105 patients. WNV co-infections with Dengue viruses were not a contributing factor for the severity of disease. Nor did prior exposure to dengue virus contribute to incidence of neurological involvement in WNV-infected patients. Patients with WNV infections were more likely to present with altered mental status, seizures, and reduced Glasgow Coma scores when compared with JEV-infected patients. Human WNV cases and vector numbers exhibited a temporal correlation with climate.
与世界上大多数地方一样，近年来巴基斯坦经蚊子传播的疾病有所增加。由于巴基斯坦没有全国性的疾病报告系统，这些疾病的规模和分布情况鲜为人知。为此开展了一项横断面研究，以确定在巴基斯坦导致虫媒病毒病的黄病毒种类。西尼罗河病毒（WNV）在与巴基斯坦接壤的国家是导致伴有神经嗜性表现的季节性发热的病因。在此，我们描述了WNV在巴基斯坦南部地区人群中的活跃且持续传播情况。这是该国关于WNV导致人类患者出现神经疾病的首例报告。在997名表现出虫媒病毒病临床特征的登记患者中，105人WNV IgM抗体呈阳性，其中71名患者拥有WNV特异性中和抗体。这105名患者中有75人出现WNV IgM抗体与日本脑炎病毒（JEV）的交叉反应。WNV与登革病毒的合并感染并非疾病严重程度的影响因素。既往接触登革病毒也不会增加WNV感染患者出现神经受累的几率。与JEV感染患者相比，WNV感染患者更易出现精神状态改变、癫痫发作以及格拉斯哥昏迷评分降低。人类WNV病例数和病媒数量与气候呈现出时间上的相关性。
