Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, V.le C. Golgi, 19 -, 27100, Pavia (PV), Italy.
Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy.
Ital J Pediatr. 2018 Nov 20;44(1):140. doi: 10.1186/s13052-018-0574-x.
West Nile virus (WNV) is a mosquito-borne RNA virus belonging to the Flaviviridae family. Symptomatic infection happens in only about 20% of the cases, while WNV neuroinvasive disease (WNND) is rare and accounts for less than 1%. There is insufficient information about natural history and clinical course in children, because underdiagnosis is common, and reports are scarce. On the other hand, Europe has seen a dramatic increase of WNV infections in the last decades, and the Po valley itself, in Northern Italy, has become an endemic region since 2013.
We hereby report a case of West-Nile virus neuroinvasive disease in a 12-year-old boy. This is one of the very few cases diagnosed in the Italian pediatric population. The clinical presentation was compatible with acute encephalitis. Diagnosis was made by detection of specific IgM in both serum and cerebrospinal fluid. He finally was discharged with complete recovery, and no neurologic sequelae after a 12-months follow up period.
Given its non-specific clinical presentation, the diffusion of WNV constitutes a crucial and emerging concern. Even though rare, neuroinvasive WNV infection should always be suspected in pediatric patients, living or traveling in endemic areas, presenting with meningitis, encephalitis or acute flaccid paralysis during the WNV transmission season.
西尼罗河病毒（WNV）是一种虫媒 RNA 病毒，属于黄病毒科。只有约 20%的病例出现症状性感染，而 WNV 神经侵袭性疾病（WNND）则较为罕见，不到 1%。关于儿童的自然史和临床病程的信息不足，因为漏诊很常见，且报告较少。另一方面，欧洲在过去几十年中看到了 WNV 感染的急剧增加，意大利北部的波河谷本身自 2013 年以来已成为一个地方性疫区。
我们在此报告一例 12 岁男孩的西尼罗河病毒神经侵袭性疾病。这是在意大利儿科人群中诊断出的极少数病例之一。临床表现与急性脑炎相符。通过在血清和脑脊液中检测到特异性 IgM 来做出诊断。经过 12 个月的随访期，他最终完全康复出院，没有留下任何神经后遗症。
鉴于其非特异性临床表现，WNV 的传播构成了一个关键且不断出现的关注点。即使罕见，WNV 神经侵袭性感染也应始终怀疑在流行地区居住或旅行、在 WNV 传播季节出现脑膜炎、脑炎或急性弛缓性麻痹的儿科患者中。
