神经型寨卡病毒的长期预后：生物学诊断的重要性。
Long-term outcome in neuroZika: When biological diagnosis matters.
机构信息
From the Service de Neurologie (A.L., Q.L.), Service de Radiologie (P.P.), Laboratoire de Microbiologie Clinique et Environnementale (C.H., S.B.), and Service de Réanimation (G.T.), Centre Hospitalier Universitaire de la Guadeloupe, Institut Pasteur de Guadeloupe (S.B.), Faculté de Médecine (A.L., Q.L., R.C., G.T., S.B., A.C.), Equipe d'accueil 4537 (F.N., R.C., A.C.), Université des Antilles; Faculté de Médecine de Sorbonne Université (A.L., E.H., E.R.), Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche 7225, Institut du Cerveau et de la Moelle Épinière, ICM, Paris; Service de Réanimation (J.-L.F., A.-C.S., R.V.), Service de Neurologie (A.S.), Service de Maladies Infectieuses et Tropicales (A.C., B.R.), and Laboratoire de Virologie (R.C., F.N.), Centre Hospitalier Universitaire de la Martinique (A.C.); Inserm CIC 1424 (B.T., A.C.), Centre d'Investigation Clinique Antilles Guyane; Emerging Diseases Epidemiology Unit (Y.M.), Institut Pasteur; Département de Neurologie (E.M., E.R.), AP-HP, Hôpital de la Pitié-Salpêtrière; and Institut Pasteur, Perception and Memory Unit (P.-M.L., F.L.), Centre National de la Recherche Scientifique, Unité Mixte de Recherche 3571, Paris, France.
出版信息
Neurology. 2019 May 21;92(21):e2406-e2420. doi: 10.1212/WNL.0000000000007536. Epub 2019 Apr 26.
OBJECTIVE
To characterize the full spectrum, relative frequency, and prognosis of the neurologic manifestations in Zika virus (ZIKV) postnatal infection.
METHODS
We conducted an observational study in consecutive ZIKV-infected patients presenting with neurologic manifestations during the French West Indies 2016 outbreak.
RESULTS
Eighty-seven patients, including 6 children, were enrolled. Ninety-five percent of all cases required hospitalization. Guillain-Barré syndrome was the most frequent manifestation (46.0%) followed by encephalitis or encephalomyelitis (20.7%), isolated single or multiple cranial nerve palsies (9.2%), other peripheral manifestations (6.9%), and stroke (1.1%). Fourteen patients (16.1%), including one child, developed a mixed disorder involving both the central and peripheral nervous system. Mechanical ventilation was required in 21 cases, all of whom had ZIKV RNA in at least one biological fluid. Two adult patients died due to neuroZika. Clinical follow-up (median 14 months; interquartile range, 13-17 months) was available for 76 patients. Residual disability (modified Rankin Scale score ≥2) was identified in 19 (25.0%) patients; in 6 cases (7.9%), disability was severe (modified Rankin Scale score ≥4). Among patients with ZIKV RNA detected in one biological fluid, the risk of residual disability or death was higher (odds ratio 9.19; confidence interval 1.12-75.22; = 0.039).
CONCLUSIONS
NeuroZika spectrum represents a heterogeneous group of clinical neurologic manifestations. During an outbreak, clinicians should consider neuroZika in patients presenting with cranial nerve palsies and a mixed neurologic disorder. Long-term sequelae are frequent in NeuroZika. ZIKV reverse-transcription PCR status at admission can inform prognosis and should therefore be taken into consideration in the management of hospitalized patients
目的
描述 Zika 病毒（ZIKV）产后感染的神经表现的全貌、相对频率和预后。
方法
我们对 2016 年法属西印度群岛爆发期间出现神经表现的连续 Zika 病毒感染患者进行了一项观察性研究。
结果
共纳入 87 例患者，包括 6 例儿童。所有病例中有 95%需要住院治疗。最常见的表现为格林-巴利综合征（46.0%），其次为脑炎或脑脊髓炎（20.7%）、孤立性单或多颅神经麻痹（9.2%）、其他周围表现（6.9%）和中风（1.1%）。14 例（16.1%）患者，包括 1 例儿童，出现了累及中枢和周围神经系统的混合性疾病。21 例患者需要机械通气，他们的至少一种生物体液中都有 ZIKV RNA。2 例成年患者因神经 Zika 而死亡。76 例患者可进行临床随访（中位数 14 个月；四分位距，13-17 个月）。19 例（25.0%）患者存在残留残疾（改良 Rankin 量表评分≥2）；6 例（7.9%）患者残疾严重（改良 Rankin 量表评分≥4）。在一种生物体液中检测到 ZIKV RNA 的患者中，残留残疾或死亡的风险更高（比值比 9.19；95%置信区间 1.12-75.22； = 0.039）。
结论
神经 Zika 谱代表了一组不同的临床神经表现。在疫情爆发期间，临床医生应考虑在出现颅神经麻痹和混合性神经障碍的患者中考虑神经 Zika。神经 Zika 后遗症较为常见。入院时的 ZIKV 逆转录酶 PCR 状态可以提示预后，因此应在管理住院患者时加以考虑。
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