Department of Neurology, Qilu Hospital of Shandong University, Jinan, China.
Department of Neurology, Peking Union Medical College Hospital, Beijing, China.
Int J Infect Dis. 2019 Oct;87:92-99. doi: 10.1016/j.ijid.2019.08.007. Epub 2019 Aug 10.
Pseudorabies virus (PRV) has been thought to cause diseases only in animals. However, recent studies have shown that PRV can also cause illnesses in humans.
This was a case series study. The cases of five patients with clinical symptoms of acute encephalitis, which were confirmed to be caused by PRV infections, were reviewed.
The five patients all had jobs involving the handling of pigs. They had acute onset and rapid progression of clinical presentations, which were consistent with central nervous system infections. Four of them had respiratory failure, which required ventilator support. Brain magnetic resonance imaging showed abnormal signals in the bilateral temporal lobes and insular cortex in all five patients, bilateral frontal lobes in one patient, and caudate nucleus in one patient. Cerebrospinal fluid analysis results were consistent with a viral infection. Next-generation sequencing of the cerebrospinal fluid confirmed the presence of PRV. All patients received human immunoglobulin, glucocorticoids, antiviral agents, and symptomatic supportive treatments. All patients survived until discharge, but suffered from various sequelae. Pneumonia was the most common complication during the disease course.
PRV encephalitis should be included in the differential diagnosis of patients with a clinical presentation of central nervous system infection, especially for those who have had recent contact with pigs.
伪狂犬病毒（PRV）以前被认为只会导致动物疾病。然而，最近的研究表明，PRV也可能导致人类患病。
这是一项病例系列研究。回顾了 5 例临床诊断为 PRV 感染引起的急性脑炎患者的病例。
5 例患者均从事与猪有关的工作。他们的临床症状具有急性起病和迅速进展的特点，符合中枢神经系统感染。其中 4 例患者发生呼吸衰竭，需要呼吸机支持。所有患者的脑磁共振成像均显示双侧颞叶和岛叶存在异常信号，1 例患者双侧额叶存在异常信号，1 例患者尾状核存在异常信号。脑脊液分析结果符合病毒感染。脑脊液的下一代测序证实存在 PRV。所有患者均接受了人免疫球蛋白、糖皮质激素、抗病毒药物和对症支持治疗。所有患者均存活至出院，但均遗留各种后遗症。肺炎是病程中最常见的并发症。
对于有中枢神经系统感染临床表现的患者，尤其是近期接触过猪的患者，应将 PRV 脑炎纳入鉴别诊断。
