蜱传脑炎：与其他病毒性中枢神经系统感染相比，鞘内体液免疫反应和炎症细胞组成的差异模式。
Tick-Borne Encephalitis: A Differential Pattern of Intrathecal Humoral Immune Response and Inflammatory Cell Composition Compared with Other Viral CNS Infections.
机构信息
Department of Neurology, University of Ulm, 89081 Ulm, Germany.
Institute of Epidemiology and Medical Biometry, Ulm University, 89075 Ulm, Germany.
出版信息
Cells. 2020 Sep 25;9(10):2169. doi: 10.3390/cells9102169.
To investigate whether and how cerebrospinal fluid (CSF) findings can contribute to distinguish tick-borne encephalitis (TBE) from herpes simplex virus (HSV) and varicella zoster virus (VZV) induced central nervous system (CNS) infections (HSV-I, VZV-I). Chart review and identification of TBE, HSV- I, and VZV-I was carried out, fulfilling the following criteria: (1) clinical signs of encephalitis and/or meningitis, (2) complete CSF analysis and confirmed viral etiology by either PCR or antibody testing in CSF, (3) hospitalized patients, and (4) available brain magnetic resonance imaging (MRI). Fifty-nine patients with 118 CSF/serum pairs were included. These comprised 21 with TBE (35 CSF/serum pairs), 20 (40 CSF/serum pairs) with HSV-I, and 18 (43 CSF/serum pairs) with VZV-I. In contrast to HSV-I and VZV-I, CSF cell differentiation in TBE showed more often an increased (>20%) proportion of granulocytes ( < 0.01) and a more frequent quantitative intrathecal IgM synthesis ( = 0.001 and < 0.01, respectively), while the second was even more pronounced when follow-up CSF analyses were included ( < 0.001). CSF findings help to distinguish TBE from other viral infections. In cases with CSF pleocytosis and a positive history for a stay in or near an endemic area, TBE antibodies in CSF and serum should be determined, especially if granulocytes in CSF cell differentiation and/or an intrathecal IgM synthesis is present.
为了探究脑脊液（CSF）检查结果能否有助于鉴别蜱传脑炎（TBE）与单纯疱疹病毒（HSV）和水痘带状疱疹病毒（VZV）引起的中枢神经系统（CNS）感染（HSV-I、VZV-I），我们进行了病例回顾并对 TBE、HSV-I 和 VZV-I 进行了鉴定，符合以下标准：（1）脑炎和/或脑膜炎的临床体征，（2）完整的 CSF 分析以及通过 CSF 中的 PCR 或抗体检测确认病毒病因，（3）住院患者，以及（4）有脑磁共振成像（MRI）结果。共有 59 名患者的 118 份 CSF/血清对符合纳入标准，其中包括 21 例 TBE（35 份 CSF/血清对）、20 例 HSV-I（40 份 CSF/血清对）和 18 例 VZV-I（43 份 CSF/血清对）。与 HSV-I 和 VZV-I 不同，TBE 的 CSF 细胞分化更常表现为粒细胞比例增加（>20%）（<0.01）和定量性鞘内 IgM 合成（分别为=0.001 和<0.01），而当纳入后续 CSF 分析时，后一种情况更为明显（<0.001）。CSF 检查结果有助于鉴别 TBE 与其他病毒感染。在 CSF 有核细胞增多且有居住于或临近流行地区病史的情况下，应检测 CSF 和血清中的 TBE 抗体，尤其是如果 CSF 细胞分化中存在粒细胞和/或鞘内 IgM 合成时。
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