School of Clinical Medicine, Weifang Medical University, Weifang, 261042, Shandong, China.
Department of Neurology, Linyi People's Hospital, Wuhan Road, Lanshan District, Linyi, 276003, Shandong, China.
Neurol Sci. 2021 Jul;42(7):2811-2817. doi: 10.1007/s10072-020-04867-8. Epub 2020 Nov 9.
Japanese encephalitis (JE) is a critical problem of public health worldwide; however, there is limited data about the clinical features and indicators of outcome in adults with severe Japanese encephalitis.
The clinical manifestations and laboratory study on brain neuroimaging of patients with severe JE were statistically analyzed retrospectively. All patients were followed up for 6 months after discharge. The patients were grouped into good outcome and poor outcome according to the results of the follow-up.
This retrospective study consists of 9 adults with severe JE, including 5 cases with poor outcome, defined as the modified Rankin Scale (mRS) scores of greater than or equal to 4 points, and remained ventilator dependent. Typical clinical manifestations of JE include fever (100%), altered consciousness (100%), headache (66.7%), flaccid weakness (66.7%), and status epilepticus (44.4%). Serological examination revealed that a higher percentage of neutrophils and a lower percentage of lymphocytes at admission may be associated with a poor outcome. Abnormal neuroimaging of the thalamus (85.7%), hippocampal (71.4%), midbrain (28.6%), and basal ganglia (14.3%) was found. 42.9% of patients left severe irreversible disability, and the most prominent were mental symptoms (71.4%) and memory or understanding disorder (57.1%).
Our data suggest that respiratory failure is one of the important causes of early death. Serologic examination, coma, and status epilepticus may indicate a poor outcome for severe JE. Additionally, the hippocampus is the second most common lesion in the adults with severe JE. A large-scale clinical trial is required to further confirm these conclusions.
日本脑炎（JE）是全球公共卫生的一个重大问题；然而，关于成人重症日本脑炎的临床特征和结局指标的数据有限。
回顾性统计分析重症 JE 患者的临床表现和脑神经影像学的实验室研究。所有患者在出院后均进行了 6 个月的随访。根据随访结果，将患者分为预后良好和预后不良两组。
这项回顾性研究包括 9 例重症 JE 成人患者，其中 5 例预后不良，定义为改良 Rankin 量表（mRS）评分≥4 分，且仍需呼吸机支持。JE 的典型临床表现包括发热（100%）、意识改变（100%）、头痛（66.7%）、弛缓性无力（66.7%）和癫痫持续状态（44.4%）。血清学检查显示，入院时较高的中性粒细胞百分比和较低的淋巴细胞百分比可能与不良预后相关。丘脑（85.7%）、海马（71.4%）、中脑（28.6%）和基底节（14.3%）的神经影像学异常。42.9%的患者遗留严重的不可逆残疾，以精神症状（71.4%）和记忆或理解障碍（57.1%）最为突出。
我们的数据表明，呼吸衰竭是导致早期死亡的重要原因之一。血清学检查、昏迷和癫痫持续状态可能预示着重症 JE 的不良预后。此外，海马是成人重症 JE 中第二常见的病变部位。需要进行大规模的临床试验来进一步证实这些结论。
