From the Division of Neuroimmunology and Neuro-Infectious Diseases (D.R.W., S.I.C., F.J.M., S.S.M.), Department of Neurology, Massachusetts General Hospital; Department of Neurology (D.R.W.), Brigham and Women's Hospital; Department of Pathology (I.H.S.), Brigham and Women's Hospital; and Department of Neurology (D.R.W., F.J.M., S.S.M.), Harvard Medical School, Boston, MA.
Neurol Neuroimmunol Neuroinflamm. 2020 Nov 10;8(1). doi: 10.1212/NXI.0000000000000917. Print 2021 Jan.
To determine the clinical presentation and patient outcomes after treatment with IV immunoglobulin (IVIG), high-dose steroids, or standard of care alone in Eastern equine encephalitis (EEE), a mosquito-borne viral infection with significant neurologic morbidity and mortality.
A retrospective observational study of patients admitted to 2 tertiary academic medical centers in Boston, Massachusetts, with EEE from 2005 to 2019.
Of 17 patients (median [IQR] age, 63 [36-70] years; 10 (59%) male, and 16 (94%) White race), 17 patients had fever (100%), 15 had encephalopathy (88%), and 12 had headache (71%). Eleven of 14 patients with CSF cell count differential had a neutrophil predominance (mean = 60.6% of white blood cells) with an elevated protein level (median [IQR], 100 mg/dL [75-145]). Affected neuroanatomic regions included the basal ganglia (n = 9/17), thalamus (n = 7/17), and mesial temporal lobe (n = 7/17). A total of 11 patients (65%) received IVIG; 8 (47%) received steroids. Of the patients who received IVIG, increased time from hospital admission to IVIG administration correlated with worse long-term disability as assessed by the modified Rankin Scale (mRS) ( = 0.72, = 0.02); steroid use was not associated with the mRS score. The mortality was 12%.
Clinicians should suspect EEE in immunocompetent patients with early subcortical neuroimaging abnormalities and CSF neutrophilic predominance. This study suggests a lower mortality than previously reported, but a high morbidity rate in EEE. IVIG as an adjunctive to standard of care may be considered early during hospitalization.
确定在东部马脑炎（EEE）中，使用静脉注射免疫球蛋白（IVIG）、大剂量类固醇或单独标准治疗后的临床表型和患者结局，EEE 是一种由蚊子传播的病毒性感染，具有显著的神经发病率和死亡率。
对 2005 年至 2019 年期间在马萨诸塞州波士顿的 2 家三级学术医疗中心因 EEE 入院的患者进行回顾性观察性研究。
在 17 名患者中（中位数[IQR]年龄为 63 [36-70]岁；10 名男性[59%]，16 名白人[94%]），17 名患者有发热（100%），15 名患者有脑病（88%），12 名患者有头痛（71%）。14 名有脑脊液细胞计数差异的患者中有 11 名（71%）中性粒细胞增多（白细胞平均为 60.6%），蛋白水平升高（中位数[IQR]，100mg/dL[75-145]）。受影响的神经解剖区域包括基底节（17 名患者中的 9 名[53%]）、丘脑（17 名患者中的 7 名[41%]）和内侧颞叶（17 名患者中的 7 名[41%]）。共有 11 名患者（65%）接受 IVIG 治疗；8 名（47%）接受类固醇治疗。在接受 IVIG 的患者中，从入院到 IVIG 给药的时间增加与改良 Rankin 量表（mRS）评估的长期残疾恶化相关（=0.72，=0.02）；类固醇的使用与 mRS 评分无关。死亡率为 12%。
临床医生应怀疑免疫功能正常的患者出现早期皮质下神经影像学异常和 CSF 中性粒细胞增多症，可能患有 EEE。本研究表明，EEE 的死亡率低于先前报告，但发病率较高。在住院期间，IVIG 作为标准治疗的辅助手段可能会被考虑。
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