Karrasch Matthias, Pein Ulrich, Fritz Annekathrin, Lange Danica, Moritz Stefan, Amann Kerstin, Schmidt-Chanasit Jonas, Cadar Daniel, Tappe Dennis, Gabriel Martin
Department für Labormedizin, Abteilung III, Universitätsklinikum Halle (Saale).
Universitätsklinik und Poliklinik für Innere Medizin II, Halle (Saale).
Dtsch Med Wochenschr. 2021 Apr;146(7):482-486. doi: 10.1055/a-1218-9096. Epub 2021 Mar 29.
West-Nile-Virus (WNV) is a widely distributed flavivirus that is mainly transmitted between birds through different mosquito species (e. g. Culex, Aedes), but may also be transmitted to mammals including humans. WNV causes a spectrum of disease, ranging from asymptomatic infection to encephalitis in a minority of cases. Risk factors for severe disease are older age, cardiovascular disease and an immunocompromised state.
Here we report about a 60-year-old male patient who was referred to the University Hospital of Halle (Saale) with severe fever two years after kidney transplantation due to hypertensive nephropathy. No infection focus could be found and by day 6 in the course of his illness the patient developed neurologic symptoms and viral encephalitis was suspected.
The patient was initially treated with aciclovir. After initial reduction of immunosuppression, coincident graft dysfunction was treated with methylprednisolon. WNV-infection was suspected due to recent emerging human cases in the nearby area of the city of Leipzig. WNV lineage 2 was detected in the patient's urine by RT-PCR and seroconversion with presence of anti WNV IgM and IgG could be demonstrated. Consecutively, aciclovir treatment was stopped. The patient fully recovered and the transplanted kidney regained adequate function. Kidney biopsy did not reveal gross rejection of the transplant.
This case highlights the need to consider rarer causes of illness like WNV-infection particularly in risk groups for more severe outcomes of infectious disease. WNV may be detected by PCR in the blood and cerebrospinal fluid early in the course of infection but it is also excreted for a prolonged period of time in the urine. Seroconversion to anti WNV IgG and IgM may be shown but serologic cross-reactivity among members of the flaviviridae family must be considered.
西尼罗河病毒（WNV）是一种广泛分布的黄病毒，主要通过不同种类的蚊子（如库蚊、伊蚊）在鸟类之间传播，但也可能传播给包括人类在内的哺乳动物。WNV可引发一系列疾病，从无症状感染到少数情况下的脑炎。重症疾病的危险因素包括高龄、心血管疾病和免疫功能低下状态。
在此，我们报告一名60岁男性患者，因高血压肾病在肾移植两年后因高热被转诊至哈雷（萨勒）大学医院。未发现感染源，在病程第6天时患者出现神经症状，怀疑为病毒性脑炎。
患者最初接受阿昔洛韦治疗。在初步降低免疫抑制后，同时出现的移植肾功能障碍用甲泼尼龙治疗。由于莱比锡市附近地区近期出现人类感染病例，怀疑该患者感染了WNV。通过逆转录聚合酶链反应（RT-PCR）在患者尿液中检测到WNV 2型，并证实存在抗WNV IgM和IgG的血清转化。随后，停止阿昔洛韦治疗。患者完全康复，移植肾恢复了足够的功能。肾活检未显示移植肾有明显排斥反应。
该病例凸显了需要考虑WNV感染等较罕见的疾病病因，尤其是在感染性疾病更易出现严重后果的风险人群中。在感染早期，WNV可通过PCR在血液和脑脊液中检测到，但它也会在尿液中长时间排泄。可能会出现抗WNV IgG和IgM的血清转化，但必须考虑黄病毒科成员之间的血清学交叉反应。
