成人肠道病毒脑膜炎：一项前瞻性全国基于人群的队列研究。

Enterovirus Meningitis in Adults: A Prospective Nationwide Population-Based Cohort Study.

机构信息

From the Department of Infectious Diseases (J.B.), Aalborg University Hospital; Department of Pulmonary and Infectious Diseases (H.M., C.T.B., P.T.P.), Nordsjællands Hospital, Hillerød; Department of Infectious Diseases (H.M., J.H.-L.), Rigshospitalet; Virology Surveillance and Research Section (S.M.), Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen; Department of Infectious Diseases (L.L.), Odense University Hospital; Department of Infectious Diseases (B.R.H.), Hvidovre University Hospital; Department of Clinical Microbiology (C.Ø.), Copenhagen University Hospital, Amager and Hvidovre; Department of Infectious Diseases (H.R.L.), Copenhagen University Hospital, Herlev and Gentofte,; Department of Medicine (L.W.), Zealand University Hospital, Roskilde; Department of Infectious Diseases (M.S.), Aarhus University Hospital; and Departments of Infectious Diseases (H.N.) and Clinical Medicine (H.N.), Aalborg University, Denmark.

出版信息

Neurology. 2021 Aug 3;97(5):e454-e463. doi: 10.1212/WNL.0000000000012294. Epub 2021 Jun 4.

DOI:10.1212/WNL.0000000000012294

PMID:34088872

Abstract

OBJECTIVE

To test the hypothesis that enterovirus meningitis (EM) is a frequent and self-limiting condition, the epidemiology of EM in adults was examined.

METHODS

Using a prospective, nationwide, population-based database, all adults with EM confirmed by PCR of the CSF from 2015 to 2019 were included. Unfavorable outcome was defined as Glasgow Outcome Scale scores of 1-4 at discharge. Modified Poisson regression was used to compute adjusted relative risks (RRs).

RESULTS

A total of 419 cases of EM in 418 adults (46% female, median age 31 years [interquartile range (IQR) 27-35]) yielded an incidence of 1.80/100,000/year. Admission diagnoses included CNS infection 247/397 (62%), other neurologic conditions 89/397 (22%), and cerebrovascular diseases 33/397 (8%). Genotype was available for 271 cases, of which echovirus 30 accounted for 155 (57%). Patients presented with headache 412/415 (99%), history of fever 303/372 (81%), photophobia 292/379 (77%), and neck stiffness 159/407 (39%). Fever (≥38.0°C) was observed in 192/399 (48%) at admission. The median CSF leukocyte count was 130 10/L (range 0-2,100) with polymorphonuclear predominance (>50%) in 110/396 (28%). Cranial imaging preceded lumbar puncture in 127/417 (30%) and was associated with non-CNS infection admission diagnoses and delayed lumbar puncture (median 4.8 hours [IQR 3.4-7.9] vs 1.5 [IQR 0.8-2.8], < 0.001). Unfavorable outcome occurred in 99/419 (24%) at discharge; more often in female patients (RR 2.30 [1.58-3.33]) and less frequent in echovirus 30 (RR 0.67 [0.46-1.00]) in adjusted analyses. Outcome remained unfavorable in 22/379 (6%) after 6 months.

CONCLUSIONS

EM is common among young, healthy adults. Although the long-term prognosis remains reassuring, a substantial proportion have moderate disability at discharge, especially female patients.

摘要

目的

为了验证肠道病毒脑膜炎（EM）是一种常见且自限性疾病的假说，本研究对成人 EM 的流行病学进行了研究。

方法

本研究使用前瞻性、全国性、基于人群的数据库，纳入了 2015 年至 2019 年通过脑脊液 PCR 确诊的所有成人 EM 患者。出院时格拉斯哥预后量表（GOS）评分为 1-4 分被定义为不良预后。采用校正后的相对风险（RR）值进行校正的多变量泊松回归分析。

结果

共纳入 418 例成人患者中的 419 例 EM 患者（46%为女性，中位年龄为 31 岁[四分位间距（IQR）27-35]），年发病率为 1.80/100,000/年。入院诊断包括中枢神经系统感染 247/397（62%）、其他神经系统疾病 89/397（22%）和脑血管疾病 33/397（8%）。271 例患者的基因型可用，其中柯萨奇病毒 30 占 155 例（57%）。415 例患者均有头痛（99%）、发热史（81%）、畏光（77%）和颈部僵硬（39%）。399 例患者中，入院时发热（≥38.0°C）192 例（48%）。中位脑脊液白细胞计数为 130×10/L（范围 0-2100），中性粒细胞占优势（>50%）的有 110/396（28%）。127/417（30%）例患者在腰椎穿刺前进行了颅脑影像学检查，且与非中枢神经系统感染入院诊断和腰椎穿刺延迟相关（中位数为 4.8 小时[IQR 3.4-7.9] vs 1.5 [IQR 0.8-2.8]，<0.001）。出院时 99/419（24%）例患者预后不良；校正分析显示，女性患者（RR 2.30[1.58-3.33]）和柯萨奇病毒 30 患者（RR 0.67[0.46-1.00]）的预后更差。在调整分析中，379 例患者中有 22 例（6%）在 6 个月后预后仍然不良。