Department of Neurology, University Hospital Leipzig, 04103 Leipzig, Germany.
Medical Intensive Care Unit, University Hospital Leipzig, 04103 Leipzig, Germany.
Viruses. 2024 Feb 22;16(3):341. doi: 10.3390/v16030341.
Viral meningitis/encephalitis (ME) is a rare but potentially harmful disease. The prompt identification of the respective virus is important to guide not only treatment but also potential public health countermeasures. However, in about 40% of cases, no virus is identified despite an extensive diagnostic workup. The aim of the present study was to analyze demographic, seasonal, and routine cerebrospinal fluid (CSF) parameters in cases of viral ME and assess their utility for the prediction of the causative virus.
Demographic data, season, and routine CSF parameters (total leucocytes, CSF cell differentiation, age-adjusted CSF/serum albumin ratio, and total immunoglobulin ratios) were retrospectively assessed in cases of viral ME.
In total, 156 cases of acute viral ME (74 female, median age 40.0 years) were treated at a tertiary-care hospital in Germany. Specific viral infections were detected in 93 (59.6%) cases. Of these, 14 (9.0%) cases were caused by herpes simplex virus (HSV), 36 (23.1%) by varicella-zoster virus (VZV), 27 (17.3%) by enteroviruses, 9 (5.8%) by West Nile virus (WNV), and 7 (4.5%) by other specific viruses. Additionally, 64 (41.0%) cases of ME of unknown viral etiology were diagnosed. Cases of WNV ME were older, predominantly male, showed a severe disruption of the blood-CSF-barrier, a high proportion of neutrophils in CSF, and an intrathecal total immunoglobulin M synthesis in the first CSF sample. In a multinominal logistic regression analysis, the accuracy of these CSF parameters together with age and seasonality was best for the prediction of WNV (87.5%), followed by unknown viral etiology (66.7%), VZV (61.8%), and enteroviruses (51.9%).
Cases with WNV ME showed a specific pattern of routine CSF parameters and demographic data that allowed for their identification with good accuracy. These findings might help to guide the diagnostic workup in cases with viral ME, in particular allowing the timely identification of cases with ME due to WNV.
病毒性脑膜炎/脑炎（ME）是一种罕见但潜在有害的疾病。及时鉴定出相应的病毒不仅对指导治疗，而且对潜在的公共卫生对策都很重要。然而，尽管进行了广泛的诊断性检查，仍有约 40%的病例无法确定病毒。本研究的目的是分析病毒性 ME 病例的人口统计学、季节性和常规脑脊液（CSF）参数，并评估其对预测致病病毒的效用。
回顾性分析德国一家三级保健医院收治的 156 例急性病毒性 ME（74 例女性，中位年龄 40.0 岁）的人口统计学数据、季节和常规 CSF 参数（总白细胞、CSF 细胞分化、年龄校正的 CSF/血清白蛋白比值和总免疫球蛋白比值）。
共发现 156 例急性病毒性 ME 患者（74 例女性，中位年龄 40.0 岁），其中 93 例（59.6%）患者有明确的病毒感染。其中，14 例（9.0%）为单纯疱疹病毒（HSV）感染，36 例（23.1%）为水痘带状疱疹病毒（VZV）感染，27 例（17.3%）为肠道病毒感染，9 例（5.8%）为西尼罗河病毒（WNV）感染，7 例（4.5%）为其他特定病毒感染。此外，还诊断出 64 例（41.0%）原因不明的病毒性 ME 病例。WNV ME 患者年龄较大，以男性为主，血脑屏障严重破坏，CSF 中中性粒细胞比例较高，第 1 次 CSF 样本中有脊髓总免疫球蛋白 M 合成。在多分类逻辑回归分析中，这些 CSF 参数与年龄和季节性结合，对 WNV 的预测准确性最佳（87.5%），其次是原因不明的病毒病因（66.7%）、VZV（61.8%）和肠道病毒（51.9%）。
WNV ME 患者的常规 CSF 参数和人口统计学数据具有特定模式，可通过良好的准确性进行识别。这些发现可能有助于指导病毒性 ME 患者的诊断性检查，特别是可以及时发现由 WNV 引起的 ME 病例。
