| Objective:Japanese encephalitis which is caused by JE virus is an acute infectious disease spread by mosquitoes. Children under15years of age are principally affected in endemic areas. When JEV first affects a nascent population, adults are also affected. After the application of vaccines, morbidity in children decreased, but the impact to adults has been underestimated, early diagnosis and early treatment is the key to reduce mortality and disability. This paper summaries and analyses the clinical manifestations, serology, cerebrospinal fluid and brain MRI characteristics of adult JE patients, which helps to rich the experience in the diagnosis.Method:This study was based on a prospective analysis of36patients of JE, diagnosed and treated in Qilu Hospital of Shandong University, from August to September of2013. The diagnosis of JE was based on clinical manifestations, imaging characteristics, and detection of JEV specific IgM in serum and cerebrospinal fluid (CSF) by ELISA. All the patients were received a detailed neurological physical examination, CSF examination and brain imaging studies (CT/MRI).Results:JE patient presented with fever (100%), and cognitive impairment, consciousness, headache, nausea, vomiting (86.1%), meningeal irritation (80.6%), Parkinson’s symptoms (30.6%) and seizures (27.8%) are also more common. JE IgM antibodies of36serum cases and23CSF cases were positive.16cases (48.5%) WBC increase in blood routine test, of that20cases (60.6%) increased in neutrophils,17cases (51.5%) increased in monocytes, and13cases (39.4%) lymphocytes decreased,26cases(78.8%) eosinophils decreased. ESR of20cases (80.0%) increased. A total of24patients underwent lumbar puncture.13cases (54.2%) suffered Intracranial hypertension, CSF cytology of23cases were abnormal,16cases (72.7%) had mixed cell response (the proportion of granulocyte neutrophils is (1%-38%),6cases (27.3%) appeared lymphocyte reaction. Sugar and chlorine were normal, while protein content and immune globulin increased.22cases of patients (61.1%) underwent brain MRI,17cases (47.2%) underwent brain CT. Besides the thalamus (59.1%), the midbrain, the basal ganglia, hippocampus and other brain lobe (27.3%) were also involved,4/22cases (18.2%) were normal.Conclusion:Except presenting with acute encephalitic syndrome, JE patients also accompany the extrapyramidal symptom (Parkinson’s symptom) which is a characteristic symptom. Cerebrospinal fluid cytology is mainly mixed-cell response, significantly increasing the proportion of neutrophils and a longer duration of mixed cell reaction are the important features differ from other types of viral encephalitis; thalamus lesions on brain CT/MRI are the characteristics features, and there are some common nonspecific changes in addition. To focus on T2W1and FLAIR sequences is helpful in diagnosis. And we should pay attention to distinguishing the herpes simplex virus encephalitis in diagnosis. |
