Clinical Analysis Of 38 Cases Of Extremely Heavy Japanese Encephalitis In Adults

Objective To analyze the clinical features of 38 patients with severe epidemic encephalitis in Ningxia,and to provide reference for the treatment of epidemic encephalitis or Japanese encephalitis(JE).Methods From August to September 2018,a total of 38 patients diagnosed as severe epidemic encephalitis by serum and/or cerebrospinal fluid(CSF)examination were enrolled in this study in Neurointensive Care Unit(NCU)of General Hospital of Ningxia Medical University.The clinical data and treatment situation were analyzed retrospectively.Results The age of the patients in this group was between 24 and 79 years old,with a median of 64.5,of which 25 cases were older than or equal to 60 years old(65.8%).Clinical manifestations: high fever(≥39°C 73.7%),disturbance of consciousness(lethargy 7.9%,coma92.1%);34 cases with flaccid paralysis in limbs(89.5%);36 cases with mechanical ventilation(94.7%);the mortality rate was as high as 42.1%,and another 21.1% of the patients showed severe sequelae,such as quadriplegia.There were 20 cases with elevated cerebrospinal fluid pressure(52.6%)and 38 cases with increased leukocyte count in CSF(100%),in which 13 cases mainly with increased neutrophil elevation(34.2%),and 16 cases mainly with increased lymphocyte(42.1%),9 cases showed mixed cell reaction(23.7%).CSF had normal sugar content in 30 cases(78.9%),with a slight increase in 8 cases(21.1%);normal chloride content in 37 cases(97.4%),with a slight increase in 1 case(2.6%);a slight increase in protein content 34 Cases(89.5%),and 4 cases(10.5%)were normal.JE showed diffuseθandδwaves in the whole brain,and the slow wave activity was significantly increased.Some patients hadsharp and slow complex waves.Electromyogram showed that both motor and sensory nerves were involved,mainly with axonal damage and accompanied by demyelinating damage.MRI showed low signal in T1 WI and high signal in T2-FLAIR and DWI for all bilateral thalamus,hippocampus,temporal lobe,basal ganglia and cerebral peduncle.Conclusion The fatality rate and disability rate of adult extremely heavy JE patients in this study were high.In this study,adults with extremely heavy JE may present with Guillain-Barré syndrome-like symptoms.The early cerebrospinal fluid cytology of JE patients in this study can be expressed in three forms:mainly neutrophil reaction,lymphocyte reaction and mixed cell reaction.Increased protein in cerebrospinal fluid biochemistry is related to inflammatory response and nerve root damage.