结核性脑膜炎和疱疹病毒脑膜脑炎脑脊液细胞学检查的特点分析

目的观察分析结核性脑膜炎(TBM)和疱疹病毒脑膜脑炎(HVME)的脑脊液细胞学特点。方法对经下一代基因测序技术确诊的28例TBM和27例HVME患者进行脑脊液细胞学检查及动态观察。结果 TBM组脑脊液嗜中性粒细胞比例显著高于HVME组(P 0. 01),而小淋巴细胞比例低于HVME组(P 0. 01)。HVME组有6例(22. 22%)患者查见红细胞和/或含铁血黄素吞噬细胞,有2例查见细胞内包涵体,而TBM组则均未查见。脑脊液细胞学动态观察发现,TBM组白细胞计数和嗜中性粒细胞比例下降的速度、小淋巴细胞比例上升的速度均较HVME组缓慢,且呈波动性。结论TBM和HVME的脑脊液细胞反应类型不同,TBM表现为混合型细胞反应,HVME则以淋巴细胞反应为主。HVME并发出血的机率显著高于TBM,而且常见细胞内包涵体。动态观察结果表明脑脊液细胞学检查可做为病情观察、疗效判定和预后评估的客观指标,具有十分重要的临床意义。     

A fatal case of Vibrio vulnificus meningoencephalitis

The objective of this paper is to report a rare case of Vibrio vulnificus presenting as meningoencephalitis without a wound infection. Vibrio vulnificus is capable of causing severe and often fatal infections in susceptible individuals. It commonly causes necrotizing wound infections, primary septicemia, and gastroenteritis. A 69-year-old man had meningoencephalitis with lesion on the red nucleus, substantia nigra, basal ganglia, and dentate nucleus as the initial clinical manifestation of a V. vulnificus infection. This is the first case of V. vulnificus infection in which MRI demonstrated the involvement of deep nuclei of the brain.     

Enterovirus A71 Meningoencephalitis Outbreak,Rostov-on-Don,Russia, 2013

Seventy-eight cases of enterovirus infection, including 25 neuroinfections, occurred in Rostov-on-Don, Russia, during May–June 2013. The outbreak was caused by an enterovirus A type 71 (EV-A71) subgenotype C4 lineage that spread to neighboring countries from China ≈3 years earlier. Enterovirus associated neuroinfection may emerge in areas with a preceding background circulation of EV-A71 with apparently asymptomatic infection.     

寨卡病毒感染引发神经系统表现的研究进展

寨卡病毒在巴西和美国等国家大规模爆发流行,而且是目前最大的一次爆发流行。寨卡病毒可引起非特异性的发热。然而,一系列合并神经系统并发症的病例报道如小头畸形和吉兰-巴雷综合征等显示与寨卡病毒感染有关,提示寨卡病毒是嗜神经性病毒。寨卡病毒感染后引发的神经系统疾病相继被报道,如脑膜脑炎、脊髓炎和视觉损害等。既往众多报道提示寨卡病毒感染和神经系统症状之间关系密切,但需对此次爆发流行进行长期的纵向研究和建立动物或活体外实验模型研究,才能更好的帮助临床医生了解该疾病的发病机制。     

Enteroviral meningoencephalitis in a patient with non‐Hodgkin's lymphoma treated previously with rituximab

A 75‐year‐old man, with a long history of recurrent lymphoplasmacytoid lymphoma, presented with diffuse large‐cell lymphoma affecting adrenal glands and causing severe hypoadrenalism. The lymphoma responded to rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R‐CHOP) chemotherapy. Seven months postcompletion of chemotherapy, he developed signs of gastroenteritis and septicaemia. He deteriorated 24 h postadmission with a significant fall in Glasgow Coma Scale Score. Polymerase chain reaction testing of cerebrospinal fluid suggested enteroviral encephalitis. He responded symptomatically to intravenous immunogobulins. His immunoglobulin levels were monitored weekly and supplemented to maintain immunoglobulin G level at 10 g/l, but in spite of this, his neurological condition deteriorated and he died after 14 weeks. Rituximab can cause prolonged B‐cell deficiency. We speculate that profound immunosuppression induced by rituximab, together with previous chemotherapy, predisposed this patient to fatal enteroviral meningoencephalitis.