Clinical And Imaging Characteristics Of Patients With Severe Adult Japanese Encephalitis

Objective:Epidemic encephalitis b is an infectious disease caused by the Japanese encephalitis virus.It is mainly found in Asia and the Pacific Ocean.Children aged 0-6years old were the main victims of previous je outbreaks.After the immunization program in 2006,je vaccines were widely administered to children in various regions,which reduced the prevalence of je among children.But to adult second brain vaccine is vaccinal propaganda is not in place,add adult fluidity to increase,the area that blame epidemic disease enters epidemic disease area,the sicken of second brain is transferred to adult by the child,make adult morbidity rate increases gradually.At present,the clinical studies on childhood je are very mature,and there are still few studies on adult je.Therefore,the main purpose of this study is to retrospectively analyze and summarize the clinical symptoms,cerebrospinal fluid laboratory examination and imaging characteristics of severe adult epidemic encephalitis b patients,so as to buy more time for the later treatment and reduce the mortality and disability rate of patients with je.Methods:In this study,289 adult patients with Japanese encephalitis diagnosed by serum and/or cerebrospinal fluid examination from July 2015 to October 2017 in hospitals above grade three in Gansu?data from Gansu CDC?were selected.214patients were able to pass laboratory and craniocerebral imaging examination completely.According to clinical symptoms,signs,cerebrospinal fluid and imaging examination,they were in accordance with severe adult patients with Japanese encephalitis.Among them,89 cases were Japanese encephalitis,and 125 cases were Japanese encephalitis patients.Therefore,89 cases of severe adult patients with Japanese encephalitis were selected as the criteria in this study.Clinical data were summarized and collated.Laboratory and craniocerebral imaging examinations were carried out.Laboratory examinations mainly focused on cerebrospinal fluid pressure,routine,biochemical,cytological and other indicators.Craniocerebral imaging mainly focused on 1.5T magnetic resonance imaging?MRI?.Comparing 89 cases of severe adult Japanese encephalitis with 125 cases of common type Japanese encephalitis,retrospective analysis and summary of clinical and craniocerebral imaging?MRI?characteristics of severe adult Japanese encephalitis are helpful for clinical re-understanding of adult Japanese encephalopathy,so as to reduce the risk of death and improve the survival rate.Result:1.The age of onset of all patients was 20 to 65 years old,with a male to female ratio of 1.22 to 1.The majority of patients were 40 to 50 years old,accounting for 42.70%.Farmers accounted for 77.53%?69/89?and others 22.47%?20/89?,and the number of patients reached the peak in September.2.The clinical manifestations of 89 severe adult patients with Japanese encephalitis included 100%fever?89/89?,100%consciousness disorder?89/89?,85.4%convulsions?76/89?,100%respiratory failure?89/89?,and 100%quadriplegia?89/89?.29 cases died,the mortality rate was 32.5%.The rest had severe sequelae such as quadriplegia,cognitive dysfunction and bulbar paralysis.3.Based on laboratory tests found that the implementation of the 89 cases with lumbar puncture,admission day 1 made a lumbar puncture,most were higher than in the normal range,pressure is 165³60mmH₂O cerebrospinal fluid pressure,average of mmH₂O?253.20?51.51?,the pressure between 80¹80 mmH₂O in 3 cases,3.37%,and lumbar puncture pressure mmH₂O in 180 and more than 86 cases,accounted for 96.63%.According to the cytological examination of cerebrospinal fluid of 89 patients,WBC count fluctuated between?0⁵53?×10⁶/L,3 cases between?0⁵?×10⁶/L,22 cases between?5¹00?×10⁶/L,61 cases between?100⁵00?×10⁶/L,and 3 cases greater than500×10⁶/L,among which the increase of WBC count?>5×10⁶/L?accounted for 96.63%?86/89?.All the patients who underwent lumbar puncture examination were examined by CSF cytology,and the results were generally abnormal cellular responses,most of which were mixed cellular responses,followed by lymphocyte responses.Protein quantification and cell number of all cerebrospinal fluid samples were generally increased.Compared with the control group,the difference showed a certain correlation with the disease,P<0.05 was statistically significant,but there was no statistically significant difference between the severe extreme stage and the severe convalescence stage?P>0.05?.There was positive correlation between CSF pressure and protein.4.In the imaging examination,89 patients were examined by craniocerebral imaging,including 54 cases of inflammatory lesions.The results showed that the damaged parts were concentrated in bilateral thalamus,basal ganglia,hippocampus,etc,in addition,the midbrain,pons,cortex,white matter and other parts were also involved,most of which showed symmetry damage.Compared with the control group,it involves many parts and has a wide range,a long course of disease and a serious condition.Conclusion:1.Adults are also susceptible to epidemic encephalitis B,and males are more than females,mainly farmers.2.The major clinical manifestations of severe adult Japanese encephalitis patients are high fever,disturbance of consciousness,quadriplegia and respiratory failure.The mortality rate is high.The surviving patients have severe sequelae such as limb paralysis,cognitive dysfunction and bulbar paralysis.3.The patients with severe Japanese encephalitis have high cerebrospinal fluid pressure,high cell number and high protein content.4.Imaging examination showed that the symmetry of the damaged parts of severe Japanese encephalitis was concentrated in bilateral thalamus,basal ganglia and hippocampus.