Clinical Characteristics And Prognosis Of 21 Adult Patients With Japanese Encephalitis

Objective:To analyze the clinical spectrum and factors affecting prognosis of patients with adult Japanese encephalitis.Methods:21 adult patients with JE in the Shengjing and First Affiliated Hospital of China Medical University from September to October in 2018 were enrolled.The clinical symptoms,laboratory tests,imaging features,treatment and outcomes were retrospectively analyzed.Results:Of the 21 adult JE patients,6 patients(28.6%)were extremely severe,9 patients(42.8%)were severe,and 6 patients(28.6%)were common.The ages of onset were from18 and 82,the median was 52 years old,the ratio of male to female was 4:3,and the onset time was concentrated in September which has seventeen cases(81.0%).Of the 21 adult JE patients,21(100%)cases had high fever,20(90.5%)cases had unconsciousness and cognitive impairment,19(90.5%)cases had increased blood pressure,11(52.4%)cases had respiratory failure,4(19.0%)cases had epilepsy,2(9.5%)cases had pulmonary embolism,the WBC was elevated in 18(85.7%)cases,the cerebrospinal fluid protein content were more than 45 mg/dL in 21 cases(100%),and the plasma D-dimer was increased in 20 cases(95.2%).There were differences between different clinical types in D-dimer of the climax phase(p<0.05).The patients with lethargy were predominant in the common type,and respiratory failure were more common in the extremely severe type.The increase of CSF sugar content compared with the normal level indicated that the condition was serious,and the clinical type was extremely severe.After treatment,4patients(19.0%)eventually died,1 patient(4.8%)was left with severe dysfunction,and12 of the survival patients(70.6%)had memory impairment.There were differences in D-dimer of the climax phase,the time interval from onset to worsening of consciousness,the presence of respiratory failure,and the sugar content of cerebrospinal fluid between the groups with good prognosis and those with poor prognosis(p<0.05).Logistic analysis showed that the sugar content of cerebrospinal fluid was the independent risk factor for the development of the poor prognosis.Conclusions:Adult JE had a high mortality rate,and most of the survivors had memory impairment.Higher plasma D-dimer values of the climax phase,increased sugar contentof cerebrospinal fluid,shorter interval from onset to worsening of consciousness and having respiratory failure usually predicted a poor prognosis,which should be taken seriously and treated in time.