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1、 Epidemic Encephalitis BDept. Of Infectious DiseaseShengjing HospitalCMU DefinitionvEpidemic encephalitis B is acute infectious disease caused by encephalitis B virus,usually occurs in summer &fall.The virus is transmitted by mosquito.vPathologic lesions: cerebral parenchymavClinical feature: high f
2、ever altered consciousness convulsion meningeal irritation respiratory failure EtiologyvCausative agent: encephalitis B virus genus flavivirus of flaviviridaesingle strain of positive-sense RNA, virion is spheric, diameter: 15 22nm, vResistance: unstable in environment, Sensitive to heat, disinfecta
3、nts, ultraviolet rays Etiologyvantigenicity: stablehemagglutination inhibiting Abcomplement fixing Abneutralizing Ab EpidemiologyvSource of infection domestic animals: pig, horse, dog poultry: chicken, duck, goose. patients: EpidemiologyvRoute of transmission insect borne: mosquito biting , vector:
4、mosquito, culex tritaeniorhynchus. Survived winter mosquitoes pigs mosquitoes mosquitoes person pigsEpidemiologyvSusceptibility of population:universal susceptiblelifelong immunitysubclinical infection : overt infection 10002000:1EpidemiologyvEpidemiologic featuressporadic from July to Sep. children
5、 under 10yrs (26yrs)hypersporadic property Pathogenesisvirusmosquito biting replication in mononuclear-phagocyte system (MPS)onset of illnessCNSblood streamblood-brain barrierbrief viremiasubclinical inf.clearanceNo. of virus of invasioncellular immunityblood brain barrierPathologyvPlace of lesion:
6、all of CNScerebral cortex, midbrain and thalamus .vPathologic featuresgross examination:congestionhemorrhagecerebral edemasoften focusesPathologymicroscopic examination:vascular lesion: endothelial cells swelling, necrosisneuron degeneration & necrosisneurogliocyte hyperplasia & inflammatory cells i
7、nfiltration, perivascular cuffing , neuronophagia.Clinical manifestationv incubation period:1014 days (421days )v typical encephalitis B Initial period crisis period convalescent period sequela periodClinical manifestationvInitial period : on the 1st to 3rd daysabrupt onsetfever with headache , naus
8、ea, vomiting lethargy,abdominal pain , diarrhea, Clinical manifestationvCrisis period- on the 4th 10th dayshigh fever: 40, sustained for 710 days.altered consciousness: lethargy, confusion, delirium, stupor, semicoma, coma.convulsion or twitch:(4060%)respiratory failure: 1540%Clinical manifestationc
9、entral RF: reason of central RF:lesion of cerebral parenchyma (respiratory center injury in oblongata medulla)cerebral edemabrain herniaintracranial hypertensionhyponatremic encephalopathy Clinical manifestationmanifestation of central RF:cacorhythmic breathing (cheyne-stokes breathing, apnea)brain
10、herniaperipheral RF: dyspnea, regular breathingClinical manifestationOther symptoms & signs of CNSmeningeal irritations (neck stiffness Kernigs & Brudzinskis signs positive)Deep tendon reflexes from hyperactive to disappearpathologic reflexes positivelimbs paralysisClinical manifestationvConvalescen
11、t periodT drop to normal in 25 daysneurologic function regain gradually(2W)remain some behavioral & psychologic abnormalities, aphasia, dementia, rigidity paralysis.6month - sequela Clinical manifestationvSequela periodaphasiadementiapersistent paralysisClinical manifestationvClinical type: mild typ
12、e common type severe type fulminant type Clinical manifestation TAC CV RFDCSQ mild2W +fulminant41deep coma + +death +Laboratory FindingsvBlood picture: WBC 1020109 /L neutrophil 80%v Cerebrospinal fluid - aseptic meningitistransparent or slightly cloudy, pressure may be elevatedpleocytosis: 50500106
13、/Lprotein may be elevated mildlyglucose and chloride are normalLaboratory FindingsvSerological test:specific IgM Ab: blood or CSF, 34d after onset, peak on 2 week ELISA or indirect immunofluorescencecomplement fixing Ab: 2 week after onset, peak on 56 week, anamnestic diagnosisepidemiologic investig
14、ationLaboratory Findingshemagglutination inhibition Ab: 5d after onset, peak on 2 weekdiagnosis: 4 fold increase in titerepidemiologic investigationneutralized Ab epidemiologic investigationLaboratory Findings vpathogenic test virus isolation: blood, CSF, brain tissue RT-PCR : RNADiagnosisvEpidemiol
15、ogical data:79 month10yrsvClinical manifestation: fever, headache, vomiting, altered consciousness, convulsion, meningeal irritation, pathologic reflexes positive.vLaboratory findings:WBC, CSF, IgMDifferential Diagnosisvtoxic bacillary dysentery high fever,convulsion,coma.24h circulatory failure: ea
16、rlystool examination: WBC, RBCCSF: normalmeningeal irritation: negative Differential Diagnosisvtuberculous meningitis CSF, meningeal irritationvpurulent meningitisvother viral encephalitis TreatmentvGeneral therapy:Isolation: preventing mosquito biting, T30nursing: mouth, skin, eye, turn over clappi
17、ng back sputum aspirationTreatmentfluid & electrolyte supplementation adult: 15002000ml/d children: 5080ml/kg/dvSymptomatic therapyhigh fever: T38 Treatmentphysical cooling (ice bag, alcohol bathing, cold saline enema)drug cooling antipyretic subhibernation: chlorpromazine 0.51mg/kg/time phenergan 0
18、.51mg/kg/time 46h, 35day Treatmentconvulsion: fever: cooling brain edema: 20% mannitol 12g/kg/time 50% glucose dexamethason Treatmentsedative: valium: adult:1020mg/time children: 0.10.3mg/ kg/ time 10% chloral hydrate: adult:12g/time children: 6080mg/kg/timesubhibernation: Treatmentrespiratory failu
19、re: keep airway clearsputum aspirationturn over , clapping back, postural drainageaerosolizationinhalation of oxygen Treatmentreducing cerebral edema & hernia dehydrate : 20% mannitol :12g/kg/time 50% glucose ,vasodilator: 654-2: adult: 20mg/time children: 0.51mg/kg/time 1030 min Treatmentrespirator
20、y stimulant: lobeline: adult: 39mg/time children: 0.150.2mg/kg/time coramine: adult: 0.3750.75g/time children: 510mg/kg/time tracheal intubation or tracheotomy, biomotorTreatmentvConvalescent & sequela periodacupuncturemassage exercise etc.Preventionv isolating patients and pig immunization, v killi
21、ng mosquito and preventing mosquito , v vaccination: killed virus vaccine: 6090% 病例分析 5 5岁患儿，岁患儿，8 8月月1515日开始发热头痛，呕吐日开始发热头痛，呕吐一次，次日排稀便两次，精神不振，第一次，次日排稀便两次，精神不振，第三天晚间开始抽搐，神志不清。查体，三天晚间开始抽搐，神志不清。查体，T40T40，急病容，脉充实有力，呼吸略促，急病容，脉充实有力，呼吸略促，节律整，皮肤无瘀点、瘀斑，颈强节律整，皮肤无瘀点、瘀斑，颈强(+)(+)，克氏征克氏征(+)(+)，肢体肌张力增强。辅助检查：，肢体肌张力增强。辅助检查： 病例分析血血WBC 1510WBC 15109 9L L，便常规便常规WBC 0WBC 05 5个个HpHp， CSFCSF细胞数细胞数751075106 6L L，糖糖3.5mmol/L,3.5mmol/L,氯化物氯化物115mmol/L115mmol/L，蛋白蛋白0.45g/L0.45g/L哪种诊断可能性大哪种诊断可能性大? ? 提供诊断依据及主要鉴别诊断提供诊断依据及主要鉴别诊断治疗要点治疗要点
