Ljiljana Perić, Danijel Šimašek
Medicinski fakultet Sveučilišta u Osijeku, Osijek
E-mail: bentonbenton@net.hr
Danijel Šimašek (Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Croatia)
Tijekom kolovoza i rujna 2012. godine, u Klinici za infektologiju KBC Osijek, liječeno je 5 bolesnika s meningoencefalitisom, u kojih je serološki (ELISA IgG i IgM pozitivni) dokazan virus Zapadnog Nila.
To su prvi dokazani slučajevi meningoencefalitisa uzrokovanog virusom Zapadnog Nila u istočnoj Slavoniji (Budimci, Vukovar, Belišće, Kuševac, Petrijevci). Bolesnici su u dobi od 48 do 77 godina. Tri su bolesnika prije godinu dana bila liječena na neurologiji: dva zbog cerebrovaskularnog inzulta, a treći zbog vertiginoznog sindroma. Hospitalizirani su od 4. do 6. dana prisutnih općih infektivnih simptoma, a prvog dana prisutnog poremećaja svijesti. Smetenost, dezorijentiranost i halucinacije imala su dva bolesnika. Somnolenciju i sopor također dva bolesnika, a u dva bolesnika bio je prisutan i tremor.
Povišenu temperaturu svi su bolesnici imali prva dva dana liječenja, od 37,2 ºC do 38,3 ºC. U svih je bolesnika nalaz likvora govorio u prilog seroznog meningitisa. Broj leukocita (pretežno limfocita) varirao je od 10 do 517 x106/L. Prisutna je bila umjerena proteinorahija i granično povišene vrijednosti laktata. Glukoza i kloridi su bili u granicama normale.
U svih bolesnika je EEG bio dizritmički promijenjen, difuzno ili postranično. CT mozga je bio uredan u dva bolesnika, u dva bolesnika prisutna je bila difuzna atrofija mozga, a u jednog kronična vaskularna lezija. Nalaz MR mozga u dva bolesnika je bio uredan.
Uz antiedematoznu terapiju (infuzije 10% Manitola i 10% Dekstroze) i drugu simptomatsku terapiju, unutar 5 dana liječenja uslijedilo je poboljšanje. Bolničko liječenje je trajalo 2-3 tjedna. Svi su otpušteni bez neuroloških posljedica.
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Clinical aspects of West Nile virus infections in humans in Croatia
Ljiljana Perić, Danijel Šimašek
Faculty of Medicine, University of Osijek, Osijek
E-mail: bentonbenton@net.hrDuring August and September of the year 2012th there were 5 patients with meningoencephalitis treated at Clinic for Infective Diseases, University Hospital Centre Osijek. In all of them West Nile virus was proved to be cause, serologically (ELISA IgG and IgM positive).
These are the first confirmed cases of West Nile encephalitis in Eastern Slavonia (Budimci, Vukovar, Belišće, Kuševac, Petrijevci). Patients ranged in age from 48 to 77 years.
One year ago, three of these patients were treated in Neurology; two of them due to the stroke, and third because the vertigo. Patients were admited to the hospital on the 4th to 6th day from the begining of general infectious symptoms, and the first day of consciousness disorders. Two patients had confusion, disorientation and hallucinations, two patients had somnolence and sopor, and two patients had tremor.
During first two days of treatment, all patients had raised body temperature in range from 37.2 ºC to 38.3 ºC. Cerebrospinal fluid analysis in all patients spoke in favor of serous meningitis. The number of leukocytes (mainly lymphocytes) ranged from 10 to 517 x106/L. There was a moderate protein elevation and marginal lactate elevation. Glucose and chlorides were within normal range.
All patients had EEG changes dysrithmic, diffuse or laterally. CT scan of the brain was normal in two patients, two patients had diffuse brain atrophy, and one had chronic vascular lesions. MRI scan of the brain in two patients was normal.
Patients were treated with anti-edematous therapy with infusion 10% Mannitol and 10% Dextrose and other symptomatic therapy. Clinical signs improved within 5 days of treatment. Hospitalization lasted 2-3 weeks. All patients were discharged without neurological sequelae.