2010留学生流行性乙型脑炎

1、Epidemic encephalitis B,Department of Infectious Diseases of the Second Affiliated Hospital of Nanchang University SUN Shui-lin,Definition,Epidemic encephalitis B Abbreviation : Japanese encephalitis , It a acute inflammatory diseases that Caused by Japanese encephalitis virus in brain parenchymal lesions,Clinical features,Acute onset Protruding heat Disturbance of consciousness Twitch Pathological reflex and meningeal irritation Severe cases may have respiratory failure,Etiology,Japanese enceph

2、alitis virus is an arbovirus group B of the Flaviviridae, spherical, about 40 50nm, the core is a single strand RNA, outside to membrane proteins and outer membrane protein Virus resistance to weak, except the low temperature and dry Of human infection with the virus can produce complement binding antibody, neutralizing antibody and serum inhibition antibody,Electron micrograph of JE virus particles in an infected neuron,Epidemiology,Source of infection: humans and animals (livestock, poultry),

3、especially the piglets are the main source of infection, humans were not an important source of infection Transmission: the mosquito is the major media, no disease after infection, the virus can be carried by the mosquito during wintering and passaged by eggs Susceptible: generally susceptible, covert infection is the major spectrum, incidence: 1:1000 2000 ,patients were more common in under the age of 10 (2 to 6 years) children ,lasting immunity,Susceptible,(zoonosis),Epidemiology,Epidemiologic

4、al characteristics: there are strict seasonal, concentrated in 7,8,9 months (80% 90%), and strong regional (Asia-based),Pathogenesis,Mosquitoes (with virus) Bites The virus enters the human body The breeding of mononuclear phagocytes Released into the blood Immunocompetent Transient viremia pathogen removal Immunity lower through the blood-brain barrier encephalitis,Pathological anatomy,range of lesions: the brain and spinal cord may be involved; especially the cerebral cortex, diencephalon The

5、naked eye: the brain and the meninges visible edema, congestion and hemorrhage, severe lesions may appear malacia necrosis,Pathological anatomy,Microscope: Neuron pathological: degeneration, swelling, necrosis Gliacyte proliferation and cell invasion: Vascular pathological : Vascular endothelial cell swelling, necrosis, loss and necrosis of blood vessels around the brain Cerebral edema,MRI examination in JE patients with brain parenchymal lesions shown: abnormal signal of the hypothalamus and br

6、ain swelling,The glial nodules formed in necrosis of nerve cells and its surrounding small lymphocytes infiltration,Infiltration of lymphocytes and monocytes,Clinical manifestations,Incubation period of 4 to 21 days (10 to 14 days) Typical Japanese encephalitis 1、 prodromal period (1 to 3 days) Acute fever , Headache, nausea, vomit, neck stiffness and convulsions may have 2、 period of apparent manifestation (410 days) The main performance of high fever, disturbance of consciousness, convulsions,

7、 respiratory failure,Clinical manifestations,2、period of apparent manifestation (410 days) High fever ： Temperature 39-40 , 7 10 days or up to 3 weeks, with severe headache, Spraying vomit 。 Disturbance of consciousness ：By the irritability, drowsiness, lethargy to coma gradually; earlier in 1 to 2 days, and more appear in the 3 to 8 days. Most patients continued in a week or so , Severe patients with up to 1 month,Clinical manifestations,2、period of apparent manifestation (410 days) Twitch ： It

8、 was local or systemic convulsions, and more with disturbance of consciousness, duration and degrees vary 。 Respiratory failure ： The main center respiratory failure - breath rhythm and the scope are uneven: as double attracts and sigh type breath, the tide breath and so on The circumference respiratory failure - the breath is weaken, first quick then slowly, but the breath rhythm is neat,Clinical manifestations,2、period of apparent manifestation (410 days) Nervous system symptoms: Meningeal irr

9、itation positive ,Changes in pupil size and shape , Pathological reflex signs positive, Paralysis , Autonomic dysfunction or cranial nerve damage,High fever,Twitch,Respiratory failure,Clinical manifestations,3、 Recovery period Many patients fully recovered within 2 weeks , In severe cases (5% 20%) can have mind slow, dementia, aphasia, sweating, paralysis and other symptoms of recovery, active treatment did not recover in 6 months for the sequela. 4 、Sequela period after 6 months ,the existence of symptoms: dementia, aphasia, paralysis etal,Clinical form,Body Mind Meningeal Twitch respiratory Course Sequela Temperature irritation failure of disease mild 40 Coma Obvious Repeatedly 3 weeks Often fulminant 41 Deep Obvious Continuing 3weeks is serious,Diagnosis,1、Epidemiology Endemic areas, occurred in 7,8,9 months; mostly occurred in children under 10

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