ABSTRACT
Objective:To explore the epidemiology, clinical features and prognosis of pseudorabies virus (PRV) infection in human.Methods:A case of human PRV encephalitis combined with acute retinal necrosis (ARN) in the First Affiliated Hospital of Zhengzhou University in May 2020 was reported. The epidemiology, clinical features, neuroimaging, cerebrospinal fluid (CSF), next-generation sequencing (NGS), treatment and prognosis of human PRV infection were summarized and analyzed with the previous published data.Results:The present case was a 38-year-old man who developed high fever, headache, cognitive decline, recurrent epileptic seizures after butchering a pig. Brain magnetic resonance imaging showed lesions in the insular lobes, temporal lobes, cingulate gyrus, frontal lobes, basal ganglia and hippocampus, with more significant signals on the left side. Afterwards, bilateral ARN occurred and resulted in his blindness. PRV DNA was detected from the aqueous humor. By literature review, a total of 20 cases (including this case) were analyzed. Most patients (95%, 19/20) had the history of direct contact with swine. The median incubation period was 7 days. The infection normally caused encephalitis (95%, 19/20), some cases with endophthalmitis (60%, 12/20). Based on the neuroimaging of the 19 patients, the lesions in neuroimaging were mainly in limbic system, especially in insular (17/19) and temporal lobes (17/19). The basal ganglia was often involved (9/19).The PRV-DNA was detected by NGS in CSF or intraocular fluid. Antiviral drugs and adjuvant treatment, including immunoglobulin and/or corticoid therapy, were effective to only few cases. Most patients (90%, 18/20) had the sequelae of severe impairment of daily living (modified Rankin Scale scores≥3).Conclusions:The cardinal clinical characteristics of human PRV infection are progressive panencephalitis and endophthalmitis, with an unfavorable outcome. The history of exposure to sick swine and typical neuroimaging suggest PRV infection. NGS of CSF and/or intraocular fluid is the dependable diagnostic method.
ABSTRACT
Objective To explore the clinical efficacy and safety of cyclosporin A combined with glucocorti-costeroid in the treatment of juvenile uveitis.Methods 66 juvenile uveitis patients(93 eyes)were selected.Accord-ing to the conditions,the patients were treated by oral administration of cyclosporin A,2-5mg·kg -1 ·d -1 ,twice per day,combined with prednisone,0.5-1mg·kg -1 ·d -1 ,taken in the morning.After 4-6 months treatment,the inflam-mation control and visual acuity improvement were observed,and before and after treatment liver and kidney function, blood glucose,blood pressure,white blood cell counts were checked.Adverse reactions in patients were recorded with regular follow-up.Results After 4-6 months treatment,heal inflammation 78 eyes,accounted for 83.87%;improved 9 eyes,accounted for 9.68%;no respond in 6 eyes,accounted for 6.45%;the total effective rate was 93.55%.Visual acuity was obviously improved in 50 eyes,improved in 27 eyes and no response in 16 eyes;the total effective rate was 82.79%;56 eyes were removed from residual standard.In the stage of therapy,6 patients had liver and kidney dys-function,6 patients had blood abnormalities,and 3 patients had low blood sugar,all were controlled by symptomatic treatment in the normal range,and no systemic progression.Conclusion Cyclosporin A combined with glucocortico-steroid applied in juvenile uveitis improved the results with obvious clinical effect and fewer systemic side effect.