PDF(Pubmed)
Abstract：
West Nile virus (WNV), a mosquito-borne flavivirus, is endemic to South Africa. However, its contribution to acute febrile and neurological disease in hospitalized patients in South Africa is unknown. This study examined two patient cohorts for WNV using molecular testing and IgM serology with confirmation of serological results by viral neutralization tests (VNT) to address this knowledge gap. Univariate analysis was performed using collected demographic and clinical information to identify risk factors. In the first cohort, 219 cerebrospinal fluid (CSF) specimens from patients with acute neurological disease in Gauteng hospitals collected in January to June 2017 were tested for WNV. The study identified WNV in 8/219 (3.65%, 95.00% CI (1.59-7.07)) patients with unsolved neurological infections. The second cohort, from 2019 to 2021, included 441 patients enrolled between January and June with acute febrile or neurological disease from urban and rural sites in Gauteng and Mpumalanga provinces. West Nile virus was diagnosed in 40/441 (9.07%, 95.00% CI (6.73-12.12)) of patients, of which 29/40 (72.50%, 95.00% CI (56.11-85.40)) had neurological signs, including headaches, encephalitis, meningitis, and acute flaccid paralysis (AFP). Notably, most of the cases were identified in children although adolescents and senior adults had a significantly higher risk of testing WNV positive. This suggests a previously underestimated disease burden and that WNV might be underrecognized as a cause of febrile and neurological diseases in hospitalized patients in South Africa, especially in children. This emphasizes the importance of further research and awareness regarding arboviruses of public health concern.
摘要：
西尼罗河病毒(WNV)蚊子传播的黄病毒,是南非特有的。然而,其对南非住院患者急性发热和神经系统疾病的影响尚不清楚.这项研究使用分子测试和IgM血清学检查了两个WNV患者队列，并通过病毒中和测试（VNT）确认了血清学结果，以解决这一知识差距。使用收集的人口统计学和临床信息进行单变量分析以确定危险因素。在第一个队列中，对2017年1月至6月在豪登省医院收集的219例急性神经系统疾病患者的脑脊液（CSF）标本进行了WNV检测。该研究确定了8/219的WNV(3.65%，95.00%CI(1.59-7.07))未解决的神经系统感染患者。第二个队列，从2019年到2021年,纳入了1月至6月在豪登省和姆普马兰加省城乡地区招募的441例急性发热或神经系统疾病患者.西尼罗河病毒在40/441（9.07%，患者的95.00%CI（6.73-12.12）），其中29/40（72.50%，95.00%CI（56.11-85.40）有神经系统体征，包括头痛,脑炎,脑膜炎,和急性弛缓性麻痹（AFP）。值得注意的是,尽管青少年和老年人检测WNV阳性的风险明显较高,但大多数病例是在儿童中发现的.这表明先前被低估的疾病负担，并且WNV可能被低估为南非住院患者的发热和神经系统疾病的原因。尤其是儿童。这强调了对公共卫生关注的虫媒病毒进行进一步研究和认识的重要性。
