背景:脑炎的早期诊断涉及识别神经炎症的体征,包括脑脊液(CSF)细胞增多症。然而,已经描述了脑炎中没有CSF细胞增多,最明显的是自身免疫性脑炎。我们检查了与不存在或存在CSF白细胞胞吞作用(≥5个细胞/μL)相关的临床特征和结果,及时诊断和治疗脑炎。
方法:这项回顾性研究比较了597例全因脑炎成年患者的初始CSF分布。
结果:在597名患者中,446(74.7%)有CSF胞质增多,而151(25.3%)没有。脑脊液细胞增多更常见于感染病例(200/446,44.8%),连同59例(13.2%)自身免疫性病例,主要包括抗NMDAR脑炎(37/59,62.7%)。值得注意的是,无细胞增多症的组感染性脑炎(47/151,31.1%)和自身免疫性脑炎(38/151,25.92%;p>0.05)的比例相似.在那些患有传染性脑炎的人中,47/247(19%)无细胞增多症,包括18/76(23.7%)的HSV-1脑炎。细胞增多症的缺乏与阿昔洛韦的给药速率降低相关(无细胞增多症患者为47.7%71.1%的细胞增多症患者,p<0.001)。尽管白细胞增多与入院时的一些临床严重程度指标相关,例如完全不反应性(FOUR)评分≤14,但与死亡率或住院时间无关。
结论:脑脊液细胞增多是诊断脑炎的重要标准,但是25.3%的全因脑炎患者和23.7%的HSV-1脑炎患者在最初的LP中没有细胞增多。在疑似脑炎的患者中,在没有细胞增多的情况下,不应延迟阿昔洛韦的开始。
BACKGROUND: Early diagnosis of encephalitis involves identifying signs of neuroinflammation, including cerebrospinal fluid (CSF) pleocytosis. However, absence of CSF pleocytosis in encephalitis has been described, most notably in autoimmune encephalitis. We examined clinical characteristics and outcomes associated with the absence or presence of CSF white blood cell pleocytosis (≥ 5 cells/µL), to inform timely diagnosis and management of encephalitis.
METHODS: This retrospective study compares initial CSF profiles in 597 adult patients with all-cause encephalitis.
RESULTS: Of the 597 patients, 446 (74.7%) had CSF pleocytosis while 151 (25.3%) did not. CSF pleocytosis occurred more commonly in infectious cases (200/446, 44.8%), along with 59 (13.2%) autoimmune cases, comprised chiefly of anti-NMDAR encephalitis (37/59, 62.7%). Notably, the group without pleocytosis was comprised of similar proportions of infectious (47/151, 31.1%) and autoimmune (38/151, 25.92%; p>0.05) encephalitis. Among those with infectious encephalitis, 47/247 (19%) had absent pleocytosis, including 18/76 (23.7%) with
HSV-1 encephalitis. The absence of pleocytosis was associated with a decreased rate of acyclovir administration (47.7% in patients without pleocytosis vs. 71.1% in patients with pleocytosis, p<0.001). Despite pleocytosis being associated with some measures of clinical severity at admission such as a Full Outline of UnResponsiveness (FOUR) score ≤14, it was not associated with mortality or prolonged hospitalization.
CONCLUSIONS: CSF pleocytosis is an important criterion for encephalitis diagnosis, but 25.3% of patients with all-cause encephalitis and 23.7% of those with
HSV-1 encephalitis exhibit absence of pleocytosis on initial LP. Acyclovir initiation should not be delayed in the absence of pleocytosis in patients with suspected encephalitis.