Clinical Research
The clinical characteristics of human pseudorabies virus infection: a case report and literature review
Liu Yanru, Yang Baibing, Bai Rong, Wang Yu, Li Jinghong, Ren Haitao, Guan Hongzhi
Published 2022-02-08
Cite as Chin J Neurol, 2022, 55(2): 146-151. DOI: 10.3760/cma.j.cn113694-20210514-00337
Abstract
ObjectiveTo explore the epidemiology, clinical features and prognosis of pseudorabies virus (PRV) infection in human.
MethodsA 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.
ResultsThe 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).
ConclusionsThe 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.
Key words:
Pseudorabies virus; Encephalitis; Endophthalmitis; Acute retinal necrosis; Next-generation sequencing
Contributor Information
Liu Yanru
Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
Yang Baibing
Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
Bai Rong
Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
Wang Yu
People′s Hospital of Xichuan County, Nanyang 473000, China
Li Jinghong
Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
Ren Haitao
Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
Guan Hongzhi
Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
