扩展奥罗普切病毒神经系统疾病谱：来自2025年巴拿马疫情的新证据

文献信息

中文摘要

奥罗普切病毒是一种新发虫媒病毒，其嗜神经潜力在美洲日益受到认识。在2024-2025年巴拿马疫情期间，我们识别出6例确诊或可能感染的患者，他们出现了广泛的神经系统表现。神经系统症状在全身性疾病起病数日后出现，包括眼球运动障碍如眼球震颤和眼阵挛，小脑体征包括共济失调和眩晕，癫痫发作，精神状态改变，以及脑膜刺激征。脑脊液分析常显示单核细胞增多，而神经影像学基本无异常。脑脊液中 consistently 检测不到病毒RNA，但在急性期后可在尿液中检出，从而延长了就诊延迟患者的诊断窗口。大多数个体经支持治疗恢复；然而，1例患者在难治性癫痫持续状态后死亡，另1例需要长时间重症监护。本病例系列是巴拿马首份有神经系统症状的奥罗普切病毒感染的报告，并扩展了该疾病已知的神经系统谱。这些发现强调了对神经侵袭性表现保持临床警惕、纳入替代诊断标本以及随着奥罗普切病毒在该地区持续出现而加强监测工作的重要性。

英文摘要

Oropouche virus is an emerging arbovirus whose neurotropic potential is increasingly recognized across the Americas. During the 2024-2025 outbreak in Panama, we identified six patients with confirmed or probable infection who developed a broad range of neurological manifestations. Neurological symptoms arose several days after the onset of systemic illness and included ocular motor disturbances such as nystagmus and opsoclonus, cerebellar signs including ataxia and vertigo, seizures, altered mental status, and meningeal irritation. Cerebrospinal fluid analyses frequently demonstrated mononuclear pleocytosis, while neuroimaging was largely unremarkable. Viral RNA was consistently undetectable in cerebrospinal fluid but was identified in urine beyond the acute phase, extending the diagnostic window in patients with delayed presentation. Most individuals recovered with supportive care; however, one patient died following refractory status epilepticus, and another required prolonged intensive care. This case series represents the first report of neurologically symptomatic Oropouche virus infections in Panama and expands the recognized neurological spectrum of the disease. These findings underscore the importance of maintaining clinical suspicion for neuroinvasive presentations, incorporating alternative diagnostic specimens, and strengthening surveillance efforts as Oropouche virus continues to emerge regionally.