tetano
Editor, Senior Moderator
Clin Infect Dis. 2019 Aug 1. pii: ciz685. doi: 10.1093/cid/ciz685. [Epub ahead of print]
[h=1]Causes and Clinical Features of Childhood Encephalitis: A Multicenter, Prospective Cohort Study.[/h] Britton PN[SUP]1,[/SUP][SUP]2,[/SUP][SUP]3[/SUP], Dale RC[SUP]1,[/SUP][SUP]4[/SUP], Blyth CC[SUP]5,[/SUP][SUP]6,[/SUP][SUP]7[/SUP], Clark JE[SUP]8,[/SUP][SUP]9[/SUP], Crawford N[SUP]10,[/SUP][SUP]11[/SUP], Marshall H[SUP]12,[/SUP][SUP]13[/SUP], Elliott EJ[SUP]1,[/SUP][SUP]14[/SUP], Macartney K[SUP]1,[/SUP][SUP]3,[/SUP][SUP]15[/SUP], Booy R[SUP]1,[/SUP][SUP]2,[/SUP][SUP]3,[/SUP][SUP]15[/SUP], Jones CA[SUP]2,[/SUP][SUP]10,[/SUP][SUP]11[/SUP].
[h=3]Author information[/h] 1 Discipline of Child and Adolescent Health, Sydney Medical School, Children's Hospital at Westmead, New South Wales. 2 Marie Bashir Institute of Infectious Diseases and Biosecurity Institute, University of Sydney, New South Wales. 3 Departments of Infectious Diseases and Microbiology, New South Wales. 4 Neurology, Children's Hospital at Westmead, New South Wales. 5 Perth Children's Hospital, Nedlands, Perth, Western Australia. 6 Telethon Kids Institute and School of Medicine, University of Western Australia, Nedlands, Perth, Western Australia. 7 PathWest Laboratory Medicine Western Australia and Queen Elizabeth II Medical Centre, Nedlands, Perth, Western Australia. 8 Children's Health Queensland, Brisbane. 9 School of Clinical Medicine, University of Queensland, Brisbane. 10 Murdoch Children's Research Institute and Royal Children's Hospital, Victoria. 11 University of Melbourne, Victoria. 12 Women's and Children's Hospital, South Australia. 13 Robinson Research Institute, University of Adelaide, South Australia, and. 14 Australian Paediatric Surveillance Unit, New South Wales, Australia. 15 National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia.
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] We aimed to determine the contemporary causes, clinical features, and short-term outcome of encephalitis in Australian children.
[h=4]METHODS:[/h] We prospectively identified children (≤14 years of age) admitted with suspected encephalitis at 5 major pediatric hospitals nationally between May 2013 and December 2016 using the Paediatric Active Enhanced Disease Surveillance (PAEDS) Network. A multidisciplinary expert panel reviewed cases and categorized them using published definitions. Confirmed encephalitis cases were categorized into etiologic subgroups.
[h=4]RESULTS:[/h] From 526 cases of suspected encephalitis, 287 children met criteria for confirmed encephalitis: 57% (95% confidence interval [CI], 52%-63%) had infectious causes, 10% enterovirus, 10% parechovirus, 8% bacterial meningoencephalitis, 6% influenza, 6% herpes simplex virus (HSV), and 6% Mycoplasma pneumoniae; 25% (95% CI, 20%-30%) had immune-mediated encephalitis, 18% acute disseminated encephalomyelitis, and 6% anti-N-methyl-d-aspartate receptor encephalitis; and 17% (95% CI, 13%-21%) had an unknown cause. Infectious encephalitis occurred in younger children (median age, 1.7 years [interquartile range {IQR}, 0.1-6.9]) compared with immune-mediated encephalitis (median age, 7.6 years [IQR, 4.6-12.4]). Varicella zoster virus encephalitis was infrequent following high vaccination coverage since 2007. Thirteen children (5%) died: 11 with infectious causes (2 influenza; 2 human herpesvirus 6; 2 group B Streptococcus; 2 Streptococcus pneumoniae; 1 HSV; 1 parechovirus; 1 enterovirus) and 2 with no cause identified. Twenty-seven percent (95% CI, 21%-31%) of children showed moderate to severe neurological sequelae at discharge.
[h=4]CONCLUSIONS:[/h] Epidemic viral infections predominated as causes of childhood encephalitis in Australia. The leading causes include vaccine-preventable diseases. There were significant differences in age, clinical features, and outcome among leading causes. Mortality or short-term neurological morbidity occurred in one-third of cases.
? The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
[h=4]KEYWORDS:[/h] child; encephalitis; epidemiology; infant; neonate
PMID: 31549170 DOI: 10.1093/cid/ciz685
[h=1]Causes and Clinical Features of Childhood Encephalitis: A Multicenter, Prospective Cohort Study.[/h] Britton PN[SUP]1,[/SUP][SUP]2,[/SUP][SUP]3[/SUP], Dale RC[SUP]1,[/SUP][SUP]4[/SUP], Blyth CC[SUP]5,[/SUP][SUP]6,[/SUP][SUP]7[/SUP], Clark JE[SUP]8,[/SUP][SUP]9[/SUP], Crawford N[SUP]10,[/SUP][SUP]11[/SUP], Marshall H[SUP]12,[/SUP][SUP]13[/SUP], Elliott EJ[SUP]1,[/SUP][SUP]14[/SUP], Macartney K[SUP]1,[/SUP][SUP]3,[/SUP][SUP]15[/SUP], Booy R[SUP]1,[/SUP][SUP]2,[/SUP][SUP]3,[/SUP][SUP]15[/SUP], Jones CA[SUP]2,[/SUP][SUP]10,[/SUP][SUP]11[/SUP].
[h=3]Author information[/h] 1 Discipline of Child and Adolescent Health, Sydney Medical School, Children's Hospital at Westmead, New South Wales. 2 Marie Bashir Institute of Infectious Diseases and Biosecurity Institute, University of Sydney, New South Wales. 3 Departments of Infectious Diseases and Microbiology, New South Wales. 4 Neurology, Children's Hospital at Westmead, New South Wales. 5 Perth Children's Hospital, Nedlands, Perth, Western Australia. 6 Telethon Kids Institute and School of Medicine, University of Western Australia, Nedlands, Perth, Western Australia. 7 PathWest Laboratory Medicine Western Australia and Queen Elizabeth II Medical Centre, Nedlands, Perth, Western Australia. 8 Children's Health Queensland, Brisbane. 9 School of Clinical Medicine, University of Queensland, Brisbane. 10 Murdoch Children's Research Institute and Royal Children's Hospital, Victoria. 11 University of Melbourne, Victoria. 12 Women's and Children's Hospital, South Australia. 13 Robinson Research Institute, University of Adelaide, South Australia, and. 14 Australian Paediatric Surveillance Unit, New South Wales, Australia. 15 National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia.
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] We aimed to determine the contemporary causes, clinical features, and short-term outcome of encephalitis in Australian children.
[h=4]METHODS:[/h] We prospectively identified children (≤14 years of age) admitted with suspected encephalitis at 5 major pediatric hospitals nationally between May 2013 and December 2016 using the Paediatric Active Enhanced Disease Surveillance (PAEDS) Network. A multidisciplinary expert panel reviewed cases and categorized them using published definitions. Confirmed encephalitis cases were categorized into etiologic subgroups.
[h=4]RESULTS:[/h] From 526 cases of suspected encephalitis, 287 children met criteria for confirmed encephalitis: 57% (95% confidence interval [CI], 52%-63%) had infectious causes, 10% enterovirus, 10% parechovirus, 8% bacterial meningoencephalitis, 6% influenza, 6% herpes simplex virus (HSV), and 6% Mycoplasma pneumoniae; 25% (95% CI, 20%-30%) had immune-mediated encephalitis, 18% acute disseminated encephalomyelitis, and 6% anti-N-methyl-d-aspartate receptor encephalitis; and 17% (95% CI, 13%-21%) had an unknown cause. Infectious encephalitis occurred in younger children (median age, 1.7 years [interquartile range {IQR}, 0.1-6.9]) compared with immune-mediated encephalitis (median age, 7.6 years [IQR, 4.6-12.4]). Varicella zoster virus encephalitis was infrequent following high vaccination coverage since 2007. Thirteen children (5%) died: 11 with infectious causes (2 influenza; 2 human herpesvirus 6; 2 group B Streptococcus; 2 Streptococcus pneumoniae; 1 HSV; 1 parechovirus; 1 enterovirus) and 2 with no cause identified. Twenty-seven percent (95% CI, 21%-31%) of children showed moderate to severe neurological sequelae at discharge.
[h=4]CONCLUSIONS:[/h] Epidemic viral infections predominated as causes of childhood encephalitis in Australia. The leading causes include vaccine-preventable diseases. There were significant differences in age, clinical features, and outcome among leading causes. Mortality or short-term neurological morbidity occurred in one-third of cases.
? The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
[h=4]KEYWORDS:[/h] child; encephalitis; epidemiology; infant; neonate
PMID: 31549170 DOI: 10.1093/cid/ciz685