Etiological and Clinical Profile of Acute Nonbacterial Encephalitis in Children: A Single-Center Prospective Study

Ali Bülent Cengiz; Ceren Günbey; Mehmet Ceyhan; Gülay Korukluoğlu; Sevgen Tanır Başaranoğlu; Nesibe Gevher Eroğlu Ertuğrul; Yasemin Coşgun; Bahadır Konuşkan; Yasemin Özsürekci; Banu Anlar

doi:10.1055/s-0041-1723954

Neuropediatrics, Inhaltsverzeichnis

Neuropediatrics 2021; 52(06): 448-454
DOI: 10.1055/s-0041-1723954

Original Article

Etiological and Clinical Profile of Acute Nonbacterial Encephalitis in Children: A Single-Center Prospective Study

Autor*innen

Ali Bülent Cengiz

¹Department of Pediatric Infectious Diseases, Hacettepe University Medical Faculty, Ankara, Turkey
Ceren Günbey

²Department of Pediatric Neurology, Hacettepe University Medical Faculty, Ankara, Turkey
Mehmet Ceyhan

¹Department of Pediatric Infectious Diseases, Hacettepe University Medical Faculty, Ankara, Turkey
Gülay Korukluoğlu

³Department of Virology, Public Health Institution, Ankara, Turkey
Sevgen Tanır Başaranoğlu

¹Department of Pediatric Infectious Diseases, Hacettepe University Medical Faculty, Ankara, Turkey
Nesibe Gevher Eroğlu Ertuğrul^¶

²Department of Pediatric Neurology, Hacettepe University Medical Faculty, Ankara, Turkey
Yasemin Coşgun

³Department of Virology, Public Health Institution, Ankara, Turkey
Bahadır Konuşkan^‡

²Department of Pediatric Neurology, Hacettepe University Medical Faculty, Ankara, Turkey
Yasemin Özsürekci

¹Department of Pediatric Infectious Diseases, Hacettepe University Medical Faculty, Ankara, Turkey
Banu Anlar

²Department of Pediatric Neurology, Hacettepe University Medical Faculty, Ankara, Turkey

Abstract

Encephalitis is a serious neurological syndrome caused by inflammation of the brain. The diagnosis can be challenging and etiology remains unidentified in about half of the pediatric cases. We aimed to investigate demographic, clinical, laboratory, electroencephalographic and neuroimaging findings, and outcome of acute encephalitis of nonbacterial etiology. This prospective study included children hospitalized with the diagnosis of acute encephalitis between 2017 and 2019. Microbiological investigations of the cerebrospinal fluid (CSF) were recorded. All CSF specimens were tested for anti-N methyl D-aspartate receptor (NMDAR) antibodies. In total, 31 children aged 10 months to 17 years (median = 6 years) were included. Pathogens were confirmed in CSF in three patients (9.7%): varicella zoster virus, herpes simplex virus type 1 (HSV-1), and both HSV-1 and NMDAR antibodies. Presenting features included encephalopathy (100%), fever (80.6%), seizure (45.2%), focal neurological signs (29%), and ataxia (19.4%). On clinical follow-up of median 9 (6–24) months, six patients showed neurological deficits: together with two patients who died in hospital, total eight (25.8%) patients were considered to have unfavorable outcome. Need for intubation, receiving immunomodulatory treatment, prolonged hospitalization, and high erythrocyte sedimentation rate at admission were associated with unfavorable outcome. The etiology of encephalitis remains unexplained in the majority of children. HSV-1 is the most frequently detected virus, consistent with the literature. The fact that anti-NMDAR encephalitis was detected in one child suggests autoimmune encephalitis not being rare in our center. The outcome is favorable in the majority while about one-fifth of cases suffer from sequelae.

Keywords

encephalitis - children - virus - anti-NMDA receptor antibodies

Volltext

Referenzen

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