Parechovirus Encephalitis and Neurodevelopmental Outcomes
Parechovirus Encephalitis and Neurodevelopmental Outcomes
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DOI：
10.1542/peds.2015-2848
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发表时间：
2016-02-01
期刊：
影响因子：
8
通讯作者：
Jones, Cheryl A.
中科院分区：
文献类型：
--
作者：
Britton, Philip N.;Dale, Russell C.;Jones, Cheryl A.
目的：描述澳大利亚儿童脑炎(ACE)研究确诊的人类副病毒(HPeV)脑炎病例的临床特征和转归。确诊的HPeV感染病例有全面的人口学、临床、实验室、影像和出院时的结果数据，由专家小组审查，并根据预先确定的病例定义进行分类。出院12个月后，用年龄和分期问卷(ASQ)评估神经发育。结果：我们在2013年5月至2014年12月确诊了13例疑似脑炎合并HPeV感染的病例。9名婴儿确诊为脑炎；年龄中位数为13天，其中包括一对双胞胎。所有患者均在脑脊液中检测到HPeV，但无细胞增多症。大多数是女孩(7例)，住进重症监护室(8例)，并有癫痫发作(8例)。许多人早产(5)。7例MRI表现为脑白质弥散受限，3例头颅超声正常。出院时，9名婴儿中有3名有后遗症；然而，在12个月的随访中，使用ASQ，8名婴儿中有5名有神经发育后遗症：3名严重(2名脑瘫，1名中枢性视力障碍)。另有2例表现为粗大运动发育。结论：HPeV脑炎患儿多为幼儿，MRI表现为癫痫发作和弥散受限的女婴。头颅超声不够灵敏。HPeV脑炎与神经发育后遗症有关，尽管短期结果令人放心。考虑到缺乏脑脊液细胞增多症和需要特殊检测，HPeV可能是新生儿脑病和随后的脑性瘫痪的原因之一。
OBJECTIVE: We aimed to describe the clinical features and outcome of human parechovirus (HPeV) encephalitis cases identified by the Australian Childhood Encephalitis (ACE) study.METHODS: Infants with suspected encephalitis were prospectively identified in 5 hospitals through the (ACE) study. Cases of confirmed HPeV infection had comprehensive demographic, clinical, laboratory, imaging, and outcome at discharge data reviewed by an expert panel and were categorized by using predetermined case definitions. Twelve months after discharge, neurodevelopment was assessed by using the Ages and Stages Questionnaire (ASQ).RESULTS: We identified thirteen cases of suspected encephalitis with HPeV infection between May 2013 and December 2014. Nine infants had confirmed encephalitis; median age was 13 days, including a twin pair. All had HPeV detected in cerebrospinal fluid with absent pleocytosis. Most were girls (7), admitted to ICU (8), and had seizures (8). Many were born preterm (5). Seven patients had white matter diffusion restriction on MRI; 3 with normal cranial ultrasounds. At discharge, 3 of 9 were assessed to have sequelae; however, at 12 months' follow-up, by using the ASQ, 5 of 8 infants showed neurodevelopmental sequelae: 3 severe (2 cerebral palsy, 1 central visual impairment). A further 2 showed concern in gross motor development.CONCLUSIONS: Children with HPeV encephalitis were predominantly young, female infants with seizures and diffusion restriction on MRI. Cranial ultrasound is inadequately sensitive. HPeV encephalitis is associated with neurodevelopmental sequelae despite reassuring short-term outcomes. Given the absent cerebrospinal fluid pleocytosis and need for specific testing, HPeV could be missed as a cause of neonatal encephalopathy and subsequent cerebral palsy.