Adenovirus-Associated Central Nervous System Disease in Children
Adenovirus-Associated Central Nervous System Disease in Children
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DOI：
10.1016/j.jpeds.2018.09.036
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发表时间：
2019-02-01
影响因子：
5.1
通讯作者：
Bitnun, Ari
中科院分区：
文献类型：
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作者：
Schwartz, Kevin L.;Richardson, Susan E.;Bitnun, Ari
目的 描述免疫功能正常儿童中腺病毒相关神经系统疾病的谱系和显着临床特征。 研究设计 通过多伦多病童医院的脑炎登记处（1996-2016 年）和微生物学数据库（2000-2016 年）并系统回顾文献，鉴定出患有与腺病毒感染相关的中枢神经系统（CNS）疾病的既往健康儿童（1 个月至 18 岁）。对数据进行汇总和分析，以确定疾病谱、临床结果以及死亡或神经功能障碍的危险因素。结果我们机构中与腺病毒感染相关的神经系统并发症包括热性惊厥、脑炎、急性播散性脑脊髓炎和无菌性脑膜炎。总共 48 名免疫功能正常的患有腺病毒相关 CNS 疾病的儿童被纳入汇总分析中，其中 38 名来自文献，10 名来自我们机构。 85% 的病例中，病毒在呼吸道或胃肠道中检测到，但在脑脊液中未检测到。 48 名患者中有 18 名 (38%) 死亡或遭受永久性神经系统后遗症。不良结果的预测因素包括年龄较小、凝血功能障碍、无脑膜痉挛、血清型 2 病毒以及是否存在癫痫发作。经过多变量调整后，只有癫痫发作仍然是显着的危险因素。结论腺病毒是免疫功能正常儿童中枢神经系统疾病的罕见原因。疾病谱多种多样，从轻度的无菌性脑膜炎和完全可逆性脑病到严重的、可能致命的急性坏死性脑病。
Objective To characterize the spectrum and salient clinical features of adenovirus-associated neurologic disease in immunocompetent children.Study design Previously healthy children (aged 1 month-18 years) with central nervous system (CNS) disease associated with adenovirus infection were identified via the Encephalitis Registry (1996-2016) and Microbiology Database (2000-2016) at The Hospital for Sick Children, Toronto, and by systematic review of the literature. The data were pooled and analyzed to identify the spectrum of illness, clinical outcome, and risk factors for death or neurologic impairment.Results Neurologic complications associated with adenovirus infection in our institution included febrile seizures, encephalitis, acute disseminated encephalomyelitis, and aseptic meningitis. A total of 48 immunocompetent children with adenovirus-associated CNS disease were included in the pooled analysis-38 from the literature and 10 from our institution. In 85% of cases, the virus was detected in the respiratory or gastrointestinal tract, but not the cerebrospinal fluid. Eighteen of the 48 (38%) patients either died or suffered permanent neurologic sequelae. Predictors of adverse outcome included younger age, coagulopathy, the absence of meningismus, serotype 2 virus, and the presence of seizures. After multivariable adjustment, only seizures remained a significant risk factor.Conclusion Adenovirus is a rare cause of CNS disease in immunocompetent children. Disease spectrum is variable, ranging from mild aspetic meningitis and fully reversible encephalopathy to severe, potentially fatal, acute necrotizing encephalopathy.