Causes and clinical features of childhood encephalitis: a multicenter, prospective cohort study

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Date

2020

Authors

Britton, P.N.
Dale, R.C.
Blyth, C.C.
Clark, J.E.
Crawford, N.
Marshall, H.
Elliott, E.J.
Macartney, K.
Booy, R.
Jones, C.A.

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Journal article

Citation

Clinical Infectious Diseases, 2020; 70(12):2517-2526

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Philip N Britton, Russell C Dale, Christopher C Blyth, Julia E Clark, Nigel Crawford, Helen Marshall ... et al.

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DOI

10.1093/cid/ciz685

Abstract

BACKGROUND:We aimed to determine the contemporary causes, clinical features, and short-term outcome of encephalitis in Australian children. METHODS: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. RESULTS: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. CONCLUSIONS: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.

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© 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. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

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http://purl.org/au-research/grants/nhmrc/1001021
 http://purl.org/au-research/grants/nhmrc/1102692
 http://purl.org/au-research/grants/nhmrc/1074547
 http://purl.org/au-research/grants/nhmrc/1145817
 http://purl.org/au-research/grants/nhmrc/1111596
 http://purl.org/au-research/grants/nhmrc/1084951
 http://purl.org/au-research/grants/nhmrc/1110891
 http://purl.org/au-research/grants/nhmrc/1059157
 http://purl.org/au-research/grants/nhmrc/1021480
 http://purl.org/au-research/grants/nhmrc/1113851

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https://doi.org/10.1093/cid/ciz685

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http://hdl.handle.net/2440/127154