Kam-Lun Ellis Hon1, Yin Ching K Tsang2, Lawrence C N Chan2, Hing Wing Tsang3, Kit Ying Kitty Wong4, Yuet Hong Gordon Wu3, Paul K S Chan5, Kam Lau Cheung2, Eric Y K Ng6, Balagangadhar R Totapally7. 1. Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, 6/F, Clinical Sciences Building, Shatin, Hong Kong. ehon@hotmail.com. 2. Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, 6/F, Clinical Sciences Building, Shatin, Hong Kong. 3. Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, Hong Kong. 4. Department of Chemical Pathology, Alice Ho Miu Ling Nethersole Hospital, New Territories, Hong Kong, Hong Kong. 5. Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. 6. Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong. 7. Division of Critical Care Medicine, Nicklaus Childrens Hospital, Miami, FL, USA.
Abstract
OBJECTIVE: To review pathogens, morbidity and mortality in pediatric intensive care unit (PICU) patients with viral and infectious encephalitis. METHODS: Retrospective chart review of all patients with encephalitis admitted to the PICU between 2002 and 2014 was done. RESULTS: Encephalitis (n = 46) accounted for 2.7 % of PICU admissions, but 11.8 % PICU mortality over a 12-y period. A microorganism (primarily virus) was identified in 59 % of encephalitis patients in the PICU. Enteroviruses and herpes viruses were isolated from the cerebrospinal fluid (CSF). Respiratory viruses [such as respiratory syncytial virus (RSV) and influenza viruses] and enteric viruses (such as rotavirus and norovirus) were obtained in the nasopharyngeal aspirate and stool respectively, but undetectable from the CSF. More than one-fourth patients with encephalitis died in the PICU. Boys accounted for 85 % of nonsurvivors and 52 % survivors (p = 0.038). Mechanical ventilation, inotrope, intravenous immunoglobulin (IVIG) and corticosteroid usage were significantly higher among non-survivors (p 0.001-0.044). Binomial logistic regression showed that patients who received corticosteroid had a lower chance of survival than those who did not after adjusting for gender, IVIG and mechanical ventilation (adjusted odd ratio = 0.071, 95 % CI 0.006-0.881; p 0.039). Eighteen (55 %) of the survivors had moderate-to-severe neurodevelopmental impairments. CONCLUSIONS: Encephalitis is associated with significant mortality despite intensive care. Over 25 % case died and 55 % of survivors had moderate-to-severe neurodevelopmental impairments. There appeared to be no emerging outbreaks of encephalitis during the 15-y study period.
OBJECTIVE: To review pathogens, morbidity and mortality in pediatric intensive care unit (PICU) patients with viral and infectious encephalitis. METHODS: Retrospective chart review of all patients with encephalitis admitted to the PICU between 2002 and 2014 was done. RESULTS:Encephalitis (n = 46) accounted for 2.7 % of PICU admissions, but 11.8 % PICU mortality over a 12-y period. A microorganism (primarily virus) was identified in 59 % of encephalitispatients in the PICU. Enteroviruses and herpes viruses were isolated from the cerebrospinal fluid (CSF). Respiratory viruses [such as respiratory syncytial virus (RSV) and influenza viruses] and enteric viruses (such as rotavirus and norovirus) were obtained in the nasopharyngeal aspirate and stool respectively, but undetectable from the CSF. More than one-fourth patients with encephalitis died in the PICU. Boys accounted for 85 % of nonsurvivors and 52 % survivors (p = 0.038). Mechanical ventilation, inotrope, intravenous immunoglobulin (IVIG) and corticosteroid usage were significantly higher among non-survivors (p 0.001-0.044). Binomial logistic regression showed that patients who received corticosteroid had a lower chance of survival than those who did not after adjusting for gender, IVIG and mechanical ventilation (adjusted odd ratio = 0.071, 95 % CI 0.006-0.881; p 0.039). Eighteen (55 %) of the survivors had moderate-to-severe neurodevelopmental impairments. CONCLUSIONS:Encephalitis is associated with significant mortality despite intensive care. Over 25 % case died and 55 % of survivors had moderate-to-severe neurodevelopmental impairments. There appeared to be no emerging outbreaks of encephalitis during the 15-y study period.
Authors: Kam Lun Hon; Erica Leung; Erica Hung; Julian Tang; Chung Mo Chow; Ting Fan Leung; Kam Lau Cheung; Pak Cheung Ng Journal: Pediatr Pulmonol Date: 2008-03
Authors: Heidi M Pöyhönen; Mikko J Nyman; Ville T Peltola; Eliisa S Löyttyniemi; Tuire T Lähdesmäki Journal: Dev Med Child Neurol Date: 2022-05-08 Impact factor: 4.864