María P Guerrero1, Andrés F Romero2,3, Miguel Luengas4,5, Diana M Dávalos6,7, Juan Gonzalo Mesa-Monsalve8, Rosalba Vivas-Trochez9, German Camacho-Moreno4,10, Mónica Trujillo-Valencia11,12,13, Juan P Calle Giraldo6,14, Luis F Mejía15, Juan P Rojas-Hernández1,15,16, Nathaly Vinasco16, Andrea Ruiz Racines16, Alejandro Meléndez16, Claudia P Beltrán17, Pio López1,6, Yamile Chaucanez18, Jaime Patiño19, Wilfrido Coronell Rodríguez20, Doris Salgado2, Marly Martínez2, Andrea Restrepo4,10, Kelly Márquez4,10, Diego Galvis4, Iván Benavidez1, Christian A Rojas1, Erika Cantor6,21, Eduardo López Medina1,6,22. 1. From the Department of Pediatrics, Universidad del Valle, Cali, Colombia. 2. Department of Pediatrics, Hospital Universitario de Neiva, Huila, Colombia. 3. Department of Pediatrics, Universidad Surcolombiana, Neiva, Colombia. 4. Department of Pediatrics, Infectious Diseases Unit, Fundación Hospital Pediátrico la Misericordia, Bogotá, Colombia. 5. Department of Pediatrics, Hospital Militar Central, Bogotá, Colombia. 6. Centro de Estudios en Infectología Pediátrica, Cali, Colombia. 7. Department of Public Health, Universidad Icesi, Cali, Colombia. 8. Department of Pediatrics, Clínica Las Américas Auna, Medellín, Colombia. 9. Department of Pediatrics, Clínica SOMA, Universidad Cooperativa de Colombia, Medellín, Colombia. 10. Universidad Nacional de Colombia, Bogotá, Colombia. 11. Department of Pediatrics, Hospital Pablo Tobón Uribe, Medellín, Colombia. 12. Universidad CES, Medellín, Colombia. 13. Universidad Pontificia Bolivariana, Medellín, Colombia. 14. Department of Pediatrics, Universidad del Quindío, Armenia, Colombia. 15. Department of Pediatrics, Fundación Clínica Infantil Club Noel, Cali, Colombia. 16. Universidad Libre, Cali, Colombia. 17. Department of Pediatrics, Universidad de Antioquia, Clínica el Rosario, Clínica del Prado, Medellín, Colombia. 18. Department of Pediatrics, Hospital Infantil Los Ángeles, Pasto, Colombia. 19. Department of Pediatrics, Fundación Valle del Lili, Cali, Colombia. 20. Department of Pediatrics, Hospital Infantil Napoleón Franco Pareja, Universidad de Cartagena, Cartagena, Colombia. 21. Universidad de Valparaíso, Valparaíso, Chile. 22. Clínica Imbanaco, Grupo Quirón Salud, Cali, Colombia.
Abstract
OBJECTIVE: To describe a cohort of pediatric patients with encephalitis and their risk factors for admission to the pediatric intensive care unit (PICU). STUDY DESIGN: Children (<18 years old), with encephalitis evaluated by conventional microbiology and syndromic, multiplex test in cerebrospinal fluid (CSF) between July 2017 and July 2020, were recruited from 14 hospitals that comprise the Colombian Network of Encephalitis in Pediatrics. Multivariate analyses were used to evaluate risk factors associated with the need for PICU admission. RESULTS: Two hundred two children were included, of which 134 (66.3%) were male. The median age was 23 months (IQR 5.7-73.2). The main etiologies were bacteria (n = 55, 27%), unspecified viral encephalitis (n = 44, 22%) and enteroviruses (n = 27, 13%), with variations according to age group. Seventy-eight patients (38.6%) required management in the PICU. In multivariate analysis, factors associated with admission to the PICU were the presence of generalized seizures (OR 2.73; 95% CI: 1.82-4.11), status epilepticus (OR 3.28; 95% CI: 2.32-4.62) and low leukocyte counts in the CSF (OR 2.86; 95% CI: 1.47-5.57). Compared with enterovirus, bacterial etiology (OR 7.50; 95% CI: 1.0-56.72), herpes simplex encephalitis (OR 11.81; 95% CI: 1.44-96.64), autoimmune encephalitis (OR 22.55; 95% CI: 3.68-138.16) and other viral infections (OR 5.83; 95% CI: 1.09-31.20) increased the risk of PICU admission. CONCLUSIONS: Data from this national collaborative network of pediatric patients with encephalitis allow early identification of children at risk of needing advanced care and can guide the risk stratification of admission to the PICU.
OBJECTIVE: To describe a cohort of pediatric patients with encephalitis and their risk factors for admission to the pediatric intensive care unit (PICU). STUDY DESIGN: Children (<18 years old), with encephalitis evaluated by conventional microbiology and syndromic, multiplex test in cerebrospinal fluid (CSF) between July 2017 and July 2020, were recruited from 14 hospitals that comprise the Colombian Network of Encephalitis in Pediatrics. Multivariate analyses were used to evaluate risk factors associated with the need for PICU admission. RESULTS: Two hundred two children were included, of which 134 (66.3%) were male. The median age was 23 months (IQR 5.7-73.2). The main etiologies were bacteria (n = 55, 27%), unspecified viral encephalitis (n = 44, 22%) and enteroviruses (n = 27, 13%), with variations according to age group. Seventy-eight patients (38.6%) required management in the PICU. In multivariate analysis, factors associated with admission to the PICU were the presence of generalized seizures (OR 2.73; 95% CI: 1.82-4.11), status epilepticus (OR 3.28; 95% CI: 2.32-4.62) and low leukocyte counts in the CSF (OR 2.86; 95% CI: 1.47-5.57). Compared with enterovirus, bacterial etiology (OR 7.50; 95% CI: 1.0-56.72), herpes simplex encephalitis (OR 11.81; 95% CI: 1.44-96.64), autoimmune encephalitis (OR 22.55; 95% CI: 3.68-138.16) and other viral infections (OR 5.83; 95% CI: 1.09-31.20) increased the risk of PICU admission. CONCLUSIONS: Data from this national collaborative network of pediatric patients with encephalitis allow early identification of children at risk of needing advanced care and can guide the risk stratification of admission to the PICU.