Causes and Clinical Features of Childhood Encephalitis: A Multicenter, Prospective Cohort Study. (1st August 2019)

• Record Type: Journal Article
• Authors: Britton, Philip N; Dale, Russell C; Blyth, Christopher C; Clark, Julia E; Crawford, Nigel; Marshall, Helen; Elliott, Elizabeth J; Macartney, Kristine; Booy, Robert; Jones, Cheryl A
• Is Part Of: Clinical infectious diseases. Volume 70:Number 12(2020)
• Page Start: 2517
• Page End: 2526
• Publication Date: 2019-08-01
• Subjects: encephalitis -- child -- infant -- neonate -- epidemiology; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciz685
• Languages: English
• ISSNs: 1058-4838

Abstract

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. Abstract : Leading causes of childhood encephalitis are epidemic enteroviruses/parechovirus or bacterial in infants; influenza, herpes simplex virus, or enteroviruses in children; and immune-mediated or Mycoplasma pneumoniae in older children/adolescents. Cause was unknown in 17%. Death (5%) and short-term neurological morbidity (27%) were frequent.