Department of Paediatrics, Hospital Sant Joan de Deu (University of Barcelona), Spain.
Department of Paediatrics, Hospital Sant Joan de Deu (University of Barcelona), Spain; Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain.
Clin Microbiol Infect. 2017 Nov;23(11):874-881. doi: 10.1016/j.cmi.2017.03.016. Epub 2017 Mar 23.
To describe the characteristics of an outbreak of brainstem encephalitis and encephalomyelitis related to enterovirus (EV) infection in Catalonia (Spain), a setting in which these manifestations were uncommon.
Clinical and microbiological data were analysed from patients with neurological symptoms associated with EV detection admitted to a reference paediatric hospital between April and June 2016.
Fifty-seven patients were included. Median age was 27.7 months (p25-p75 17.1-37.6). Forty-one (72%) were diagnosed with brainstem encephalitis, seven (12%) with aseptic meningitis, six (11%) with encephalitis, and three (5%) with encephalomyelitis (two out of three with cardiopulmonary failure). Fever, lethargy, and myoclonic jerks were the most common symptoms. Age younger than 12 months, higher white-blood-cell count, and higher procalcitonin levels were associated with cardiopulmonary failure. Using a PAN-EV real-time PCR, EV was detected in faeces and/or nasopharyngeal aspirate in all the patients, but it was found in cerebrospinal fluid only in patients with aseptic meningitis. EV was genotyped in 47 out of 57 and EV-A71 was identified in 40 out of 47, being the only EV type found in patients with brainstem symptoms. Most of the detected EV-A71 strains were subgenogroup C1. Intravenous immunoglobulins were used in 34 patients. Eight cases (14%) were admitted to the intensive care unit. All the patients but three, those with encephalomyelitis, showed a good clinical course and had no significant sequelae. No deaths occurred.
The 2016 outbreak of brainstem encephalitis in Catalonia was associated with EV-A71 subgenogroup C1. Despite the clinical manifestations of serious disease, a favourable outcome was observed in the majority of patients.
描述与肠道病毒（EV）感染相关的脑干部位脑炎和脑脊髓炎在加泰罗尼亚（西班牙）暴发的特征，在该地区这些表现并不常见。
分析了 2016 年 4 月至 6 月期间因 EV 检测相关的神经症状而入住一家参考儿科医院的患者的临床和微生物学数据。
共纳入 57 例患者。中位年龄为 27.7 个月（p25-p75 为 17.1-37.6）。41 例（72%）诊断为脑干部位脑炎，7 例（12%）为无菌性脑膜炎，6 例（11%）为脑炎，3 例（5%）为脑脊髓炎（其中 2 例伴有心肺衰竭）。发热、昏睡和肌阵挛性抽搐是最常见的症状。年龄小于 12 个月、白细胞计数较高和降钙素原水平较高与心肺衰竭有关。使用 PAN-EV 实时 PCR，所有患者的粪便和/或鼻咽抽吸物中均检测到 EV，但仅在无菌性脑膜炎患者的脑脊液中检测到。对 57 例患者中的 47 例进行了 EV 基因分型，在 47 例中发现了 40 例 EV-A71，这是唯一在脑干部位症状患者中发现的 EV 类型。检测到的大多数 EV-A71 株属于 C1 亚组。34 例患者使用了静脉注射免疫球蛋白。8 例（14%）患者被收住重症监护病房。除 3 例脑脊髓炎患者外，所有患者的临床病程均良好，无明显后遗症。无死亡病例。
2016 年加泰罗尼亚的脑干部位脑炎暴发与 EV-A71 C1 亚组有关。尽管临床表现为严重疾病，但大多数患者的预后良好。
