Paediatric Infectious Diseases Research Group, St George's University of London, London, UK.
Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK.
Arch Dis Child. 2019 Jun;104(6):552-557. doi: 10.1136/archdischild-2018-315643. Epub 2018 Dec 8.
This study aimed to prospectively collect detailed clinical information for all enterovirus (EV) and human parechovirus (HPeV) meningitis cases in infants aged <90 days in the UK and Ireland.
PARTICIPANTS, DESIGN AND SETTING: Prospective, active national surveillance during July 2014 to July 2015 through the British Paediatric Surveillance Unit. Reporting paediatricians completed questionnaires requesting information on clinical presentation, investigations, management and outcomes at hospital discharge and after 12 months.
To describe the clinical burden of EV and HPeV meningitis in infants aged <90 days.
During the 13-month surveillance period, 703 cases (668 EV, incidence0.79/1,000 live- births; 35 HPeV, 0.04/1,000 live-births) were identified. The most common clinical presentations were fever (EV: 570/668(85%); HPeV: 28/35(80%)), irritability (EV: 441/668(66%); HPeV: 23/35(66%)) and reduced feeding (EV: 363/668(54%); HPeV 23/35(66%)). Features of circulatory shock were present in 27% (182/668) of EV and 43% (15/35) of HPeV cases. Overall, 11% (76/668) of EV and 23% (8/35) of HPeV cases required intensive care support. Nearly all cases (678/703, 96%) were confirmed by cerebrospinal fluid (CSF) PCR, with 52% (309/600) having normal CSF white cell count for age. Two infants with EV meningitis died (2/668, 0.3%) and four survivors (4/666, 0.6%) had long-term complications at 12 months' follow-up. Infants with HPeV meningitis survived without sequelae. Overall 189 infants had a formal hearing test and none had sensorineural hearing loss.
The incidence of laboratory-confirmed EV/HPeV meningitis in young infants is more than twice that for bacterial meningitis. Less than 1% will develop severe neurological complications or die of their infection. Further studies are required to formally assess long-term neurodevelopmental sequelae.
本研究旨在前瞻性收集英国和爱尔兰所有小于 90 天龄婴儿的肠道病毒（EV）和人肠道病毒（HPeV）脑膜炎病例的详细临床信息。
参与者、设计和设置：2014 年 7 月至 2015 年 7 月期间，通过英国儿科监测单位进行了前瞻性、主动的全国性监测。报告儿科医生通过问卷完成了调查，要求提供入院时和 12 个月后的临床表现、检查、治疗和结局信息。
描述小于 90 天龄婴儿中 EV 和 HPeV 脑膜炎的临床负担。
在 13 个月的监测期间，共发现 703 例病例（668 例 EV，发病率为 0.79/1000 活产；35 例 HPeV，0.04/1000 活产）。最常见的临床表现为发热（EV：570/668（85%）；HPeV：28/35（80%））、烦躁（EV：441/668（66%）；HPeV：23/35（66%））和喂养减少（EV：363/668（54%）；HPeV：23/35（66%））。循环休克的特征存在于 27%（182/668）的 EV 和 43%（15/35）的 HPeV 病例中。总体而言，11%（76/668）的 EV 和 23%（8/35）的 HPeV 病例需要重症监护支持。几乎所有病例（703/703，96%）通过脑脊液（CSF）PCR 得到证实，其中 52%（309/600）的 CSF 白细胞计数正常。2 例 EV 脑膜炎患儿死亡（2/668，0.3%），4 例幸存者（4/666，0.6%）在 12 个月的随访中出现长期并发症。HPeV 脑膜炎患儿存活且无后遗症。共有 189 名婴儿进行了正式听力测试，均无感觉神经性听力损失。
小于 90 天龄婴儿中实验室确诊的 EV/HPeV 脑膜炎的发病率是细菌性脑膜炎的两倍多。不到 1%的患者会出现严重的神经并发症或死于感染。需要进一步研究来正式评估长期神经发育后遗症。
