Section of Pediatric Tropical Medicine, National School of Tropical Medicine.
Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Houston, Texas.
Pediatrics. 2020 Jun;145(6). doi: 10.1542/peds.2019-2543. Epub 2020 May 1.
Encephalitis can result in neurologic morbidity and mortality in children. Newly recognized infectious and noninfectious causes of encephalitis have become increasingly important over the past decade.
We retrospectively reviewed medical records from pediatric patients in Houston diagnosed with encephalitis in both an urban and rural catchment area between 2010 and 2017. We conducted an investigation to understand the etiology, clinical characteristics, and diagnostic testing practices in this population.
We evaluated 231 patients who met the case definition of encephalitis, among which 42% had no recognized etiology. Among those with an identified etiology, the most common were infectious (73; 31%), including viral ( = 51; 22%), with the most frequent being West Nile virus (WNV; = 12), and bacterial ( = 19; 8%), with the most frequent being ( = 7). Among cases of autoimmune encephalitis ( = 60; 26%), the most frequent cause was anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis ( = 31). Autoimmune causes were seen more commonly in female ( < .01) patients. Testing for herpes simplex virus and enterovirus was nearly universal; testing for anti-NMDAR encephalitis, WNV, and was less common.
WNV was the most common infectious cause of encephalitis in our pediatric population despite lower testing frequency for WNV than herpes simplex virus or enterovirus. Increasing testing for anti-NMDAR encephalitis resulted in frequent identification of cases. Increased awareness and testing for WNV and would likely result in more identified causes of pediatric encephalitis. Earlier etiologic diagnosis of encephalitides may lead to improve clinical outcomes.
脑炎可导致儿童出现神经功能残疾和死亡。在过去十年中，新发现的感染性和非感染性脑炎病因变得越来越重要。
我们回顾性分析了 2010 年至 2017 年间，休斯顿市区和农村地区被诊断为脑炎的儿科患者的病历。我们进行了一项调查，以了解该人群的病因、临床特征和诊断检测实践。
我们评估了 231 名符合脑炎病例定义的患者，其中 42%的患者病因不明。在有明确病因的患者中，最常见的是感染性病因（73 例；31%），包括病毒性脑炎（51 例；22%），最常见的病原体是西尼罗河病毒（WNV；12 例），细菌性脑炎（19 例；8%），最常见的病原体是 （7 例）。在自身免疫性脑炎（60 例；26%）中，最常见的病因是抗 N-甲基-D-天冬氨酸受体（NMDAR）脑炎（31 例）。女性患者中更常见自身免疫性病因（ <.01）。单纯疱疹病毒和肠病毒检测几乎普遍进行；抗 NMDAR 脑炎、WNV 和 检测则不太常见。
尽管 WNV 检测频率低于单纯疱疹病毒或肠病毒，但 WNV 是我们儿科人群中最常见的感染性脑炎病因。增加抗 NMDAR 脑炎检测导致了更多病例的确诊。增加对 WNV 和 的认识和检测可能会发现更多导致小儿脑炎的病因。早期确定脑炎的病因可能会改善临床结局。
