Abe Yuichi, Ohno Takuro, Matsumoto Hiroshi, Daimon Yusuke, Kurahashi Hirokazu, Takayama Rumiko, Sakaguchi Yuri, Tanabe Saori, Tanaka Fumiko, Miyamoto Yusaku, Kawano Akiko, Yamanouchi Hideo
Department of Pediatrics, Saitama Medical University, Saitama, Japan; Division of Neurology, National Center for Child Health and Development, Tokyo, Japan.
Department of Pediatrics, Oita Prefectural Hospital, Oita, Japan.
Brain Dev. 2021 Apr;43(4):528-537. doi: 10.1016/j.braindev.2020.12.010. Epub 2021 Jan 8.
The current study aimed to identify and compare the clinical characteristics of human parechovirus type 3 (HPeV3)-associated acute encephalitis/encephalopathy (HPeV3E/E) between infants with abnormal brain magnetic resonance imaging (MRI) findings (typical, or MRI-positive HPeV3E/E) and those with MRI-negative findings (MRI-negative HPeV3E/E).
This is a retrospective study on patients with HPeV3 infection, and a two-step questionnaire survey performed on 837 hospitals in Japan between 2014 and 2016.
We identified 240 infants with HPeV3 infection, of which 34 had been clinically-diagnosed HPeV3E/E (cHPeV3E/E). However, detailed clinical data were provided by 32 of the 34 patients. Among these 32, 23 had undergone MRI and were categorized into two groups, MRI-positive (n = 17) and -negative (n = 6). There were no significant intergroup differences in clinical lab results or symptoms, except for gastrointestinal symptoms that were only present in the MRI-negative patients. The MRI-positive group showed white matter involvement on brain MRI during the acute phase, and 8 patients presented with lesions on follow-up MRI. Furthermore, 4 (50%) of the 8 patients had neurological sequelae.
Clinical characteristics of cHPeV3E/E patients with and without lesions on brain MRI showed no significant differences. Therefore, considering the difficulty in distinguishing febrile infants with cHPeV3E/E from those with a sepsis-like illness, during an HPeV3 infection epidemic, it is imperative to frequently perform brain MRI in febrile infants presenting with severe disease for the early diagnosis of HPeV3E/E presenting with brain lesions.
本研究旨在识别和比较3型人细小病毒（HPeV3）相关急性脑炎/脑病（HPeV3E/E）在脑磁共振成像（MRI）结果异常的婴儿（典型或MRI阳性HPeV3E/E）与MRI结果阴性的婴儿（MRI阴性HPeV3E/E）之间的临床特征。
这是一项对HPeV3感染患者的回顾性研究，于2014年至2016年期间在日本的837家医院进行了两步问卷调查。
我们识别出240例HPeV3感染婴儿，其中34例临床诊断为HPeV3E/E（cHPeV3E/E）。然而，34例患者中有32例提供了详细的临床数据。在这32例中，23例接受了MRI检查，并分为两组，MRI阳性（n = 17）和阴性（n = 6）。除了仅在MRI阴性患者中出现的胃肠道症状外，临床实验室结果或症状在组间无显著差异。MRI阳性组在急性期脑MRI显示白质受累，8例患者在随访MRI时有病变。此外，8例患者中有4例（50%）有神经后遗症。
脑MRI有或无病变的cHPeV3E/E患者的临床特征无显著差异。因此，考虑到区分cHPeV3E/E发热婴儿与脓毒症样疾病婴儿的困难，在HPeV3感染流行期间，对于患有严重疾病的发热婴儿，必须频繁进行脑MRI检查，以便早期诊断出现脑病变的HPeV3E/E。
