儿童单纯疱疹性中枢神经系统感染的流行病学和长期神经后遗症。
Epidemiology and long-term neurological sequelae of childhood herpes simplex CNS infection.
机构信息
Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
Queensland Children's Hospital, Brisbane, Queensland, Australia.
出版信息
J Paediatr Child Health. 2022 Aug;58(8):1372-1378. doi: 10.1111/jpc.15992. Epub 2022 May 5.
AIM
Herpes simplex CNS infection is a rare but important cause of neurological disability. Long term outcomes after HSV CNS infection in Australia have not yet been fully described. We sought to provide a comprehensive review of HSV CNS infection in children using a retrospective 13-year evaluation of statewide laboratory and clinical records and a parent survey conducted at least one year after the initial infection.
METHODS
All positive PCR HSV 1 and 2 results from cerebrospinal fluid (CSF) or brain tissue were obtained from Queensland pathology providers for children aged 0-16 years between 1 January 2005 and 31 December 2017. Clinical data were obtained from patient records and longer-term outcomes via parent survey at least 1 year after initial infection.
RESULTS
Forty-three children were identified over the 13-year period, 17 (39.5%) neonates and 26 (60.4%) non-neonates. The annual incidence for HSV CNS infection in Queensland children aged ≤16 years was 0.3/100 000 (95% confidence intervals (CIs): 0.2-0.4) with neonates at highest risk (incidence 2.5/100 000 live births, 95% CI: 1.5-3.9). HSV 1 was the predominant serotype in both neonates and non-neonates (9/17, 52.9% neonates and 19/26, 73.1% non-neonates). Seven (16.3%) children died, five (5/17, 29.4% neonates), directly attributable to HSV CNS infection (all neonates). Twenty-five (58.1%) had neurological morbidity at discharge (9/17 neonates (52.9%) vs. 16/26 (61.5%) non-neonates) and 20/27 (74.1%) reported long-term neurological morbidity at follow-up (5/9 neonates (55.6%) vs. 15/18 non-neonates (83.3%)). Seven children (two neonates and four non-neonates) with long-term neurological sequelae had no neurological morbidity identified at discharge.
CONCLUSION
Significant long-term neurologic sequelae were seen in children with HSV CNS infection even in children with no neurological disability identified at discharge from hospital. Careful neurodevelopmental follow-up of all children is recommended.
目的
单纯疱疹病毒中枢神经系统感染是一种罕见但重要的引起神经功能障碍的原因。在澳大利亚，单纯疱疹病毒中枢神经系统感染后的长期结局尚未得到充分描述。我们旨在通过对全州范围内实验室和临床记录的回顾性 13 年评估，以及在初次感染后至少一年进行的家长调查，对儿童单纯疱疹病毒中枢神经系统感染进行全面综述。
方法
从 2005 年 1 月 1 日至 2017 年 12 月 31 日，我们从昆士兰州病理提供者处获取了年龄在 0 至 16 岁的儿童脑脊液（CSF）或脑组织中单纯疱疹病毒 1 和 2 的所有阳性 PCR 结果。通过患者记录和初次感染后至少 1 年的家长调查获取临床数据。
结果
在 13 年期间，共发现 43 例患儿，其中 17 例（39.5%）为新生儿，26 例（60.4%）为非新生儿。在昆士兰州≤16 岁的儿童中，单纯疱疹病毒中枢神经系统感染的年发病率为 0.3/100000（95%置信区间：0.2-0.4），新生儿的风险最高（发病率为 2.5/100000 活产儿，95%置信区间：1.5-3.9）。单纯疱疹病毒 1 是新生儿和非新生儿中主要的血清型（9/17，52.9%新生儿和 19/26，73.1%非新生儿）。7 例（16.3%）患儿死亡，其中 5 例（5/17，29.4%新生儿）直接归因于单纯疱疹病毒中枢神经系统感染（均为新生儿）。25 例（58.1%）患儿出院时有神经功能障碍（9/17 例新生儿（52.9%）与 16/26 例非新生儿（61.5%）），20 例（74.1%）患儿在随访时报告有长期神经功能障碍（5/9 例新生儿（55.6%）与 15/18 例非新生儿（83.3%））。7 例（2 例新生儿和 4 例非新生儿）有长期神经后遗症的患儿出院时未发现有神经功能障碍。
结论
即使在出院时没有发现神经功能障碍的儿童中，单纯疱疹病毒中枢神经系统感染也会导致严重的长期神经后遗症。建议对所有儿童进行仔细的神经发育随访。
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