Gunaratna Gayana P S, Mohammad Shekeeb S, Blyth Christopher C, Clark Julia, Crawford Nigel, Marshall Helen, Dale Russell C, Jones Cheryl A, Britton Philip N
Department of Infectious Diseases & Microbiology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Department of Parasitology, Faculty of Medicine, University of Kelaniya, Sri Lanka.
J Child Neurol. 2022 May 12:8830738221093209. doi: 10.1177/08830738221093209.
Postinfectious acute cerebellar syndromes show a wide spectrum of acute severity and can occur with acute febrile illness or vaccine receipt. Varicella has historically been the most common cause, associated with up to 25% of cases in large cohorts. This study aimed to describe the spectrum of syndromes in a setting with high varicella vaccine coverage.
Data were collected on children initially identified as "suspected encephalitis" subsequently designated "not-encephalitis" at participating children's hospitals in the Paediatric Active Enhanced Disease Surveillance (PAEDS) network, Australia, as part of the Acute Childhood Encephalitis study. A comprehensive descriptive analysis was undertaken on prospectively identified, national series of children with postinfectious acute cerebellar syndromes from 2013 to 2018. Cases were classified using a previously validated severity score, and the outcome was assessed at 12 months using the Liverpool Outcome Scale score.
A total of 20 cases (65% were vaccinated for varicella) were included, of which 70% were subcategorized as acute cerebellar ataxia (ACA), 20% acute cerebellitis (AC), and 10% acute fulminant cerebellitis (AFC). An acute febrile illness was noted in 55% and none were related to varicella or were temporally related to varicella vaccination or other childhood vaccines. A subset (total of 7 children) followed up at 12 months all showed reduced Liverpool Outcome Scale scores.
The study provides an overall description of this uncommon spectrum of neurologic syndromes and shows the infrequency of varicella zoster virus as a cause in a vaccinated population.
感染后急性小脑综合征的严重程度各异，可发生于急性发热性疾病或接种疫苗之后。水痘一直是最常见的病因，在大型队列研究中，高达25%的病例与之相关。本研究旨在描述在水痘疫苗高覆盖率背景下的综合征谱。
作为儿童急性脑炎研究的一部分，在澳大利亚儿科主动强化疾病监测（PAEDS）网络的参与儿童医院收集最初被确定为“疑似脑炎”、随后被指定为“非脑炎”的儿童数据。对2013年至2018年前瞻性确定的全国性感染后急性小脑综合征儿童系列进行全面的描述性分析。使用先前验证的严重程度评分对病例进行分类，并在12个月时使用利物浦结局量表评分评估结局。
共纳入20例（65%接种了水痘疫苗），其中70%被归类为急性小脑性共济失调（ACA），20%为急性小脑炎（AC），10%为急性暴发性小脑炎（AFC）。55%的病例有急性发热性疾病史，无一例与水痘有关，也无病例在时间上与水痘疫苗接种或其他儿童疫苗相关。12个月时随访的一个亚组（共7名儿童）的利物浦结局量表评分均降低。
本研究对这种罕见的神经综合征谱进行了全面描述，并显示在接种疫苗的人群中，水痘带状疱疹病毒作为病因并不常见。
