Lin Hsiang-Yuan, Chen Yi-Lung, Chou Pei-Hsuan, Gau Susan Shur-Fen, Chang Luan-Yin
Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Brain Behav Immun Health. 2022 Jun 1;23:100479. doi: 10.1016/j.bbih.2022.100479. eCollection 2022 Aug.
Long-term neurological and neurodevelopmental sequelae are a concerning issue for people with Enterovirus A71 (EV-A71) central nervous system (CNS) infection. Unfortunately, no longitudinal prospective clinical study has systematically investigated the consequences of EV-A71 CNS infection during early life on the later development of other psychiatric disorders. In this naturalistic longitudinal follow-up design, we followed forty-three youth, who got EV-A71 CNS involvement 6-18 years ago and were enrolled in other EV-A71 clinical studies then. Their psychiatric presentation, emotional/behavioral problems, and cognitive issues were examined using a psychiatrist-conducted diagnostic interview, parent- and self-rated questionnaires, and neuropsychological tests, respectively. We compared the prevalence of psychiatric disorders in youth with EV-A71 CNS involvement to a nationally representative cohort. Emotion/behavior and cognition in EV-A71-CNS-infected youth were compared to those in a matched community-based sample of healthy controls and youth with attention-deficit/hyperactivity disorder (ADHD). Compared to a national sample (absolute ADHD prevalence 10.1%), youth with EV-A71 CNS involvement had three times the odds of receiving an ADHD diagnosis (standardized prevalence ratio, 95% CI = 1.8, 4.2; absolute ADHD prevalence 34.9%). No other psychiatric diagnoses were more common in EV-A71-CNS-infected youth. Compared to community-based ADHD youth, EV-A71-CNS-infected youth with psychiatric disorders showed comparable core ADHD symptoms, opposition/defiance, autistic features, and suboptimal sustained attention performance (based on the Conners' Continuous Performance Test), all of which were more severe than healthy controls. EV-A71-CNS-infected youth without psychiatric disorders showed comparable autistic features to EV-A71-CNS-infected youth with psychiatric disorders and ADHD youth. EV-A71 CNS involvement may cause long-term, adverse psychiatric outcomes that develop into an ADHD diagnosis alongside social/communication/emotion problems and autistic features. We recommend earlier identification and intervention of these problems among these children.
肠道病毒A71（EV - A71）中枢神经系统（CNS）感染患者的长期神经和神经发育后遗症是一个令人担忧的问题。不幸的是，尚无纵向前瞻性临床研究系统地调查过早年EV - A71中枢神经系统感染对后期其他精神障碍发展的影响。在这项自然主义纵向随访设计中，我们追踪了43名青少年，他们在6至18年前曾有EV - A71中枢神经系统受累情况，当时参加了其他EV - A71临床研究。分别通过精神科医生进行的诊断访谈、家长和自评问卷以及神经心理学测试，对他们的精神症状表现、情绪/行为问题和认知问题进行了检查。我们将有EV - A71中枢神经系统受累的青少年中精神障碍的患病率与一个具有全国代表性的队列进行了比较。将EV - A71中枢神经系统感染青少年的情绪/行为和认知与匹配的社区健康对照样本以及患有注意力缺陷/多动障碍（ADHD）的青少年进行了比较。与全国样本（ADHD绝对患病率10.1%）相比，有EV - A71中枢神经系统受累的青少年被诊断为ADHD的几率是其三倍（标准化患病率比，95%CI = 1.8，4.2；ADHD绝对患病率34.9%）。在有EV - A71中枢神经系统感染的青少年中，没有其他精神诊断更为常见。与社区ADHD青少年相比，患有精神障碍的EV - A71中枢神经系统感染青少年表现出相当的ADHD核心症状、对立/违抗、自闭症特征以及持续注意力表现欠佳（基于康纳斯连续性能测试），所有这些都比健康对照更为严重。没有精神障碍的EV - A71中枢神经系统感染青少年表现出与患有精神障碍的EV - A71中枢神经系统感染青少年以及ADHD青少年相当的自闭症特征。EV - A71中枢神经系统受累可能会导致长期不良精神后果，发展为ADHD诊断，并伴有社交/沟通/情绪问题和自闭症特征。我们建议对这些儿童中的这些问题进行更早的识别和干预。
