Chang Yi-Jung, Huang Chung-Guei, Shie Shian-Sen, Lin Jainn-Jim, Chen Chih-Jung
Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 333 Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Department of Laboratory Medicine, Linkou-Chang Gung Memorial Hospital, Taiwan; Department of Medical Biotechnology and Laboratory Science, Graduate Institute of Biomedical Sciences, Chang Gung University, Taiwan.
J Microbiol Immunol Infect. 2024 Feb;57(1):48-54. doi: 10.1016/j.jmii.2023.10.005. Epub 2023 Oct 29.
A surge of encephalitis was reported in children during the early wave of the omicron epidemic in Taiwan. Information on the COVID-19-associated encephalitis, including epidemiologic features and factors of unfavorable outcomes, remained unclear.
A total of 128 hospitalized Taiwanese children with laboratory-confirmed COVID-19 were enrolled between April 01, 2022, and May 31, 2022. The information on demographics and clinical features was abstracted from the medical records. Virologic lineages were determined by sequences of the spike protein. Factors associated with encephalitis and unfavorable outcomes were identified by comparisons to children without encephalitis and with favorable outcomes, respectively.
The leading syndromes associated with COVID-19 in hospitalized children were febrile seizure (20, 15.7%), fever as the solitary symptom (18, 14.1%), and croup syndrome (14, 10.9%). Encephalitis was diagnosed in nine (7.03%) children. When compared to the three leading syndromes, children with encephalitis were at older ages, had greater rates of hypotension, PICU admissions, use of inotropic agents (P < .001 for all above comparisons), mortality (P = .008), and longer hospital stays (P = .016), but not the underlying comorbidities (P = .376). Unfavorable outcomes were identified in 3 (33.3%) of 9 encephalitis cases and associated with a lower Glasgow coma scale, hypotension, and higher C-reactive protein (P < .05 for all). BA.2.3.7 was the dominant sublineage in children with or without encephalitis.
Omicron BA.2.3.7 can cause fulminant and lethal encephalitis in healthy children. Depressed consciousness and hypotension at presentation were significant risks of unfavorable outcomes for pediatric COVID-19-associated encephalitis.
台湾地区在奥密克戎疫情早期报告了儿童脑炎病例激增的情况。关于新型冠状病毒肺炎（COVID-19）相关脑炎的信息，包括流行病学特征和不良预后因素，仍不明确。
2022年4月1日至2022年5月31日期间，共纳入128例实验室确诊COVID-19的台湾住院儿童。人口统计学和临床特征信息从病历中提取。通过刺突蛋白序列确定病毒谱系。分别与无脑炎且预后良好的儿童进行比较，确定与脑炎和不良预后相关的因素。
住院儿童中与COVID-19相关的主要综合征为热性惊厥（20例，15.7%）、单纯发热症状（18例，14.1%）和哮吼综合征（14例，10.9%）。9例（7.03%）儿童被诊断为脑炎。与三种主要综合征相比，脑炎患儿年龄较大，低血压、入住儿科重症监护病房（PICU）、使用血管活性药物的比例更高（上述所有比较P<0.001），死亡率更高（P=0.008），住院时间更长（P=0.016），但基础合并症情况无差异（P=0.376）。9例脑炎病例中有3例（33.3%）出现不良预后，与较低的格拉斯哥昏迷量表评分、低血压和较高的C反应蛋白水平相关（所有P<0.05）。BA.2.3.7是有或无脑炎患儿中的主要亚谱系。
奥密克戎BA.2.3.7可导致健康儿童发生暴发性致死性脑炎。发病时意识障碍和低血压是儿童COVID-19相关脑炎不良预后的重要风险因素。
