Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
Institute for Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2024 Feb;65(2):78-88. doi: 10.3349/ymj.2023.0250.
Encephalitis is a heterogeneous syndrome that occurs in childhood and is not rare. However, epidemiological studies of encephalitis based on the International Encephalitis Consortium (ICS) and expert recommendations are lacking. We investigated the aetiology and prognosis of encephalitis in Korean children.
This retrospective study included children aged <19 years hospitalised for encephalitis at Severance Children's Hospital between 2005 and 2020. The 2013 ICS criteria were used to diagnose encephalitis, and causality was classified according to the site from which the specimen was obtained. Neurological sequelae were categorised using the modified Rankin Scale (mRS) score.
In total, 551 children were included, with 7% classified as possible, 77% as probable, and 15% as proven cases. A cause was identified in 42% of the cases (n=222), with viruses being the most common (42%), followed by bacteria (38%) and autoimmune encephalitis (12%). In cases of proven/probable encephalitis (n=65), bacteria accounted for 52%, followed by viruses (25%) and autoimmune encephalitis (22%). In cases with a single pathogen, the anti-N-methyl-D-aspartate receptor autoantibody (n=14) was the most common, followed by Group B (n=13), herpes simplex virus (n=11), enterovirus (n=4), and others. Approximately 37% of patients had severe sequelae (mRS score ≥3) at discharge, which decreased to 31% 6 months after discharge.
This large-scale study showed that autoimmune and infectious causes accounted for a significant proportion of encephalitis in Korean children. Further studies are needed to determine whether early targeted treatment following early diagnosis leads to a favourable prognosis in these populations.
脑炎是一种在儿童中发生且并不罕见的异质性综合征。然而，基于国际脑炎联盟（ICS）和专家建议的脑炎流行病学研究尚不多见。我们旨在调查韩国儿童脑炎的病因和预后。
本回顾性研究纳入了 2005 年至 2020 年期间在 Severance 儿童医院因脑炎住院的年龄<19 岁的儿童。采用 2013 年 ICS 标准诊断脑炎，并根据获取标本的部位对病因进行分类。采用改良 Rankin 量表（mRS）评分对神经后遗症进行分类。
共纳入 551 例患儿，7%为可能病例，77%为很可能病例，15%为确诊病例。42%（n=222）的病例确定了病因，其中病毒最常见（42%），其次是细菌（38%）和自身免疫性脑炎（12%）。在确诊/很可能脑炎病例（n=65）中，细菌占 52%，其次是病毒（25%）和自身免疫性脑炎（22%）。在单一病原体感染的病例中，抗 N-甲基-D-天冬氨酸受体自身抗体（n=14）最常见，其次是 B 组（n=13）、单纯疱疹病毒（n=11）、肠道病毒（n=4）和其他病原体。出院时约 37%的患者存在严重后遗症（mRS 评分≥3），出院后 6 个月时降至 31%。
本大规模研究表明，自身免疫和感染性病因在韩国儿童脑炎中占很大比例。需要进一步研究以确定在这些人群中，早期诊断后早期靶向治疗是否可改善预后。
