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Neurodevelopment and cognition in children after enterovirus 71 infection
Luan-Yin Chang1, Li-Min Huang, Susan Shur-Fen Gau
1Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. ly7077@tpts6.seed.net.tw
Insights
Enterovirus 71 infection can cause long-term neurologic issues, especially in children with cardiopulmonary failure. Those without cardiopulmonary issues generally showed good neurodevelopmental outcomes.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Enterovirus 71 (EV71) is a significant cause of hand, foot, and mouth disease and encephalitis, particularly in Asia.
- The long-term neurological and psychiatric consequences of EV71 infection on the central nervous system (CNS) remain incompletely understood.
Purpose of the Study:
- To investigate the long-term neurologic and developmental outcomes in children following enterovirus 71 infection with central nervous system involvement.
- To differentiate outcomes based on the severity of CNS involvement and the presence of cardiopulmonary complications.
Main Methods:
- Long-term follow-up of 142 children with confirmed EV71 CNS involvement.
- Assessment included physical and neurologic examinations, the Denver Developmental Screening Test II (DDST II) for younger children, and Wechsler intelligence tests for older children.
- Children were categorized by the severity of CNS involvement: aseptic meningitis, severe CNS involvement, and cardiopulmonary failure.
Main Results:
- Neurologic sequelae, including limb weakness and atrophy, were observed in a significant proportion of patients, particularly those with a poliomyelitis-like syndrome and those with prior cardiopulmonary failure.
- Delayed neurodevelopment was significantly more prevalent in children with cardiopulmonary failure (75%) compared to those with severe CNS involvement alone (5%).
- Children with cardiopulmonary failure exhibited lower scores on intelligence tests compared to children with CNS involvement without cardiopulmonary failure.
Conclusions:
- Enterovirus 71 infection involving the CNS, especially when accompanied by cardiopulmonary failure, is associated with adverse neurologic sequelae, delayed neurodevelopment, and impaired cognitive function.
- Children with CNS involvement but without cardiopulmonary failure generally demonstrated positive neurodevelopmental outcomes.
- These findings highlight the critical impact of cardiopulmonary complications on long-term recovery and cognitive function after EV71 CNS infections.
Background:
Enterovirus 71 is a common cause of hand, foot, and mouth disease and encephalitis in Asia and elsewhere. The long-term neurologic and psychiatric effects of this viral infection on the central nervous system (CNS) are not well understood.
Methods:
We conducted long-term follow-up of 142 children after enterovirus 71 infection with CNS involvement - 61 who had aseptic meningitis, 53 who had severe CNS involvement, and 28 who had cardiopulmonary failure after CNS involvement. At a median follow-up of 2.9 years (range, 1.0 to 7.4) after infection, the children received physical and neurologic examinations. We administered the Denver Developmental Screening Test (DDST II) to children 6 years of age or younger and the Wechsler intelligence test to children 4 years of age or older.
Results:
Nine of the 16 patients with a poliomyelitis-like syndrome (56%) and 1 of the 5 patients with encephalomyelitis (20%) had sequelae involving limb weakness and atrophy. Eighteen of the 28 patients with cardiopulmonary failure after CNS involvement (64%) had limb weakness and atrophy, 17 (61%) required tube feeding, and 16 (57%) required ventilator support. Among patients who underwent DDST II assessment, delayed neurodevelopment was found in only 1 of 20 patients (5%) with severe CNS involvement and in 21 of 28 patients (75%) with cardiopulmonary failure (P<0.001 for the overall comparison). Children with cardiopulmonary failure after CNS involvement scored lower on intelligence tests than did children with CNS involvement alone (P=0.003).
Conclusions:
Enterovirus 71 infection with CNS involvement and cardiopulmonary failure may be associated with neurologic sequelae, delayed neurodevelopment, and reduced cognitive functioning. Children with CNS involvement without cardiopulmonary failure did well on neurodevelopment tests. (ClinicalTrials.gov number, NCT00172393 [ClinicalTrials.gov].).
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