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Prognostic factors in childhood acute encephalitis
J Rautonen1, M Koskiniemi, A Vaheri
1Children's Hospital, Helsinki, Finland.
Insights
Young children and those with altered consciousness face higher risks of death or severe outcomes from acute encephalitis. Early detection of herpes simplex virus or Mycoplasma pneumoniae is crucial for better prognosis.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
Background:
- Acute encephalitis poses a significant threat to children, with varying outcomes.
- Identifying prognostic factors is essential for timely intervention and improved patient management.
Purpose of the Study:
- To investigate the key prognostic factors associated with mortality and severe sequelae in pediatric acute encephalitis.
- To identify specific patient groups and etiological agents that increase the risk of poor outcomes.
Main Methods:
- Retrospective analysis of 462 pediatric patients diagnosed with acute encephalitis.
- Statistical evaluation of age, level of consciousness, and specific pathogens (herpes simplex virus, Mycoplasma pneumoniae) as risk factors.
Main Results:
- Mortality was 2.8%, with 6.7% experiencing severe damage; 90.5% recovered with minor or no sequelae.
- Infants under 1 year had a 5.0-fold increased risk of death or severe damage.
- Impaired consciousness (disorientation or unconsciousness) significantly elevated the risk (3.9-fold and 25.4-fold, respectively).
- Herpes simplex virus encephalitis (11.7-fold risk) and Mycoplasma pneumoniae encephalitis (7.0-fold risk) were associated with poorer outcomes.
Conclusions:
- Young age and impaired consciousness are critical risk factors for severe outcomes in pediatric acute encephalitis.
- Herpes simplex virus and Mycoplasma pneumoniae infections present a higher risk and warrant focused diagnostic and therapeutic efforts.
- Patients without identified risk factors generally had favorable outcomes, emphasizing the importance of identifying and managing these specific risk elements.
Abstract:
We have studied the prognostic factors in 462 children, from 1 month to 16 years old, with acute encephalitis. Death occurred in 2.8% patients, 6.7% were severely damaged and 90.5% were cured with no or only minor sequelae. The risk of death or severe damage in patients less than 1 year of age was 5.0-fold (95% confidence limits, 2.2 to 11.6; P less than 0.001) greater than that of older children. When compared with those children whose level of consciousness had been normal before admission, children who had been disoriented before admission had a 3.9-fold (1.1 to 14.3, P less than 0.05) risk and those who had been unconscious had a 25.4-fold (7.3 to 88.1, P less than 0.001) greater risk of death or severe damage. The risk of death or severe damage in patients with herpes simplex virus encephalitis was 11.7-fold (3.8 to 35.8, P less than 0.001) and in patients with Mycoplasma pneumoniae encephalitis it was 7.0-fold (2.6 to 18.7, P less than 0.001) that of other children. All patients with none of the above mentioned risk factors were cured without any major sequelae. We conclude that specific attention should be paid to the youngest patients, especially to those with an impaired level of consciousness, and all available measures should be focused on early detection of herpes simplex virus or M. pneumoniae infection.