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Enteroviral and herpes simplex virus central nervous system infections in infants < 90 days old: a Paediatric
Dara Petel1, Michelle Barton1, Christian Renaud2
1Department of Pediatrics, Western University, London, Ontario, Canada.
Insights
In young infants, enterovirus (EV) and herpes simplex virus (HSV) cause central nervous system (CNS) infections. HSV infections are associated with more severe outcomes, even without cerebrospinal fluid pleocytosis.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Neurology
Background:
- The role of viruses in central nervous system (CNS) infections in infants is not well-defined.
- Limited data exist on features suggesting herpes simplex virus (HSV) etiology or predictors of poor outcomes in viral CNS infections.
Purpose of the Study:
- To determine the relative contribution of enterovirus (EV) and HSV to CNS infections in infants.
- To identify clinical features and predictors of outcome in infants with EV or HSV CNS infections.
Main Methods:
- A retrospective, cross-sectional study involving seven Canadian pediatric centers.
- Identified infants <90 days old with CNS infections due to EV or HSV between January 2013 and December 2014.
Main Results:
- Of 174 CNS infections, EV accounted for 59% and HSV for 4%.
- HSV cases were more likely to present early (<21 days), have seizures, require ICU admission, and have extra-CNS disease.
- Unfavorable outcomes were more common in HSV infections (57%) compared to EV infections (8%).
Conclusions:
- Viruses cause approximately two-thirds of CNS infections in infants under 90 days.
- Empiric HSV therapy is recommended for suspected CNS infections in the first 21 days, even without CSF pleocytosis.
- Neurodevelopmental follow-up is advised for infants with seizures during their CNS infection course.
Background:
The relative contribution of viruses to central nervous system (CNS) infections in young infants is not clear. For viral CNS infections, there are limited data on features that suggest HSV etiology or on predictors of unfavorable outcome.
Methods:
In this cross-sectional retrospective study, seven centers from the Pediatric Investigators Collaborative Network on Infections in Canada identified infants < 90 days of age with CNS infection proven to be due to enterovirus (EV) or herpes simplex virus (HSV) January 1, 2013 through December 31, 2014.
Results:
Of 174 CNS infections with a proven etiology, EV accounted for 103 (59%) and HSV for 7 (4%). All HSV cases and 41 (40%) EV cases presented before 21 days of age. Four HSV cases (57%) and 5 EV cases (5%) had seizures. Three (43%) HSV and 23 (23%) EV cases lacked cerebrospinal fluid (CSF) pleocytosis. HSV cases were more likely to require ICU admission (p = 0.010), present with seizures (p = 0.031) and have extra-CNS disease (p < 0.001). Unfavorable outcome occurred in 12 cases (11% of all EV and HSV infections) but was more likely following HSV than EV infection (4 (57%) versus 8 (8%); p = 0.002).
Conclusions:
Viruses accounted for approximately two-thirds of proven CNS infections in the first 90 days of life. Empiric therapy for HSV should be considered in suspected CNS infections in the first 21 days even in the absence of CSF pleocytosis unless CSF parameters are suggestive of bacterial meningitis. Neurodevelopmental follow-up should be considered in infants whose course of illness is complicated by seizures.