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Long-term outcome of acute central nervous system infection in children
1Department of Infectious Diseases Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China.
Insights
Most children recover from acute central nervous system infections, but many face long-term challenges like cognitive deficits and epilepsy. Key predictors of poor outcomes include coma, brain abnormalities, and herpes simplex virus encephalitis.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neuroscience
Background:
- Central nervous system infections pose a significant threat to children's health.
- Long-term outcomes for pediatric central nervous system infections are not well-understood across different causes.
Purpose of the Study:
- To evaluate the long-term outcomes in children treated for acute central nervous system infection.
- To identify prognostic factors associated with long-term sequelae.
Main Methods:
- Follow-up evaluations were conducted 3.8-4.7 years post-discharge for 139 children treated for acute central nervous system infection.
- Parental interviews and medical record reviews were used to assess clinical features and outcomes.
- The Pediatric Version of the Glasgow Outcome Scale-Extended was employed to determine global outcomes.
Main Results:
- A favorable outcome was observed in 78% of patients; however, 27% experienced mild, 4% moderate, and 10% severe impairments.
- Common long-term symptoms included concentration difficulties, epilepsy, and limb paralysis.
- Coma, brain parenchymal abnormalities on neuroimaging, and herpes simplex virus encephalitis (HSVE) were independently associated with poor outcomes.
Conclusions:
- The majority of children achieve a favorable outcome after acute central nervous system infection, but a significant proportion experience persistent disabilities.
- Coma, neuroimaging findings of brain parenchymal abnormalities, and HSVE are critical predictors of adverse long-term prognoses.
- Further research into early identification and intervention strategies for high-risk children is warranted.
Importance:
Central nervous system infection is a severe illness in children. Little is known about the long-term outcome in children with central nervous system infection of various etiologies.
Objective:
The aims of this study were to investigate the long-term outcomes of childhood acute central nervous system infection and to examine possible prognostic factors.
Methods:
Of 172 children who were treated for acute central nervous system infection from January 2009 through December 2009, 139 were eligible for follow-up evaluations. A structured interview was conducted with the parents 3.8-4.7 years after hospital discharge. The global outcome was determined in all patients using the Pediatric Version of the Glasgow Outcome Scale-Extended. Clinical features of the acute episode were retrieved from medical records.
Results:
The outcome was favorable in 109 of 139 patients (78%), 38 (27%) were mildly impaired, six (4%) were moderately impaired, 14 (10%) were severely impaired and two (1%) were in a vegetative state. There were eight deaths. The most frequent symptoms were difficulty concentrating (16%), epilepsy (12%), limb paralysis (12%), memory impairment (10%), speech disorders (9%), irritability (9%). Significant risk factors for epilepsy included the presence of recurrent seizures or status epilepticus, the existence of pure spikes in the electroencephalogram, brain parenchyma abnormalities on neuroimaging and herpes simplex virus encephalitis (HSVE). A multivariate analysis identified three factors that were independently associated with poor outcome: coma, brain parenchyma abnormalities on neuroimaging and HSVE.
Interpretation:
Most children with acute central nervous system infection experienced a favorable outcome 3.8-4.7 years after discharge from the hospital. Minor to severe disability persists in a high proportion of cases. Coma, brain parenchymal abnormalities on neuroimaging and HSVE may predict poor long-term outcome.
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