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Prospective Evaluation of Childhood Encephalitis: Predisposing Factors, Prevention and Outcome
Åsa Fowler1, Sofia Ygberg2, Eva Svensson2
1From the Pediatric Emergency Department, Karolinska University Hospital, Sweden.
Insights
Childhood acute encephalitis is serious, with identifiable causes in most cases. A significant portion are preventable through vaccination, highlighting the need for early diagnosis and intervention.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Clinical Epidemiology
Background:
- Childhood acute encephalitis presents a significant clinical challenge, with reported severity often influenced by study design and case selection.
- Understanding the clinical spectrum and etiological factors in a general pediatric population is crucial for accurate diagnosis and management.
Purpose of the Study:
- To prospectively investigate the clinical presentation and etiological landscape of acute encephalitis in children within a Swedish healthcare setting.
- To identify potential risk factors and outcomes associated with childhood encephalitis.
Main Methods:
- Prospective cohort study including children diagnosed with acute encephalitis between 2011 and 2016.
- Standardized protocols for laboratory testing, clinical investigations, and follow-up were applied.
Main Results:
- Etiology was determined in 61/89 children, with tick-borne encephalitis virus, enterovirus, and rotavirus being predominant. Notably, 34% of cases were linked to vaccine-preventable viruses.
- Neurological abnormalities were common, including abnormal electroencephalography (77/86) and seizures (38/89). Sequelae were reported in 49% of children.
- Immune-mediated encephalitis occurred in 7 children. Pre-existing mental health contacts and family history of CNS disease may correlate with longer hospital stays.
Conclusions:
- Childhood encephalitis has lasting consequences, often requiring hospitalization and intensive care.
- Etiological diagnosis is achievable in most cases, with a substantial proportion being vaccine-preventable.
- Electroencephalography remains a critical diagnostic tool for acute encephalitis.
Background:
Acute encephalitis in childhood is a serious condition. The severity varies between studies, partly reflecting differences in study design where only severe cases from referral centers often are reported. The aim of this study was to prospectively study the clinical picture and etiology of acute encephalitis in childhood at a primary and tertiary pediatric hospital in Sweden.
Methods:
All children with acute encephalitis were prospectively included from 2011 to 2016. Laboratory tests, investigations and follow-up were performed according to standardized study protocols.
Results:
Eighty-nine children were included (46 female and 43 male) with a median age of 53 months. An etiology was established in 61/89. Tick-borne encephalitis virus, enterovirus and rotavirus dominated and 34% were caused by a virus preventable by vaccination. Immune-mediated encephalitis was seen in 7 children. An abnormal electroencephalography picture was seen in 77/86, pathologic findings on neuroimaging in 13/49, and 38/89 children had seizures. Sequelae were reported by 49%. A high prevalence of previous contact with child and adolescent psychiatry was seen and, although not statistically significant, the need for extra support at school before encephalitis and the presence of central nervous system disease in the family seemed to predispose for a longer hospital stay.
Conclusion:
Encephalitis is a condition with long-term consequences. Most children need admission to hospital, and many need surveillance in the intensive care unit. The etiology can be determined in a majority of cases, and 1/3 could have been prevented by vaccination. This study corroborates electroencephalography as a cornerstone in diagnosis.
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