Risk factors for neurological complications in children with Flavivirus infection

Area of Science:

• Neuroscience
• Infectious Diseases
• Pediatrics

Background:

• Dengue virus (DENV), Zika virus (ZIKV), and Yellow Fever Virus (YFV) are flaviviruses that can cause central nervous system (CNS) infections.
• Neurological manifestations in children require thorough characterization and risk factor identification for effective management.

Purpose of the Study:

• To characterize acute neurological manifestations of DENV, ZIKV, and YFV in hospitalized children.
• To identify risk factors for persistent neurological complications post-discharge.
• To evaluate the time to neurological complication resolution.

Main Methods:

• A prospective study of 505 children hospitalized with suspected CNS infections between March 2014 and July 2019.
• Real-time reverse transcription-polymerase chain reaction (RT-PCR) used to confirm viral RNA in cerebrospinal fluid (CSF).
• Clinical follow-up, predictive factor analysis, and survival curves were employed.

Main Results:

• Clinical symptoms, CSF analysis, EEG, and CNS imaging predicted complications in children with DENV, ZIKV, or YFV CNS infections.
• No significant difference in complication resolution time was observed among the three flaviviruses (p=0.574).
• Children with YFV showed a 53% higher risk of developing neurological complications.

Conclusions:

• Early etiological diagnosis via RT-PCR in CSF is crucial for managing pediatric flavivirus CNS infections.
• Identifying predictors of complications aids in improving prognosis and clinical follow-up.
• While recovery times are similar, YFV poses a greater risk for neurological complications.