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Encephalitis and cytokine storm secondary to respiratory viruses in children: Two case reports

Pollyana C P Santos1, Adrian J Holloway2, Jason W Custer2

  • 1Pediatric Critical Care Observation Program, Department of Pediatric Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD, United States.

Frontiers in Pediatrics
|February 6, 2023
PubMed

Insights

Respiratory viruses like parainfluenza and RSV can cause severe encephalitis in children, sometimes leading to a dangerous cytokine storm and multi-organ dysfunction. This rare complication highlights the need for further understanding of viral-induced neurological syndromes.

Area of Science:

  • Pediatric Neurology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Encephalitis, characterized by brain inflammation, cognitive impairment, and altered cerebrospinal fluid, is primarily caused by viral infections in children.
  • Respiratory Syncytial Virus (RSV) and parainfluenza virus are typically linked to respiratory illnesses, but can uncommonly cause severe neurological complications.
  • A cytokine storm, an exacerbated host response, can occur in viral encephalitis, but its link to these specific respiratory viruses is rare and poorly understood.

Observation:

  • Two pediatric cases of encephalitis associated with parainfluenza and RSV infections are presented.
  • Both patients experienced severe illness requiring pediatric intensive care, presenting with seizures and hemodynamic instability.
  • One patient showed specific MRI findings and elevated IL-6 levels, while the other developed cerebral edema and succumbed.

Findings:

  • Encephalitis secondary to respiratory viral infections can trigger a cytokine storm and multi-organ inflammatory responses in children.
  • Case presentations illustrate the severe spectrum of this rare complication, from rapid recovery to fatal outcomes.
  • The pathophysiology linking these respiratory viruses to severe neurological syndromes and cytokine storms remains unclear.

Implications:

  • This study underscores the potential for severe neurological complications, including cytokine storms, from common respiratory viruses in children.
  • Early recognition and understanding of this rare association are crucial for pediatric critical care.
  • Further research is needed to elucidate the underlying mechanisms of viral-induced encephalitis and cytokine storm in pediatric populations.
Abstract

Keywords:
childrencytokine stormencephalitis (MeSH)parainfluenza virusrespiratory syncytial virus

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