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Severe encephalitis: aetiology, management and outcomes over 10 years in a paediatric intensive care unit
Giordano Palmas1,2, Trevor Duke2,3
1Department of Paediatrics, Meyer Children's Hospital IRCCS, Florence, Italy giordano.palmas@gmail.com.
Insights
Severe pediatric encephalitis, often caused by enterovirus or herpes simplex virus (HSV), can lead to death or disability. Young age, specific viral causes, and prolonged ventilation are key risk factors for poor outcomes in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Neurology
Background:
- Severe encephalitis in children is a critical condition with significant morbidity and mortality.
- Understanding the diverse etiologies and risk factors is crucial for effective management.
Purpose of the Study:
- To characterize the epidemiology, clinical presentations, management strategies, and outcomes of severe encephalitis in children admitted to a pediatric intensive care unit (PICU).
- To identify risk factors associated with severe disability or death in this pediatric population.
Main Methods:
- A 10-year retrospective cohort study of children (0-17 years) with suspected encephalitis admitted to a tertiary PICU.
- Data collected included demographics, clinical features, causative agents, treatments (mechanical ventilation, ECMO), and follow-up outcomes (disability, death).
Main Results:
- 175 children were admitted with encephalitis; enterovirus was the most common cause (28%).
- Mortality was 6.3% (11 deaths), with Human Herpesvirus-6 (HHV-6) being the most frequent cause of death.
- Factors associated with severe disability or death included age <2 years, Herpesviridae infection, and prolonged intubation.
Conclusions:
- Encephalitis in critically ill children has a varied etiology and a substantial risk of death or severe disability.
- Early identification of high-risk factors such as young age and specific viral infections is essential for improving outcomes.
Objective:
To describe the characteristics, differential diagnoses, management and outcomes of severe encephalitis in children.
Design:
A 10-year retrospective cohort study in children admitted to a tertiary paediatric intensive care unit (PICU) with suspected encephalitis. One to 6 months' follow-up data were compared between different categories.
Participants:
Patients from 0 to 17 years of age with acute encephalopathy and one or more of fever, seizure, focal neurological findings, cerebrospinal fluid abnormalities, EEG/neuroimaging consistent with encephalitis.
Main Outcome Measures:
Epidemiology, clinical features, outcomes and risk factor analysis.
Results:
175 children with encephalitis required intensive care unit (ICU) admission over 10 years. The median age was 4.5 months (IQR 1.6-54.8). The leading cause was enterovirus (n=49, 28%), followed by parechovirus, influenza, herpes simplex virus (HSV), human herpesvirus-6 (HHV-6), Streptococcus pneumoniae, acute-disseminated encephalomyelitis and anti-N-methyl-D-aspartate-receptor-associated encephalitis. Immune-mediated encephalitis had higher prevalence in females, older age and longer duration of encephalopathy. Mechanical ventilation was required by 74 children (42%); haemodynamic support by 28 children (16%), 3 received extracorporeal membrane oxygenation (ECMO) support. Eleven patients died (case fatality rate 6.3%): five with HHV-6, two enterovirus, two influenza, one HSV, one human-metapneumovirus. At follow-up, 34 children had mild or moderate disability, and six severe disability. In a multivariable logistic regression model, three factors were associated with severe disability or death: age <2 years old (OR 8.2, CI 1.0 to 67.2), Herpesviridae aetiology (OR 14.5, CI 1.2 to 177.3) and length of intubation (OR 1.005, CI 1.00 to 1.01).
Conclusions:
Encephalitis has a varied aetiology and causes death or severe disability in 1 in every 10 children requiring intensive care.
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