美国儿童流感相关的急性死脑病
, Andrew Silverman1, Rachel Walsh2
1Pediatric Neurology and Neuroimmunology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California.
JAMA
|July 30, 2025
概括
儿童急性死性脑病 (ANE) 是一种与流感有关的严重疾病,导致高发病率和死亡率. 早期识别和标准化管理对于流感相关的ANE的更好的结果至关重要.
科学领域:
- 神经学
- 传染性疾病
- 儿童医学
背景情况:
- 急性死性脑病 (ANE) 是一种罕见但严重的神经疾病,流行病学和治疗数据有限.
- 在最近的美国流感季节,有传闻报告显示儿童流感相关的NEE病例有所增加.
研究的目的:
- 调查美国儿童流感相关NEE的临床表现,干预措施和结果.
- 了解儿童群体中与NE相关的流行病学和风险因素.
主要方法:
- 一个多中心病例系列,涉及被诊断患有ANE和确诊的流感感染的儿童.
- 收集的数据包括临床症状,疫苗接种情况,实验室发现,基因检测,干预措施和临床结果 (修改的兰金表,停留时间,死亡率).
- 在2023年10月1日至2025年5月30日期间,从76个美国学术中心征集了病例.
主要成果:
- 这项研究在儿童中发现了41例流感相关的NE,主要是年轻和以前健康的个体.
- 常见的症状包括发烧,脑病和. 最常见的原因是A型流感.
- 观察到高发病率和死亡率,27%的患者死亡,63%的幸存者患有中度至重度残疾.
- 在很大一部分患者中发现了包括RANBP2变异在内的遗传风险等位基因,并且很少有人接种了流感疫苗.
结论:
- 流感相关的NEE是儿童的严重疾病,其特征是高发病率和死亡率.
- 这些研究结果强调了预防流感,及时诊断和密集,标准化的治疗方案的重要性.
- 需要进一步研究遗传倾向和优化ANE管理策略.
相关概念视频
01:18Bacterial Gastroenteritis
88
Bacterial gastroenteritis, characterized by diarrhea, abdominal cramps, and vomiting, is often caused by ingestion of contaminated food or water and is frequently associated with pathogenic Escherichia coli strains. These microbes exploit two principal mechanisms to inflict disease.Shiga toxin–producing E. coli, also referred to as STEC—notably O157:H7—release Shiga toxins that target ribosomes, blocking protein synthesis. The B subunit of the toxin binds the host glycolipid...
88
01:18Viral Meningitis
199
Viral meningitis is the most common form of meningitis and is often referred to as aseptic meningitis to indicate the absence of bacterial involvement. It is generally milder than bacterial meningitis, with symptoms including fever, headache, stiff neck, drowsiness, nausea, photophobia, and vomiting. Rarely, more severe manifestations or death may occur. Common causative agents include enteroviruses, particularly coxsackie A and B viruses and echoviruses, all members of the Enterovirus genus...
199
01:25Arboviral Encephalitis
59
Arboviral encephalitis refers to brain inflammation caused by arthropod-borne viruses, particularly those transmitted through mosquito vectors. Among these, West Nile virus (WNV), a member of the Flaviviridae family, is a significant public health concern. WNV is an enveloped, positive-sense, single-stranded RNA virus. Human infection typically begins when an infected mosquito introduces the virus into the dermis during feeding. The primary transmission cycle involves birds as amplifying hosts...
59
01:22Bacterial Meningitis I: Introduction
15
Bacterial meningitis is a severe, life-threatening inflammation of the meninges, particularly the pia mater and arachnoid mater, affecting the subarachnoid space, ventricles, and cerebrospinal fluid (CSF). If untreated, it can lead to significant neurological complications or death.Causative AgentsCommon pathogens vary with age and immune status. In adults, major organisms include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Streptococcus agalactiae (group B...
15
01:19Encephalitis l: Introduction
15
Encephalitis is inflammation of the brain parenchyma, most often due to infections or autoimmune processes. It presents with neuropsychiatric features such as fever, altered mental status, behavioral changes, cognitive dysfunction, seizures, focal deficits, and sometimes autonomic instability. In some cases, the meninges are also involved, resulting in meningoencephalitis.Infectious CausesInfectious encephalitis is most commonly viral but can also result from bacterial, fungal, or parasitic...
15
01:26Encephalitis ll: Pathophysiology
22
Encephalitis is inflammation of the brain parenchyma caused by direct viral invasion or immune-mediated mechanisms triggered by infections or tumors. Both processes lead to neuronal injury, disrupted neurotransmission, and diverse neurological symptoms, often with overlapping clinical and pathological features.Autoimmune EncephalitisIn autoimmune encephalitis, antibodies target neuronal antigens on cell surfaces, synapses, or within neurons. A key example is anti-NMDAR encephalitis, which can...
22