Особливості сучасного перебігу енцефалітів у дітей (огляд клінічних випадків)

Secondary epilepsy is a common concomitant disease of viral encephalitis (VE) in children. However, the risk factors for secondary epilepsy after VE remain debated. The aim of this study was to perform a 10-year single-center retrospective analysis to investigate the incidence and risk factors of secondary epilepsy after VE in children. A total of 8691 patients suffered from VE in our hospital between December 2011 and February 2022 were included. The patients were divided into control group (Group C) and epilepsy group (Group E) according to whether they followed secondary epilepsy. Information about treatment process was collected from medical records to determine the incidence. Univariate analysis and multivariate logistic regression analysis were performed to identify the independent risk factors. In the current study, the occurrence of secondary epilepsy after VE in pediatric patients was 10.99% (385 of 3503). The results of univariate and multivariate analysis showed that unconsciousness, convulsions, times of epilepsy >2, epileptiform discharge of Electroencephalogram (EEG), and cortical and subcortical damage of magnetic resonance imaging/computer tomography were the significant risk factors for secondary epilepsy after VE. Nearly one tenth of pediatric patients suffered from secondary epilepsy after VE. Interventions for identified risk factors should be used to prevent the occurrence of secondary epilepsy.

Encephalitis in children may lead to adverse outcomes and long-term neurodevelopmental sequelae. The prompt identification of the causative agent is important to guide proper management in cases with encephalitis; however, the etiology often remains undetermined. The use of polymerase chain reaction (PCR) analysis in the cerebrospinal fluid (CSF) has increased the diagnostic yield in encephalitis cases; however, it may be occasionally misleading. In this article, we describe the case of a male immunocompetent child with encephalitis in which human herpesvirus-7 (HHV-7) was detected in CSF by PCR. As the detection of HHV-7 DNA in the CSF alone is insufficient to prove an etiologic association of severe encephalitis in immunocompetent children, alternative diagnoses were pursued. Enterovirus (E-11) was detected by PCR analysis of the nasopharyngeal and rectal swabs of the male patient. The final diagnosis was facilitated by the findings in his sibling, which presented concurrently with enteroviral encephalitis. Failure to detect enterovirus in the CSF by PCR does not exclude enteroviral encephalitis; screening of other samples, from other body sites, may be necessary to identify the virus, and physicians should take into consideration all evidence, including history, clinical presentation, and sick contacts’ clinical status.

Background: Viral encephalitis is a rare condition affecting approximately 1.4 individuals per 100.000 annually worldwide. It is characterized by inflammation of the brain parenchyma due to common viral infections in Brazil, such as dengue, Zika, and chikungunya. Given the high mortality associated with viral encephalitis and the lack of studies focusing on the Brazilian Midwest and, more specifically, the pediatric population, conducting an epidemiological analysis of mortality cases in this region is crucial. Objective: To analyze the epidemiological profile of mortality cases due to viral encephalitis in the pediatric population of the Brazilian Midwest from 2008 to 2023. Methods: This is a descriptive, retrospective, and quantitative epidemiological study based on data from the Hospital Information System (SIH/SUS) provided by the Department of Information Technology of the Unified Health System (DATASUS), regarding the mortality from viral encephalitis in pediatric patients from 2008 to 2023 in Goiás, Mato Grosso, Mato Grosso do Sul, and Distrito Federal. Filters applied included: ICD-10 morbidity list (viral encephalitis), midwest region, race/ethnicity, gender, age group, available period (January 2008 to December 2023), and year of processing. Data were tabulated in Excel and subjected to descriptive statistical analysis using R 4.40 with RStudio 2024.04.1 + 748. Since this study utilizes publicly available anonymous data, it is exempt from the Ethics Committee’s approval. Results: During the study period, the average mortality rate was 2.85 %, with 2012 having the highest mortality rate (6.9%) followed by 2009 (6.45%). On the other hand, records from 2023 show the lowest mortality rate, 1.02%. Among the analyzed regions, Mato Grosso exhibited the highest mortality rate (4.12%), whereas Distrito Federal had the lowest (1.93%). Notably, individuals of indigenous ethnicity were most affected, with a mortality rate of 12.5%. Additionally, males showed a higher mortality rate compared to females, with rates of 3.49% and 1.95%, respectively. The most affected age group was 10-14 years, with a mortality rate of 4.62%. Conclusion: This study identified the indigenous population as vulnerable to viral encephalitis, likely due to geographical isolation and insufficient healthcare services available. Therefore, there is a clear need to invest in public health policies targeted at this social minority. It is also worth mentioning that Mato Grosso had the highest mortality rate, while the Federal District had the lowest. Furthermore, the highest mortality rates were concentrated about 10 years ago, notably in 2009 and 2012, while there is a decreasing trend in mortality rates, as demonstrated by the 2023 rate, the lowest recorded in the study. Given the data analysis, further studies are needed to investigate the factors influencing the correlation between mortality and viral encephalitis in the Brazilian Midwest regions.

BackgroundFew cases concerning acute retinal necrosis with viral encephalitis in children have been reported, especially cases where the fundus cannot be identified due to severe vitreous opacity in the early stage that makes diagnosis difficult.MethodsWe conducted a retrospective review of an unusual case of herpes simplex virus-2 (HSV-2) acute retinal necrosis with viral encephalitis in an immunocompetent child, along with a review of relevant literature published up to September 2021.ResultAn 11-year-old girl presented with an approximate 20-day history of ocular redness and decreased visual acuity in the left eye. Examination revealed anterior uveitis and vitreous opacity in the left eye. An anterior chamber tap was performed because the fundus could not be observed clearly, and the aqueous humor was positive for HSV-2 DNA. Cerebrospinal fluid also tested positive for HSV-2. She was diagnosed with acute retinal necrosis syndrome and viral encephalitis. The condition was controlled with timely antiviral and steroid therapy. She was also treated with prophylactic laser therapy to prevent retinal detachment during subsequent follow-up. The pathogenesis, diagnosis, and treatment of HSV-2 acute retinal necrosis in children and the association between acute retinal necrosis and viral encephalitis are further discussed, based on published literature.ConclusionHSV-2-related pediatric acute retinal necrosis may be due to the acquisition of subclinical infection with HSV-2 during parturition, followed by reactivation of the virus latent in the body on account of certain factors. Moreover, it may be complicated with viral encephalitis. For suspected cases with invisible fundus, early intraocular fluid examination is especially helpful for differential diagnosis. Early diagnosis, early treatment, and timely prophylactic laser treatment to prevent retinal detachment are key to a better prognosis. Physicians need to pay attention to such suspected cases during diagnosis and treatment.

Viral encephalitis, despite varying etiologies, often presents with similar clinical features, challenging clinicians in determining appropriate management strategies. This study aimed to investigate the etiological agents and associated clinical features of viral encephalitis in pediatric patients. A multicenter observational cross-sectional study was conducted over 15 months at the Department of Pediatric Neurology, Bangladesh Medical University (BMU), and the Department of Pediatrics, Dhaka Medical College Hospital. Sixty-four children with acute encephalitis were enrolled based on inclusion and exclusion criteria. Detailed clinical history, physical examination, and cerebrospinal fluid (CSF) analyses, including biochemical, cytological, bacteriological, and Neuro-9 viral panel studies, were performed. Informed consent was obtained from guardians. The mean age of participants was 4.10±3.87 years, with 59.4% aged ≤3 years. Varicella zoster virus (VZV) was the most frequently identified pathogen, present in 18.8% of cases, followed by Herpes Simplex Virus (HSV)-1 (3.1%) and Human Adenovirus (1.6%). No viral pathogen was identified in 76.5% of cases. Common presenting symptoms included fever (95.3%), seizures (87.5%), altered sensorium (85.9%), and prodromal symptoms (76.6%). In this cohort, the etiology of acute viral encephalitis remained unidentified in the majority of cases. VZV was the predominant virus detected, followed by HSV-1 and Adenovirus. Fever, seizures, altered sensorium, and prodromal symptoms were the most frequent clinical features. Thorough clinical evaluation is crucial for guiding management and excluding other differential diagnoses. Faridpur Med. Coll. J. 2025;20(2):07-12

Background: Myelin oligodendrocyte glycoprotein (MOG) may be implicated in the immunopathogenesis of multiple sclerosis (MS) inducing demyelination in the animal model of MS. In adults reported anti-MOG antibody frequencies have been variable across a number of studies and can also be detected in controls. Objective: To measure antibodies against MOG in paediatric patients with demyelinating disorders of the central nervous system and in controls. Methods: Serum antibodies against MOG and myelin basic protein were measured by ELISA, flow cytometry (FACS) and in the liquid phase in 11 children with acute disseminated encephalomyelitis (ADEM), 22 children with MS, seven children with acute viral encephalitis and 13 healthy controls. The serostatus of Epstein–Barr virus (EBV) infections were assessed. Results: Anti-MOG antibodies, measured either by ELISA or FACS were exclusively detected in children with demyelination. In ADEM these antibodies were highly reactive. Anti-MBP reactivity was detectable equally in all groups. The presence of either autoantibodies did not associate with EBV serostatus, age, gender or disease course. Conclusions: This study independently corroborates recently published results of seroprevalence and specificity of the assay. Due to their low sensitivity anti-MOG antibodies will not serve as disease-specific biomarkers, but could help to support the diagnosis of ADEM in difficult cases.

Background: Japanese encephalitis (JE) is an important cause of viral encephalitis in children in South East Asian countries including India. Aims and Objective: We have done this study in an JE endemic district of India to know the demographic profile, clinical presentation, seasonal variation, outcome and about the vaccination status of the JE cases. Materials and Methods: This observational, cross sectional study was done for a period of one year in the Pediatric department of Burdwan Medical College, West Bengal in children up to the age of 12 year, presented with acute encephalitis syndrome (AES). Demographic data, clinical presentation and JE vaccination status were recorded and confirmed JE cases were detected by either serum or CSF JE IgM antibody. Outcome of the JE cases were noted as discharge, death or leave against medical advice (LAMA). Results: We have found confirmed JE in 18 children out of total 125 AES cases (14.4%). 61.1% of them were within 6 to 12 year age, mostly from low socioeconomic status and 100% case occurred during monsoon and post monsoon period. History, was of JE vaccination were present in only 11.1% case of JE. Most common presenting symptoms were high fever (100%), convulsion (94.4%) and altered sensorium (72.2%). 77.8% JE case were discharged and 11.1% expired. Conclusion: We must consider JE whenever a child from any endemic district comes with AES and we should try to bring every child under the JE vaccination coverage in the endemic regions globally to reduce the burden of this preventable encephalitis.

Japanese encephalitis (JE) disease, a viral brain fever is caused by Japanese encephalitis virus (JEV). Despite the availability of effective vaccines against this deadly infection, JE is the leading cause of epidemic viral encephalitis in children in South-east Asia. There is no treatment available for the JE disease which might be due to incomplete understanding of the pathogenesis of JE virus. The JEV infections lead to permanent neurological deficits even in those who survive from the infection. Activated microglia may play a potentially detrimental role by eliciting the expression of pro-inflammatory cytokines such as interleukin (IL)-1β, IL-6, and tumor necrosis factor-α (TNF-α) influencing the surrounding brain tissue. Microglial activation, proinflammatory cytokine release and leukocytes trafficking are associated following JEV infection in central nervous system (CNS). How the pattern recognition receptors sense the viral nucleic acid and how the microglial and neuronal cells behaves following JEV infection is still unelucidated. There is scarcity of data on the expression levels of toll like receptors (TLRs), cytokines and chemokines in JEV infection in invitro model. To explore the molecular mechanisms of JEV infection of microglial cells and neuronal cells, we studied the expression profile of TLRs, cytokines and chemokines in JEV infected microglial cell line BV2 and Neuronal cell line Neuro 2A. For the present study, we developed the mouse model of encephalitis by intracerebral (IC) injection of JE virus for virus propagation, disease progression and damage study. Our results demonstrate the exaggerated release of some specific TLRs, cytokines and chemokines in invitro cell culture of microglial and Neuro 2A cell line, which are associated with bad outcome in invivo study.

Herpes simplex encephalitis (HSE) is a leading cause of sporadic, nonepidemic viral encephalitis in children and adults. We report a very rare case of HSE with involvement of bilateral thalamus, putamen, upper pons and midbrain, with development of extrapyramidal symptoms which responded to corticosteroid therapy. A 15-mth-old female baby admitted with complaint of fever for 5 days and generalised tonic clonic seizure 10 hours before admission. On clinical examination patient was drowsy, temperature was 39.4 degrees C and vitals were stable with signs of increased intracranial tension. There were no signs of meningeal irritation. Patient gradually become unconscious in the next few hours and pupils were constricted bilaterally with development of atonia in all four limbs and neck muscles. Doll's eye phenomenon was absent.

To investigate if two important epidemic viral encephalitis in children, Enterovirus 71 (EV71) encephalomyelitis and Japanese encephalitis (JE) whose clinical and pathological features may be nonspecific and overlapping, could be distinguished. Tissue sections from the central nervous system of infected cases were examined by light microscopy, immunohistochemistry and in situ hybridization. All 13 cases of EV71 encephalomyelitis collected from Asia and France invariably showed stereotyped distribution of inflammation in the spinal cord, brainstem, hypothalamus, cerebellar dentate nucleus and, to a lesser extent, cerebral cortex and meninges. Anterior pons, corpus striatum, thalamus, temporal lobe, hippocampus and cerebellar cortex were always uninflamed. In contrast, the eight JE cases studied showed inflammation involving most neuronal areas of the central nervous system, including the areas that were uninflamed in EV71 encephalomyelitis. Lesions in both infections were nonspecific, consisting of perivascular and parenchymal infiltration by inflammatory cells, oedematous/necrolytic areas, microglial nodules and neuronophagia. Viral inclusions were absent. Immunohistochemistry and in situ hybridization assays were useful to identify the causative virus, localizing viral antigens and RNA, respectively, almost exclusively to neurones. The stereotyped distribution of inflammatory lesions in EV71 encephalomyelitis appears to be very useful to help distinguish it from JE.

Acute Viral Encephalitis in Children : Clinical Characteristics

The burden of inflammatory stress and antibiotic treatment in preterm neonates and neuro-developmental outcome

We aimed to determine the independent effect of maternal antepartum hemorrhage (APH) on mortality and major neonatal morbidities among very low birth weight (VLBW), very preterm infants. A population-based cohort study of VLBW singleton infants born at 24 to 31 weeks of gestation between 1995 and 2016 was performed. Infants born with the following pregnancy associated complications were excluded: maternal hypertensive disorders, prolonged rupture of membranes, amnionitis, maternal diabetes, and small for gestational age. APH included hemorrhage due to either placenta previa or placental abruption. Univariate and multivariable logistic regression analyses were performed to assess the effect of maternal APH on mortality and major neonatal morbidities. The initial cohort included 33,627 VLBW infants. Following exclusions, the final study population comprised 6,235 infants of whom 2,006 (32.2%) were born following APH and 4,229 (67.8%) without APH. In the APH versus no APH group, there were higher rates of extreme prematurity (24-27 weeks of gestation; 51.6% vs. 45.3%, p < 0.0001), mortality (20.2 vs. 18.5%, p = 0.011), bronchopulmonary dysplasia (BPD, 16.1 vs. 13.0%, p = 0.004) and death or adverse neurologic outcome (37.4 vs. 34.5%, p = 0.03). In the multivariable analyses, APH was associated with significantly increased odds ratio (OR) for BPD in the extremely preterm infants (OR: 1.31, 95% confidence interval: 1.05-1.65). The OR's for mortality, adverse neurological outcomes, and death or adverse neurological outcome were not significantly increased in the APH group. Among singleton, very preterm VLBW infants, maternal APH was associated with increased odds for BPD only in extremely premature infants, but was not associated with excess mortality or adverse neonatal neurological outcomes. · Outcome of very low birth weight infants born after antepartum hemorrhage (APH) was assessed.. · APH was not associated with higher infant mortality.. · APH was not associated with adverse neurological outcome.. · APH was associated with increased bronchopulmonary dysplasia in extremely preterm infants..

In the 21st century it is important to every child to belong to a certain society, to learn its cultural values, its norms and requirements, thus socially adapting and integrating. The first weeks or months in school are considered as a period of particular importance in a 7-year-old child's life, when is the period of the child's social adaptation. A 7-year-old child’s further education at school can be predicted by depending on how the social adaptation of the 7-year-old child goes on, based on the legality of child development. Unfortunately, there are no unified research criteria developed so far in school practice by which it would be possible to determine the 7-year-old child's social adaptation. Taking into consideration the analysis of theoretical policies, there are research criteria groups and levels of children's social adaptation named and formulated within this paper, in order to explore the 7-year-old children's social adaptation and to provide appropriate educational support.

Childhood encephalitis in the Greater Mekong region: critical to public health policy