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Fang Y, Gao Q, Jin W, Li J, Yuan H, Lin Z, Pan G, Lin W. Clinical characteristics and prognostic analysis of acute necrotizing encephalopathy of childhood: a retrospective study at a single center in China over 3 years. Front Neurol 2023; 14:1308044. [PMID: 38178890 PMCID: PMC10766426 DOI: 10.3389/fneur.2023.1308044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/28/2023] [Indexed: 01/06/2024] Open
Abstract
Objective Acute Necrotizing Encephalopathy of Childhood (ANEC) is a rare, fulminant neurological disease in children with unknown mechanisms and etiology. This study summarized the clinical characteristics, treatment, and prognosis of ANEC through a retrospective analysis, providing insights into the ANEC early diagnosis and prognosis assessment. Methods Clinical data of children diagnosed with ANEC at the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from July 1, 2020, to June 30, 2023, were retrospectively analyzed. Results There were 25 cases, 14 males and 11 females, with a median age of 3 years. Hospital admissions were mainly in the winter (14/25, 56%) and spring (9/25, 36%). All patients presented with varying degrees of fever and altered consciousness, with 92% (23/25) experiencing high body temperatures (>39.1°C) and 88% (22/25) having a Glasgow coma scale (GCS) score of ≤8. Seizures were observed in 88% (22/25) of patients. Laboratory findings indicated 100% B lymphocyte activation (14/14), and 78% (14/18) of patients showed cytokine storm (interleukin (IL)-6, IL-8, IL-10, interferon (IFN)-α). Neuroimaging showed symmetrical thalamus involvement, commonly involving basal ganglia and brainstem regions. Viral infection (23/24, 96%) was the predominant etiological finding, with 42% (10/24) of cases due to SARS-CoV-2 infection and 42% (10/24) to influenza A virus infection. Multi-organ dysfunction occurred in 68% (17/25) of patients, and 52% (13/25) died. Correlation analysis revealed the death group exhibited higher proportion of male, lower GCS scores, higher IL-6 level and a greater likelihood of associated brainstem impairment (p < 0.05). Conclusion ANEC is more prevalent in the winter and spring, and its etiology may be associated with B lymphocyte activation and cytokine storm following viral infections. Clinical manifestations lack specific features, with fever, consciousness disturbances, and seizures being the main presentations, particularly in cases of high fever and hyperpyrexia. ANEC progresses rapidly and has a high mortality rate. The child's gender, GCS score, IL-6 levels, and the presence of brainstem involvement can serve as important risk factors for assessing the risk of mortality.
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Affiliation(s)
- Yu Fang
- Department of Pediatrics, The Second School of Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Perinatal Medicine of Wenzhou, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qiqi Gao
- Department of Pediatrics, The Second School of Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Perinatal Medicine of Wenzhou, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wenwen Jin
- Department of Pediatrics, The Second School of Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Perinatal Medicine of Wenzhou, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jianshun Li
- Department of Pediatrics, The Second School of Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Perinatal Medicine of Wenzhou, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hao Yuan
- Department of Pediatrics, The Second School of Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Perinatal Medicine of Wenzhou, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhenlang Lin
- Department of Pediatrics, The Second School of Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Perinatal Medicine of Wenzhou, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Structural Malformations in Children of Zhejiang Province, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Guoquan Pan
- Department of Pediatrics, The Second School of Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Perinatal Medicine of Wenzhou, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Lin
- Department of Pediatrics, The Second School of Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Perinatal Medicine of Wenzhou, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Carroll E, Neumann H, Aguero-Rosenfeld ME, Lighter J, Czeisler BM, Melmed K, Lewis A. Post-COVID-19 inflammatory syndrome manifesting as refractory status epilepticus. Epilepsia 2020; 61:e135-e139. [PMID: 32944946 PMCID: PMC7537028 DOI: 10.1111/epi.16683] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 01/21/2023]
Abstract
There have been multiple descriptions of seizures during the acute infectious period in patients with COVID‐19. However, there have been no reports of status epilepticus after recovery from COVID‐19 infection. Herein, we discuss a patient with refractory status epilepticus 6 weeks after initial infection with COVID‐19. Extensive workup demonstrated elevated inflammatory markers, recurrence of a positive nasopharyngeal SARS‐CoV‐2 polymerase chain reaction, and hippocampal atrophy. Postinfectious inflammation may have triggered refractory status epilepticus in a manner similar to the multisystemic inflammatory syndrome observed in children after COVID‐19.
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Affiliation(s)
- Elizabeth Carroll
- Department of Neurology, NYU Langone Medical Center, New York, New York
| | - Henry Neumann
- Department of Medicine, NYU Langone Medical Center, New York, New York
| | | | - Jennifer Lighter
- Department of Pediatrics, NYU Langone Medical Center, New York, New York
| | - Barry M Czeisler
- Department of Neurology, NYU Langone Medical Center, New York, New York.,Department of Neurosurgery, NYU Langone Medical Center, New York, New York
| | - Kara Melmed
- Department of Neurology, NYU Langone Medical Center, New York, New York.,Department of Neurosurgery, NYU Langone Medical Center, New York, New York
| | - Ariane Lewis
- Department of Neurology, NYU Langone Medical Center, New York, New York.,Department of Neurosurgery, NYU Langone Medical Center, New York, New York
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Mammas IN, Theodoridou M, Thiagarajan P, Melidou A, Papaioannou G, Korovessi P, Koutsaftiki C, Papatheodoropoulou A, Calachanis M, Dalianis T, Spandidos DA. A paediatric influenza update 100 years after the Skyros island Spanish flu outbreak. Exp Ther Med 2019; 17:4327-4336. [PMID: 31186675 PMCID: PMC6507498 DOI: 10.3892/etm.2019.7515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/16/2019] [Indexed: 12/17/2022] Open
Abstract
This year marks the 100th anniversary of the 1918 Spanish flu outbreak on the Greek Aegean Sea island of Skyros, which devastated its population in less than 30 days. According to Constantinos Faltaits's annals published in 1919, the influenza attack on the island of Skyros commenced acutely ‘like a thunderbolt’ on the 27th of October, 1918 and was exceptionally severe and fatal. At that time, the viral cause of the influenza had not been detected, while the total number of victims of the Spanish flu outbreak has been estimated to have surpassed 50 million, worldwide. Almost one century after this Aegean Sea island's tragedy, the ‘4th Workshop on Paediatric Virology’, organised on the 22nd of September, 2018 in Athens, Greece, was dedicated to the 100 years of the ‘Spanish’ flu pandemic. This review article highlights the plenary and key lectures presented at the workshop on the recent advances on the epidemiology, clinical management and prevention of influenza in childhood.
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Affiliation(s)
- Ioannis N Mammas
- Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Maria Theodoridou
- First Department of Paediatrics, 'Aghia Sophia' Children's Hospital, University of Athens School of Medicine, 115 27 Athens, Greece
| | - Prakash Thiagarajan
- Neonatal Unit, Division for Women's & Children Health, Noble's Hospital, IM4 4RJ Douglas, Isle of Man, British Isles
| | - Angeliki Melidou
- Second Laboratory of Microbiology, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Georgia Papaioannou
- Department of Paediatric Radiology, 'Mitera' Children's Hospital, 151 23 Athens, Greece
| | - Paraskevi Korovessi
- Department of Paediatrics, 'Penteli' Children's Hospital, 152 36 Penteli, Greece
| | - Chryssie Koutsaftiki
- Paediatric Intensive Care Unit (PICU), 'Penteli' Children's Hospital, 152 36 Penteli, Greece
| | - Alexia Papatheodoropoulou
- Paediatric Intensive Care Unit (PICU), 'P. and A. Kyriakou' Children's Hospital, 115 27 Athens, Greece
| | - Marcos Calachanis
- Department of Paediatric Cardiology, 'Penteli' Children's Hospital, 152 36 Penteli, Greece
| | - Tina Dalianis
- Karolinska Institutet, Karolinska University Hospital, SE-117 77 Stockholm, Sweden
| | - Demetrios A Spandidos
- Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
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