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Ribeiro JF, Virtuoso J, Santos Silva Í, Fernandes P, Santos S, Guerra P. The Multiple Faces of Mycoplasma pneumoniae. Clin Pediatr (Phila) 2024; 63:226-230. [PMID: 37671732 DOI: 10.1177/00099228231198959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Affiliation(s)
- Joana Filipe Ribeiro
- Department of Pediatrics, Hospital Sousa Martins, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - João Virtuoso
- Department of Pediatrics, Hospital Sousa Martins, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - Íris Santos Silva
- Department of Pediatrics, Hospital Sousa Martins, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - Pedro Fernandes
- Department of Pediatrics, Hospital Sousa Martins, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - Sónia Santos
- Department of Pediatrics, Hospital Sousa Martins, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - Pedro Guerra
- Department of Pediatrics, Hospital Sousa Martins, Unidade Local de Saúde da Guarda, Guarda, Portugal
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Huff HV, Wilson-Murphy M. Neuroinfectious Diseases in Children: Pathophysiology, Outcomes, and Global Challenges. Pediatr Neurol 2024; 151:53-64. [PMID: 38103523 DOI: 10.1016/j.pediatrneurol.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/22/2023] [Accepted: 09/24/2023] [Indexed: 12/19/2023]
Abstract
Pathogens with affinity for the central nervous system (CNS) in children are diverse in their mechanisms of infecting and attacking the brain. Infections can reach the CNS via hematogenous routes, transneurally thereby avoiding the blood-brain barrier, and across mucosal or skin surfaces. Once transmission occurs, pathogens can wreak havoc both by direct action on host cells and via an intricate interplay between the protective and pathologic actions of the host's immune system. Pathogen prevalence varies depending on region, and susceptibility differs based on epidemiologic factors such as age, immune status, and genetics. In addition, some infectious diseases are monophasic, whereas others may lie dormant for years, thereby causing a dynamic effect on outcomes. Outcomes in survivors are highly variable for each particular pathogen and depend on the vaccination and immune status of the patient as well as the speed by which the patient receives evidence-based treatments. Given pathogens cause communicable diseases that can cause morbidity and mortality on a population level when spread, the burden is often the greatest and the outcomes the worst in low-resource settings. Here we will focus on the most common infections with a propensity to affect a child's brain, the pathologic mechanisms by which they do so, and what is known about the developmental outcomes in children who are affected by these infections.
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Affiliation(s)
- Hanalise V Huff
- Department of Neurology, National Institutes of Health, Bethesda, Maryland
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Kim A, Kim M, Baek JY, Lee JY, Kim SH, Kang JM, Ahn JG, Kang HC. Aetiology and Prognosis of Encephalitis in Korean Children: A Retrospective Single-Centre Study, 2005-2020. Yonsei Med J 2024; 65:78-88. [PMID: 38288648 PMCID: PMC10827636 DOI: 10.3349/ymj.2023.0250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/25/2023] [Accepted: 10/16/2023] [Indexed: 02/01/2024] Open
Abstract
PURPOSE Encephalitis is a heterogeneous syndrome that occurs in childhood and is not rare. However, epidemiological studies of encephalitis based on the International Encephalitis Consortium (ICS) and expert recommendations are lacking. We investigated the aetiology and prognosis of encephalitis in Korean children. MATERIALS AND METHODS This retrospective study included children aged <19 years hospitalised for encephalitis at Severance Children's Hospital between 2005 and 2020. The 2013 ICS criteria were used to diagnose encephalitis, and causality was classified according to the site from which the specimen was obtained. Neurological sequelae were categorised using the modified Rankin Scale (mRS) score. RESULTS In total, 551 children were included, with 7% classified as possible, 77% as probable, and 15% as proven cases. A cause was identified in 42% of the cases (n=222), with viruses being the most common (42%), followed by bacteria (38%) and autoimmune encephalitis (12%). In cases of proven/probable encephalitis (n=65), bacteria accounted for 52%, followed by viruses (25%) and autoimmune encephalitis (22%). In cases with a single pathogen, the anti-N-methyl-D-aspartate receptor autoantibody (n=14) was the most common, followed by Group B streptococcus (n=13), herpes simplex virus (n=11), enterovirus (n=4), and others. Approximately 37% of patients had severe sequelae (mRS score ≥3) at discharge, which decreased to 31% 6 months after discharge. CONCLUSION This large-scale study showed that autoimmune and infectious causes accounted for a significant proportion of encephalitis in Korean children. Further studies are needed to determine whether early targeted treatment following early diagnosis leads to a favourable prognosis in these populations.
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Affiliation(s)
- Ahra Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Minyoung Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Yeon Baek
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Young Lee
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hee Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Pediatric Neurology, Epilepsy Research Institute, Severance Children's Hospital, Seoul, Korea.
| | - Ji-Man Kang
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Korea.
| | - Jong Gyun Ahn
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Hoon-Chul Kang
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Pediatric Neurology, Epilepsy Research Institute, Severance Children's Hospital, Seoul, Korea
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Ha EK, Kim JH, Cha HR, Han BE, Shin YH, Baek HS, Choi SH, Han MY. Investigating the occurrence of autoimmune diseases among children and adolescents hospitalized for Mycoplasma pneumoniae infections. Front Immunol 2023; 14:1165586. [PMID: 38124736 PMCID: PMC10732509 DOI: 10.3389/fimmu.2023.1165586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
Background Mycoplasma pneumoniae infection is common in the general population and may be followed by immune dysfunction, but links with subsequent autoimmune disease remain inconclusive. Objective To estimate the association of M. pneumoniae infection with the risk of subsequent autoimmune disease. Methods This retrospective cohort study examined the medical records of South Korean children from 01/01/2002 to 31/12/2017. The exposed cohort was identified as patients hospitalized for M. pneumoniae infection. Each exposed patient was matched with unexposed controls based on birth year and sex at a 1:10 ratio using incidence density sampling calculations. The outcome was subsequent diagnosis of autoimmune disease, and hazard ratios (HRs) were estimated with control for confounders. Further estimation was performed using hospital-based databases which were converted to a common data model (CDM) to allow comparisons of the different databases. Results The exposed cohort consisted of 49,937 children and the matched unexposed of 499,370 children. The median age at diagnosis of M. pneumoniae infection was 4 years (interquartile range, 2.5-6.5 years). During a mean follow-up time of 9.0 ± 3.8 years, the incidence rate of autoimmune diseases was 66.5 per 10,000 person-years (95% CI: 64.3-68.8) in the exposed cohort and 52.3 per 10,000 person-years (95% CI: 51.7-52.9) in the unexposed cohort, corresponding to an absolute rate of difference of 14.3 per 10,000 person-years (95% CI: 11.9-16.6). Children in the exposed cohort had an increased risk of autoimmune disease (HR: 1.26; 95% CI: 1.21-1.31), and this association was similar in the separate analysis of hospital databases (HR: 1.25; 95% CI 1.06-1.49). Conclusion M. pneumoniae infection requiring hospitalization may be associated with an increase in subsequent diagnoses of autoimmune diseases.
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Affiliation(s)
- Eun Kyo Ha
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Ju Hee Kim
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Hye Ryeong Cha
- Department of Computer Science and Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| | - Bo Eun Han
- Department of Software, Sejong University, Seoul, Republic of Korea
| | - Youn Ho Shin
- Department of Pediatrics, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hey-Sung Baek
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Sun Hee Choi
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Man Yong Han
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
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Bloch KC, Glaser C, Gaston D, Venkatesan A. State of the Art: Acute Encephalitis. Clin Infect Dis 2023; 77:e14-e33. [PMID: 37485952 DOI: 10.1093/cid/ciad306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Indexed: 07/25/2023] Open
Abstract
Encephalitis is a devastating neurologic disease often complicated by prolonged neurologic deficits. Best practices for the management of adult patients include universal testing for a core group of etiologies, including herpes simplex virus (HSV)-1, varicella zoster virus (VZV), enteroviruses, West Nile virus, and anti-N-methyl-D-aspartate receptor (anti-NMDAR) antibody encephalitis. Empiric acyclovir therapy should be started at presentation and in selected cases continued until a second HSV-1 polymerase chain reaction test is negative. Acyclovir dose can be increased for VZV encephalitis. Supportive care is necessary for other viral etiologies. Patients in whom no cause for encephalitis is identified represent a particular challenge. Management includes repeat brain magnetic resonance imaging, imaging for occult malignancy, and empiric immunomodulatory treatment for autoimmune conditions. Next-generation sequencing (NGS) or brain biopsy should be considered. The rapid pace of discovery regarding autoimmune encephalitis and the development of advanced molecular tests such as NGS have improved diagnosis and outcomes. Research priorities include development of novel therapeutics.
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Affiliation(s)
- Karen C Bloch
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carol Glaser
- California Department of Public Health, Richmond, California, USA
| | - David Gaston
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arun Venkatesan
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
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Xu K, Wang D, He Y, Wang S, Liu G, Pan Y, Jiang H, Peng Y, Xiao F, Huang Y, Wang Q, Wu Y, Pan S, Hu Y. Identification of Anti-Collapsin Response Mediator Protein 2 Antibodies in Patients With Encephalitis or Encephalomyelitis. Front Immunol 2022; 13:854445. [PMID: 35479088 PMCID: PMC9036435 DOI: 10.3389/fimmu.2022.854445] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/14/2022] [Indexed: 12/03/2022] Open
Abstract
Background and Purpose An increasing number of autoimmune encephalitis (AE)-associated autoantibodies have been successfully characterized. However, many cases of AE remain unexplained on account of unknown antibodies. The aim of the present study was to identify a novel antibody against collapsin response mediator protein 2 (CRMP2) in suspected AE patients. Methods A patient’s serum and cerebrospinal fluid samples tested negative for known AE antibodies; however, strong immunolabel signals were observed in the neuronal cytoplasm of the cortex, hippocampus, and Purkinje cells on rat brain sections. Immunoprecipitation from the rat brain protein lysate, followed by mass spectrometry analysis, was used to identify the targeting antigen. Western blotting and cell-based assay with antigen-overexpressing HEK293T cells were used for antibody specificity, epitope, IgG subtype determination, and retrospective study. Results An antibody against CRMP2, a synaptic protein involved in axon guidance, was identified. The immunostains of the patient’s samples on rat brain sections were eliminated by pre-absorption with HEK293T cells overexpressing CRMP2. The samples specifically immunoreacted with CRMP2, but not with CRMP1, CRMP3, CRMP4, and CRMP5. The C-terminus of CRMP2 with 536 amino acids contained the epitope for antibody binding. The subtype analysis showed that the anti-CRMP2 antibody was IgG4. Furthermore, a screening of 46 patients with neurological disoders and neuro-cytoplasm immunostainings on rat brain sections resulted in the identification of anti-CRMP2 antibodies in a case of encephalomyelitis. The two patients responded well to immunotherapies. Conclusions This study discovered that a novel anti-CRMP2 antibody was associated with suspected AE and thus should be included in the testing list for AE.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Yongming Wu
- *Correspondence: Yafang Hu, ; Suyue Pan, ; Yongming Wu,
| | - Suyue Pan
- *Correspondence: Yafang Hu, ; Suyue Pan, ; Yongming Wu,
| | - Yafang Hu
- *Correspondence: Yafang Hu, ; Suyue Pan, ; Yongming Wu,
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Benninger F, Steiner I. Non-infectious mechanisms of neurological damage due to infection. J Neurol Sci 2021; 431:120057. [PMID: 34800841 DOI: 10.1016/j.jns.2021.120057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
Infections of the nervous system is a growing aspect of clinical neurology. Accumulating knowledge in early diagnosis, course, therapy and prognosis is enlarging the clinical tools required for effective therapy. Of special importance is the ability to differentiate between proper infections, where anti-microbial agents, when available, should be introduced and used and post infectious conditions where therapy is mainly directed against the host immune system. The two conditions sometimes overlap, a situation that requires the ability to combine clinical skills with the use of laboratory tools such as polymerase chain reaction (PCR), serology, and antigenic detection. In the era of the SARS-CoV-2 pandemic, the need to make this distinction is emphasized as correct diagnosis of post infectious conditions and expedited therapy is important and sometimes lifesaving. We here attempt to present several infectious agents and their possible indirect damage to the nervous system causing in some cases significant neurological deficits. We try to limit our focus on those mechanisms which do not involve the direct tissue damage by the infectious agents but rather are connected to para- and post-infectious mechanisms. We attempt to delineate the features that will enable to tailor the correct diagnosis and following the effective therapy.
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Affiliation(s)
- Felix Benninger
- Felsenstein Medical Research Center, Petach Tikva, Israel; Department of Neurology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Lai WC, Hsieh YC, Chen YC, Kuo CY, Chen CJ, Huang YC, Chiu CH, Lin TY, Huang KYA. A potent antibody-secreting B cell response to Mycoplasma pneumoniae in children with pneumonia. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2021; 55:413-420. [PMID: 34503921 DOI: 10.1016/j.jmii.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/09/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mycoplasma pneumoniae is a major pathogen for community-acquired pneumonia and frequently causes outbreaks in children. M. pneumoniae-specific antibody response is detected upon acute infection and the serology is widely used in the clinical setting. Nevertheless, the cellular basis for antigen-specific antibody response to acute M. pneumoniae infection is largely undetermined in children. METHODS Hospitalized children with community-acquired pneumonia were enrolled and the infection with M. pneumoniae was confirmed with positive PCR result and negative findings for other pathogens. The M. pneumoniae P1-specific antibody-secreting B cell (ASC) response was examined with the ex vivo enzyme-linked immunosorbent spot assay and the relationships between the ASC frequency and serological level and clinical parameters within M. pneumoniae patients were studied. RESULTS A robust M. pneumoniae P1-specific ASC response was detected in the peripheral blood among M. pneumoniae-positive patients. By contrast, no M. pneumoniae-specific ASCs were detected among M. pneumoniae-negative patients. The IgM-secreting B cells are the predominant class and account for over 60% of total circulating M. pneumoniae-specific ASCs in the acute phase of illness. The M. pneumoniae P1-specific ASC frequency significantly correlated with the fever duration, and the IgG ASC frequency significantly correlated with serological titer among patients. CONCLUSION A rapid and potent elicitation of peripheral M. pneumoniae-specific ASC response to acute infection provides the cellular basis of antigen-specific humoral response and indicates the potential of cell-based diagnostic tool for acute M. pneumoniae infection. Our findings warrant further investigations into functional and molecular aspects of antibody immunity to M. pneumoniae.
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Affiliation(s)
- Wan-Chun Lai
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Chia Hsieh
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Yi-Ching Chen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chen-Yen Kuo
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Jung Chen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yhu-Chering Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tzou-Yien Lin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuan-Ying A Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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9
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Badenoch J, Searle T, Watson I, Cavanna AE. Tics in patients with encephalitis. Neurol Sci 2021; 42:1311-1323. [PMID: 33486621 PMCID: PMC7955972 DOI: 10.1007/s10072-021-05065-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 01/15/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Movement disorders have been described in the context of different types of encephalitis. Among hyperkinetic manifestations, tics have sporadically been reported in cases of encephalitis resulting from a range of aetiologies. OBJECTIVE This review aimed to assess the prevalence and characteristics of tics in patients with encephalitis. METHODS We conducted a systematic literature review of original studies on the major scientific databases, according to the standards outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS In addition to the established association between tics and encephalitis lethargica, our literature search identified reports of tics in patients with immune-mediated pathologies (including autoimmune encephalitides affecting the N-methyl-D-aspartate receptor, voltage-gated potassium channels, and glycine receptors) and infective processes (ranging from relatively common viral pathogens, such as herpes simplex, to prions, as in Creutzfeldt-Jakob disease). Tics were most commonly reported in the post-encephalitic period and involvement of the basal ganglia was frequently observed. DISCUSSION The association of new-onset tics and encephalitis, in the background of other neuropsychiatric abnormalities, has practical implications, potentially improving the detection of encephalitis based on clinical features. Future research should focus on the categorisation and treatment of hyperkinetic movement disorders associated with encephalitis.
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Affiliation(s)
- James Badenoch
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, UK
| | - Tamara Searle
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, UK
| | - Iona Watson
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, UK
| | - Andrea E Cavanna
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, UK.
- School of Life and Health Sciences, Aston University, Birmingham, UK.
- University College London and Institute of Neurology, London, UK.
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Esposito S, Argentiero A, Gramegna A, Principi N. Mycoplasma pneumoniae: a pathogen with unsolved therapeutic problems. Expert Opin Pharmacother 2021; 22:1193-1202. [PMID: 33544008 DOI: 10.1080/14656566.2021.1882420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Despite the amount of new information, the most effective approach for the diagnosis and treatment of Mycoplasma pneumoniae infections is not established. In this narrative review the pharmacological options for macrolide-resistant (ML) M. pneumoniae infections in children are discussed. AREAS COVERED Despite significant improvement in the diagnosis and in the definition of diseases potentially associated with this pathogen, not all the problems related to M. pneumoniae infection are solved. True epidemiology of M. pneumoniae diseases and the real role of this pathogen in extra-respiratory manifestations is still unestablished. This reflects on therapy. It is not known whether antibiotics are really needed in all the cases, independently of severity and localization. The choice of antibiotic therapy is debated as it is not known whether ML resistance has clinical relevance. Moreover, not precisely defined is the clinical importance of corticosteroids for improvement of severe cases, including those associated with ML-resistant strains. EXPERT OPINION Improvement in M. pneumoniae identification is mandatory to reduce antibiotics overuse , especially in the presence of ML-resistant strains. Priority for future studies includes the evaluation of the true benefit of therapeutic approaches including corticosteroids in patients with severe CAP and in those with extra-respiratory M. pneumoniae diseases.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Alberto Argentiero
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Andrea Gramegna
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Nicola Principi
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
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Britton PN, Dale RC, Blyth CC, Clark JE, Crawford N, Marshall H, Elliott EJ, Macartney K, Booy R, Jones CA. Causes and Clinical Features of Childhood Encephalitis: A Multicenter, Prospective Cohort Study. Clin Infect Dis 2021; 70:2517-2526. [PMID: 31549170 DOI: 10.1093/cid/ciz685] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/24/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND We aimed to determine the contemporary causes, clinical features, and short-term outcome of encephalitis in Australian children. METHODS We prospectively identified children (≤14 years of age) admitted with suspected encephalitis at 5 major pediatric hospitals nationally between May 2013 and December 2016 using the Paediatric Active Enhanced Disease Surveillance (PAEDS) Network. A multidisciplinary expert panel reviewed cases and categorized them using published definitions. Confirmed encephalitis cases were categorized into etiologic subgroups. RESULTS From 526 cases of suspected encephalitis, 287 children met criteria for confirmed encephalitis: 57% (95% confidence interval [CI], 52%-63%) had infectious causes, 10% enterovirus, 10% parechovirus, 8% bacterial meningoencephalitis, 6% influenza, 6% herpes simplex virus (HSV), and 6% Mycoplasma pneumoniae; 25% (95% CI, 20%-30%) had immune-mediated encephalitis, 18% acute disseminated encephalomyelitis, and 6% anti-N-methyl-d-aspartate receptor encephalitis; and 17% (95% CI, 13%-21%) had an unknown cause. Infectious encephalitis occurred in younger children (median age, 1.7 years [interquartile range {IQR}, 0.1-6.9]) compared with immune-mediated encephalitis (median age, 7.6 years [IQR, 4.6-12.4]). Varicella zoster virus encephalitis was infrequent following high vaccination coverage since 2007. Thirteen children (5%) died: 11 with infectious causes (2 influenza; 2 human herpesvirus 6; 2 group B Streptococcus; 2 Streptococcus pneumoniae; 1 HSV; 1 parechovirus; 1 enterovirus) and 2 with no cause identified. Twenty-seven percent (95% CI, 21%-31%) of children showed moderate to severe neurological sequelae at discharge. CONCLUSIONS Epidemic viral infections predominated as causes of childhood encephalitis in Australia. The leading causes include vaccine-preventable diseases. There were significant differences in age, clinical features, and outcome among leading causes. Mortality or short-term neurological morbidity occurred in one-third of cases.
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Affiliation(s)
- Philip N Britton
- Discipline of Child and Adolescent Health, Sydney Medical School, Children's Hospital at Westmead, New South Wales.,Marie Bashir Institute of Infectious Diseases and Biosecurity Institute, University of Sydney, New South Wales.,Departments of Infectious Diseases and Microbiology, New South Wales
| | - Russell C Dale
- Discipline of Child and Adolescent Health, Sydney Medical School, Children's Hospital at Westmead, New South Wales.,Neurology, Children's Hospital at Westmead, New South Wales
| | - Christopher C Blyth
- Perth Children's Hospital, Nedlands, Perth, Western Australia.,Telethon Kids Institute and School of Medicine, University of Western Australia, Nedlands, Perth, Western Australia.,PathWest Laboratory Medicine Western Australia and Queen Elizabeth II Medical Centre, Nedlands, Perth, Western Australia
| | - Julia E Clark
- Children's Health Queensland, Brisbane.,School of Clinical Medicine, University of Queensland, Brisbane
| | - Nigel Crawford
- Murdoch Children's Research Institute and Royal Children's Hospital, Victoria.,University of Melbourne, Victoria
| | - Helen Marshall
- Women's and Children's Hospital, South Australia.,Robinson Research Institute, University of Adelaide, South Australia, and
| | - Elizabeth J Elliott
- Discipline of Child and Adolescent Health, Sydney Medical School, Children's Hospital at Westmead, New South Wales.,Australian Paediatric Surveillance Unit, New South Wales, Australia
| | - Kristine Macartney
- Discipline of Child and Adolescent Health, Sydney Medical School, Children's Hospital at Westmead, New South Wales.,Departments of Infectious Diseases and Microbiology, New South Wales.,National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - Robert Booy
- Discipline of Child and Adolescent Health, Sydney Medical School, Children's Hospital at Westmead, New South Wales.,Marie Bashir Institute of Infectious Diseases and Biosecurity Institute, University of Sydney, New South Wales.,Departments of Infectious Diseases and Microbiology, New South Wales.,National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - Cheryl A Jones
- Marie Bashir Institute of Infectious Diseases and Biosecurity Institute, University of Sydney, New South Wales.,Murdoch Children's Research Institute and Royal Children's Hospital, Victoria.,University of Melbourne, Victoria
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12
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Park SH, Oh S, Eun BL, Byeon JH. Acute Necrotizing Encephalopathy Secondary to Mycoplasma pneumoniae Infection in a 4-Year-Old Boy. ANNALS OF CHILD NEUROLOGY 2021. [DOI: 10.26815/acn.2020.00185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Becker MA, Cannon J, Certa K. A Case of Mycoplasma Pneumoniae Encephalopathy Presenting as Mania. J Acad Consult Liaison Psychiatry 2020; 62:150-154. [PMID: 33127068 DOI: 10.1016/j.psym.2020.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Madeleine A Becker
- Department of Psychiatry and Human Behavior, Department of Integrative Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Jennifer Cannon
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, PA.
| | - Kenneth Certa
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, PA
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Nagata T, Odawara K, Hosoyama S, Shida N, Ohori N. [MERS type II mimicking leukoencephalopathy was suspected to be associated with mycoplasma pneumonia infection]. Rinsho Shinkeigaku 2020; 60:328-333. [PMID: 32307392 DOI: 10.5692/clinicalneurol.cn-001356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 16-year-old male with language disorders, such as motor aphasia or mutism, was hospitalized on day 4 after the onset of fever. Magnetic resonance imaging (MRI) on admission revealed lesions of the corpus callosum and brain white matter. Brain single photon emission computed tomography (99mTc-ethyl cysteinate dimer) on day 7 shows hypoperfusion (with right dominance) of bilateral upper parietal region. His condition improved gradually with symptomatic treatments alone, and he was discharged on day 13. The lesions on the MRI disappeared by day 15. Although this case might have suffered from leukoencephalopathy, clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) type II was suspected from the reversible splenial lesion. Except for the elevation (640 times) of mycoplasma pneumonia antibody titer (particle agglutination) in the serum, the blood tests and cerebrospinal fluid findings showed no significant abnormalities. We then considered this encephalopathy was related to mycoplasma pneumonia infection. Since no symptoms of mycoplasma infection except for neurologic symptoms were observed, indirect mechanism, such as immune-mediated reactions, is suggested to cause encephalopathy in this case.
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Affiliation(s)
- Tomoyuki Nagata
- Department of Neurology, Japanese Red Cross Yamaguchi Hospital
| | - Kyoko Odawara
- Department of Neurology, Japanese Red Cross Yamaguchi Hospital
| | - Sachiko Hosoyama
- Department of Neurology, Japanese Red Cross Yamaguchi Hospital
- Department of Neurology, Nagoya Ekisaikai Hospital
| | - Norihiko Shida
- Department of Neurology, Japanese Red Cross Yamaguchi Hospital
- Department of Neurology, Saiseikai Hita Hospital
| | - Nobuhira Ohori
- Department of Neurology, Japanese Red Cross Yamaguchi Hospital
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15
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Extra-pulmonary diseases related to Mycoplasma pneumoniae in children: recent insights into the pathogenesis. Curr Opin Rheumatol 2019; 30:380-387. [PMID: 29432224 DOI: 10.1097/bor.0000000000000494] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Providing an overview on Mycoplasma pneumoniae-related extra-pulmonary diseases (MpEPDs) in children, who represent the preferred target population by those complications, and discussing the main pathogenic mechanisms implicated or potentially involved. RECENT FINDINGS Recent evidences supported the fact that M. pneumoniae is more than an extra-cellular pathogen colonizing epithelial cells of the respiratory tract. It is able to penetrate the cell membrane of host cells and to invade the respiratory mucosa, leading to pronounced inflammatory responses and also spreading outside the respiratory system, to some extent. Thus, direct and indirect (immune-mediated) mechanisms have been described in M. pneumoniae infections, but the latter ones have been mainly implicated in MpEPDs, as reviewed here. Recently, interesting insights have been provided, especially as concern neurologic complications, and new potential mechanisms of disease have been emerging for autoimmunity. SUMMARY The awareness of the occurrence of MpEPDs, showing very variable clinical expressions, could promote a correct diagnosis and an appropriate treatment. The knowledge of disease mechanisms in MpEPDs is largely incomplete, but recent advances from clinical studies and murine models might promote and direct future research.
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16
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Haston JC, Rostad CA, Jerris RC, Milla SS, McCracken C, Pratt C, Wiley M, Prieto K, Palacios G, Shane AL, McElroy AK. Prospective Cohort Study of Next-Generation Sequencing as a Diagnostic Modality for Unexplained Encephalitis in Children. J Pediatric Infect Dis Soc 2019; 9:326-333. [PMID: 31107955 PMCID: PMC7457329 DOI: 10.1093/jpids/piz032] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/25/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Encephalitis is an inflammatory condition of the brain associated with long-term neurologic sequelae and even death in children. Although viruses are often implicated, an etiology is not identified in the majority of cases. Metagenomics-based next-generation sequencing (mNGS) is a high-throughput sequencing technique that can enhance the detection of novel or low-frequency pathogens. METHODS Hospitalized immunocompetent children aged 6 months to 18 years with encephalitis of unidentified etiology were eligible for enrollment. Demographic, historical, and clinical information was obtained, and residual blood and cerebrospinal fluid (CSF) samples were subjected to mNGS. Pathogens were identified by querying the sequence data against the NCBI GenBank database. RESULTS Twenty children were enrolled prospectively between 2013 and 2017. mNGS of CSF identified 7 nonhuman nucleic acid sequences of significant frequency in 6 patients, including that of Mycoplasma bovis, parvovirus B19, Neisseria meningitidis, and Balamuthia mandrillaris. mNGS also detected Cladophialophora species, tobacco mosaic virus, and human bocavirus, which were presumed to be contaminants or nonpathogenic organisms. One patient was found to have positive serology results for California encephalitis virus, but mNGS did not detect it. Patients for whom mNGS identified a diagnosis had a significantly higher CSF white blood cell count, a higher CSF protein concentration, and a lower CSF glucose level than patients for whom mNGS did not identify a diagnosis. CONCLUSION We describe here the results of a prospective cohort analysis to evaluate mNGS as a diagnostic tool for children with unexplained encephalitis. Although mNGS detected multiple nonpathogenic organisms, it also identified multiple pathogens successfully and was most useful in patients with a CSF abnormality.
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Affiliation(s)
- Julia C Haston
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia,Children’s Healthcare of Atlanta, Georgia
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia,Children’s Healthcare of Atlanta, Georgia
| | | | - Sarah S Milla
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia,Children’s Healthcare of Atlanta, Georgia
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia,Children’s Healthcare of Atlanta, Georgia
| | - Catherine Pratt
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Frederick, Maryland,College of Public Health, University of Nebraska Medical Center, Omaha
| | - Michael Wiley
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Frederick, Maryland,College of Public Health, University of Nebraska Medical Center, Omaha
| | - Karla Prieto
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Frederick, Maryland,College of Public Health, University of Nebraska Medical Center, Omaha
| | - Gustavo Palacios
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Frederick, Maryland
| | - Andi L Shane
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia,Children’s Healthcare of Atlanta, Georgia
| | - Anita K McElroy
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia,Children’s Healthcare of Atlanta, Georgia,Department of Pediatrics, University of Pittsburgh, Pennsylvania,Correspondence: A. K. McElroy, MD, PhD, University of Pittsburgh, Department of Pediatrics, 3501 Fifth Ave, Pittsburgh, PA 15261 ()
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17
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Thusang K, Onyearugbulem C, Chao J, Skaricic D. Case 4: Altered Mental Status in a 6-year-old Boy. Pediatr Rev 2019; 40:88-89. [PMID: 30709977 DOI: 10.1542/pir.2016-0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Kabelo Thusang
- Division of Emergency Medicine, Department of Pediatrics, Kings County Medical Center, Brooklyn, NY.,State University of New York, Brooklyn, NY
| | - Chineyere Onyearugbulem
- Division of Emergency Medicine, Department of Pediatrics, Kings County Medical Center, Brooklyn, NY.,State University of New York, Brooklyn, NY
| | - Jennifer Chao
- Division of Emergency Medicine, Department of Pediatrics, Kings County Medical Center, Brooklyn, NY.,State University of New York, Brooklyn, NY
| | - Davor Skaricic
- Division of Emergency Medicine, Department of Pediatrics, Kings County Medical Center, Brooklyn, NY.,State University of New York, Brooklyn, NY
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18
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D'Alonzo R, Mencaroni E, Di Genova L, Laino D, Principi N, Esposito S. Pathogenesis and Treatment of Neurologic Diseases Associated With Mycoplasma pneumoniae Infection. Front Microbiol 2018; 9:2751. [PMID: 30515139 PMCID: PMC6255859 DOI: 10.3389/fmicb.2018.02751] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 10/26/2018] [Indexed: 12/14/2022] Open
Abstract
Mycoplasma pneumoniae is mainly recognized as a respiratory pathogen, although it is associated with the development of several extra-respiratory conditions in up to 25% of the cases. Diseases affecting the nervous system, both the peripheral (PNS) and the central nervous system (CNS), are the most severe. In some cases, particularly those that involve the CNS, M. pneumoniae-related neuropathies can lead to death or to persistent neurologic problems with a significant impact on health and a non-marginal reduction in the quality of life of the patients. However, the pathogenesis of most of the M. pneumoniae-related neuropathies remains undefined. The main aim of this paper is to discuss what is presently known regarding the pathogenesis and treatment of the most common neurologic disorders associated with M. pneumoniae infection. Unfortunately, the lack of knowledge of the true pathogenesis of most of the cases of M. pneumoniae-mediated neurological diseases explains why treatment is not precisely defined. However, antibiotic treatment with drugs that are active against M. pneumoniae and able to pass the blood-brain barrier is recommended, even though the best drug, dosage, and duration of therapy have not been established. Sporadic clinical reports seem to indicate that because immunity plays a relevant role in the severity of the condition and outcome, attempts to reduce the immune response can be useful. However, further studies are needed before the problem of the best therapy for M. pneumoniae-mediated neurological diseases can be efficiently solved.
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Affiliation(s)
- Renato D'Alonzo
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Elisabetta Mencaroni
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Lorenza Di Genova
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Daniela Laino
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | | | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
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Armstrong-Javors A, Berndtson K, Naureckas Li C, Schwartz K. Focal Neurologic Deficits in a Febrile Adolescent. Clin Pediatr (Phila) 2018; 57:1597-1601. [PMID: 30024277 DOI: 10.1177/0009922818790048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Meesters K, Mauel R, Dhont E, Walle JV, De Bruyne P. Systemic fluoroquinolone prescriptions for hospitalized children in Belgium, results of a multicenter retrospective drug utilization study. BMC Infect Dis 2018; 18:89. [PMID: 29471791 PMCID: PMC5824605 DOI: 10.1186/s12879-018-2994-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/14/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Fluoroquinolones (FQ) are increasingly prescribed for children, despite being labeled for only a limited number of labeled pediatric indications. In this multicenter retrospective drug utilization study, we analyzed indications for systemic FQ prescriptions in hospitalized children and the appropriateness of the prescribed dose. METHODS Using data obtained from electronic medical files, the study included all children who received a systemic FQ prescription in two Belgian university children's hospitals between 2010 and 2013. Two authors reviewed prescribed daily doses. Univariate and multivariate logistic regression models were used to analyze risk factors for inadequately dosing. Results262 FQ prescriptions for individual patients were included for analysis. 16.8% of these prescriptions were for labeled indications, and 35.1% were guided by bacteriological findings. Prescribed daily dose was considered to be inappropriate in 79 prescriptions (30.2%). Other FQ than ciprofloxacin accounted for 9 prescriptions (3.4%), of which 8 were correctly dosed. Underdosing represented 45 (56.9%) dosing errors. Infants and preschool children were at particular risk for dosing errors, with associated adjusted OR of 0.263 (0.097-0.701) and 0.254 (0.106-0.588) respectively. CONCLUSIONS FQ were often prescribed off-label and not guided by bacteriological findings in our study population. Dosing errors were common, particularly in infants and preschool children. FQ prescriptions for children should be improved by specific pediatric antimicrobial stewardship teams. Furthermore, pharmacokinetic studies should optimise dosing recommendations for children.
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Affiliation(s)
- Kevin Meesters
- Department of Pediatrics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
- Department of Pediatrics, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Reiner Mauel
- Department of Pediatrics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
- Department of Pediatrics, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Evelyn Dhont
- Pediatric Intensive Care Unit, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Johan Vande Walle
- Department of Pediatrics, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Pauline De Bruyne
- Department of Pediatrics, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
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21
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Management of adult infectious encephalitis in metropolitan France. Med Mal Infect 2017; 47:206-220. [PMID: 28336304 DOI: 10.1016/j.medmal.2017.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 02/06/2023]
Abstract
Infectious encephalitis is a severe disease leading to a high mortality and morbidity. The most frequent causes include Herpes simplex virus, Varicella Zoster virus, Listeria monocytogenes, and Mycobacterium tuberculosis. Urgent treatment is required (anti-infective therapy and nonspecific supportive care). The aim of this study was to define treatment strategy, empirical and after microbiological documentation at 48hours, through a systematic literature review.
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22
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Fillatre P, Crabol Y, Morand P, Piroth L, Honnorat J, Stahl JP, Lecuit M. Infectious encephalitis: Management without etiological diagnosis 48hours after onset. Med Mal Infect 2017; 47:236-251. [PMID: 28314470 PMCID: PMC7131623 DOI: 10.1016/j.medmal.2017.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 02/22/2017] [Indexed: 12/18/2022]
Abstract
Introduction The etiological diagnosis of infectious encephalitis is often not established 48 hours after onset. We aimed to review existing literature data before providing management guidelines. Method We performed a literature search on PubMed using filters such as “since 01/01/2000”, “human”, “adults”, “English or French”, and “clinical trial/review/guidelines”. We also used the Mesh search terms “encephalitis/therapy” and “encephalitis/diagnosis”. Results With Mesh search terms “encephalitis/therapy” and “encephalitis/diagnosis”, we retrieved 223 and 258 articles, respectively. With search terms “encephalitis and corticosteroid”, we identified 38 articles, and with “encephalitis and doxycycline” without the above-mentioned filters we identified 85 articles. A total of 210 articles were included in the analysis. Discussion Etiological investigations must focus on recent travels, animal exposures, age, immunodeficiency, neurological damage characteristics, and potential extra-neurological signs. The interest of a diagnosis of encephalitis for which there is no specific treatment is also to discontinue any empirical treatments initially prescribed. Physicians must consider and search for autoimmune encephalitis.
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Affiliation(s)
- P Fillatre
- Service de maladies infectieuses et réanimation médicale, CHU Pontchaillou, 35000 Rennes, France
| | - Y Crabol
- Médecine interne, CHBUA site de Vannes, 56017 Vannes, France
| | - P Morand
- Virologie, CHU Grenoble Alpes, 38043 Grenoble cedex 9, France
| | - L Piroth
- Infectiologie, CHU de Dijon, 21000 Dijon, France
| | - J Honnorat
- Inserm U1028, CNRS UMR5292, équipe neuro-oncologie et neuro-inflammation (Oncoflam), centre de recherche en neurosciences (CRNL), université Lyon 1, 69500 Bron, France
| | - J P Stahl
- Service d'infectiologie, CHU de Grenoble, 38043 Grenoble cedex 9, France.
| | - M Lecuit
- Institut Pasteur, Biology of Infection Unit, CNR CCOMS Listeria, Inserm U1117, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Department of Infectious Diseases and Tropical Medicine, Necker-Enfants-Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France
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23
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Wickström R, Fowler Å, Bogdanovic G, Bennet R, Eriksson M. Review of the aetiology, diagnostics and outcomes of childhood encephalitis from 1970 to 2009. Acta Paediatr 2017; 106:463-469. [PMID: 27886400 DOI: 10.1111/apa.13682] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 10/27/2016] [Accepted: 11/22/2016] [Indexed: 01/07/2023]
Abstract
AIM Encephalitis is a rare, serious condition, and antiviral therapies, increased knowledge of inflammatory pathways and improved diagnostics have increased the therapeutic possibilities. We describe 40 years of childhood encephalitis in Sweden, covering the diagnostics, aetiology and outcomes. METHODS We reviewed the clinical data that were available for all children discharged from the Karolinska University Hospital in Stockholm following treatment for encephalitis from 1970 to 2009. The hospital treated all children in the region with the condition during the study period. RESULTS There were 408 episodes of encephalitis from 1970 to 2009 and the incidence was similar over the whole period, ranging from 6.4 to 8.7 per 100 000 child years. Although mortality markedly decreased from 10% in the first decade to zero in the last decade, and aetiologies shifted, no clear long-term improvements in outcome were seen. The need for intensive care was unchanged (18-20%) for each of the study intervals, possibly indicating that the severity of cases remained unaltered. CONCLUSION Understanding the pathophysiological mechanisms of encephalitis is vitally important for developing more efficient treatment regimens. As well as reporting the results of this 40-year study, this study considers possible explanations, addresses current therapeutic options and explores directions for central nervous system infection research.
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Affiliation(s)
- Ronny Wickström
- Neuropediatric Unit; Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Åsa Fowler
- Neuropediatric Unit; Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Gordana Bogdanovic
- Department of Microbiology; Tumor and Cell Biology; Karolinska Institutet; Stockholm Sweden
| | - Rutger Bennet
- Pediatric Infectious Disease Unit; Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Margareta Eriksson
- Pediatric Infectious Disease Unit; Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
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25
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Pelkonen T, Sarajuuri A, Rautanen T, Sinkkonen ST, Jero J. Meningoencephalitis and otitis media in a child with Mycoplasma pneumoniaeinfection. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2017. [DOI: 10.1080/23772484.2016.1247249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Tuula Pelkonen
- Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Anne Sarajuuri
- Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Tarja Rautanen
- Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Saku T. Sinkkonen
- Department of Otorhinolaryngology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jussi Jero
- Department of Otorhinolaryngology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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26
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Ueda N, Minami S, Akimoto M. Mycoplasma pneumoniae-associated mild encephalitis/encephalopathy with a reversible splenial lesion: report of two pediatric cases and a comprehensive literature review. BMC Infect Dis 2016; 16:671. [PMID: 27836006 PMCID: PMC5106775 DOI: 10.1186/s12879-016-1985-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND No literature review exists on Mycoplasma pneumoniae-associated mild encephalitis/encepharopathy with a reversible splenial lesion (MERS). METHODS M.pneumoniae-associated MERS cases were searched till August 2016 using PubMed/Google for English/other-language publications and Ichushi ( http://www.jamas.or.jp/ ) for Japanese-language publications. Inclusion criteria were children fulfilling definition for encephalitis, M.pneumoniae infection, and neuroimaging showing hyperintensity in the splenium of the corpus callosum (SCC) alone (type I) or SCC/other brain areas (type II). RESULTS We described two children with type I and II M.pneumoniae-associated MERS. Thirteen cases found by the search and our 2 cases were reviewed. Mean age, male/female ratio, duration of prodromal illness was 8.3 years, 1.5 and 3.5 days. The most common neurological symptom was drowsiness, followed by abnormal speech/behavior, ataxia, seizure, delirium, confusion, tremor, hallucination, irritability, muscle weakness, and facial nerve paralysis. Fever was the most common non-neurological symptom, followed by cough, headache, gastrointestinal symptoms, headache, lethargy and dizziness. Seizure and respiratory symptoms were less common. All were diagnosed for M.pneumoniae by serology. Cerebrospinal fluid (CSF) M.pneumoniae was undetectable by PCR in the 3 patients. Three patients were clarithromycin-resistant. Leukocytosis, positive C-reactive protein, hyponatremia, CSF pleocytosis and slow wave on electroencephalography frequently occurred. All except 2 were type I MERS. Neuroimaging abnormalities disappeared within 18 days in the majority of patients. All type I patients completely recovered within 19 days. Two type II patients developed neurological sequelae, which recovered 2 and 6 months after onset. CONCLUSIONS Prognosis of M.pneumoniae-associated MERS is excellent. Type II MERS may increase a risk of neurological sequelae.
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Affiliation(s)
- Norishi Ueda
- Department of Pediatrics, Public Central Hospital of Matto Ishikawa, 3-8 Kuramitsu, Hakusan, 924-8588, Ishikawa, Japan.
| | - Satoshi Minami
- Department of Pediatrics, Public Central Hospital of Matto Ishikawa, 3-8 Kuramitsu, Hakusan, 924-8588, Ishikawa, Japan
| | - Manabu Akimoto
- Department of Radiology, Public Central Hospital of Matto Ishikawa, Hakusan, Ishikawa, Japan
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Abstract
A 3-state syndromic surveillance system documented reduction and emergence of neurologic infectious diseases. Encephalitis is a devastating illness that commonly causes neurologic disability and has a case fatality rate >5% in the United States. An etiologic agent is identified in <50% of cases, making diagnosis challenging. The Centers for Disease Control and Prevention Emerging Infections Program (EIP) Encephalitis Project established syndromic surveillance for encephalitis in New York, California, and Tennessee, with the primary goal of increased identification of causative agents and secondary goals of improvements in treatment and outcome. The project represents the largest cohort of patients with encephalitis studied to date and has influenced case definition and diagnostic evaluation of this condition. Results of this project have provided insight into well-established causal pathogens and identified newer causes of infectious and autoimmune encephalitis. The recognition of a possible relationship between enterovirus D68 and acute flaccid paralysis with myelitis underscores the need for ongoing vigilance for emerging causes of neurologic disease.
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28
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Chang PT, Yang E, Swenson DW, Lee EY. Pediatric Emergency Magnetic Resonance Imaging: Current Indications, Techniques, and Clinical Applications. Magn Reson Imaging Clin N Am 2016; 24:449-80. [PMID: 27150329 DOI: 10.1016/j.mric.2015.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
MR imaging plays an important role in the detection and characterization of several pediatric disease entities that can occur in the emergent setting because of its cross-sectional imaging capability, lack of ionizing radiation exposure, and superior soft tissue contrast. In the age of as low as reasonably achievable, these advantages have made MR imaging an increasingly preferred modality for diagnostic evaluations even in time-sensitive settings. In this article, the authors discuss the current indications, techniques, and clinical applications of MR imaging in the evaluation of pediatric emergencies.
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Affiliation(s)
- Patricia T Chang
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward Yang
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - David W Swenson
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward Y Lee
- Division of Thoracic Imaging, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Saker A, Athman S, Aldosari M, Frayha H. Encephalopathy and Axonal Neuropathy Associated With Mycoplasma Pneumoniae Infection: Response to Intravenous Immunoglobulin Therapy. Child Neurol Open 2016; 3:2329048X16632140. [PMID: 28503607 PMCID: PMC5417265 DOI: 10.1177/2329048x16632140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 12/16/2015] [Accepted: 12/29/2015] [Indexed: 11/24/2022] Open
Abstract
Mycoplasma pneumoniae infection frequently presents as a self-limited process, however, severe cases and even fatalities have been reported. The authors present a case of Mycoplasma pneumoniae infection associated with both encephalopathy and peripheral neuropathy that responded to intravenous immunoglobulin therapy. To our knowledge, this is the first documented case of Mycoplasma pneumoniae related to encephalitis and peripheral axonal neuropathy. To date, there is insufficient data on the effect of intravenous immunoglobulin on the course of mycoplasma-associated central nervous system/peripheral nervous system disease. While intravenous immunoglobulin has aided in a variety of autoimmune-mediated disorders, its efficacy in mycoplasma-mediated encephalitis treatment remains unclear. In this patient case, reversal of both central and peripheral nervous system symptoms after treatment with intravenous immunoglobulin suggested a possible therapeutic benefit.
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Affiliation(s)
- Ali Saker
- Damascus University, Faculty Of Medicine, Damascus, Syria
| | | | - Mohammed Aldosari
- Department of Pediatric Neurology & Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Husn Frayha
- Section of Infectious Diseases, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Meyer Sauteur PM, Unger WWJ, Nadal D, Berger C, Vink C, van Rossum AMC. Infection with and Carriage of Mycoplasma pneumoniae in Children. Front Microbiol 2016; 7:329. [PMID: 27047456 PMCID: PMC4803743 DOI: 10.3389/fmicb.2016.00329] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/02/2016] [Indexed: 12/18/2022] Open
Abstract
“Atypical” pneumonia was described as a distinct and mild form of community-acquired pneumonia (CAP) already before Mycoplasma pneumoniae had been discovered and recognized as its cause. M. pneumoniae is detected in CAP patients most frequently among school-aged children from 5 to 15 years of age, with a decline after adolescence and tapering off in adulthood. Detection rates by polymerase chain reaction (PCR) or serology in children with CAP admitted to the hospital amount 4–39%. Although the infection is generally mild and self-limiting, patients of every age can develop severe or extrapulmonary disease. Recent studies indicate that high rates of healthy children carry M. pneumoniae in the upper respiratory tract and that current diagnostic PCR or serology cannot discriminate between M. pneumoniae infection and carriage. Further, symptoms and radiologic features are not specific for M. pneumoniae infection. Thus, patients may be unnecessarily treated with antimicrobials against M. pneumoniae. Macrolides are the first-line antibiotics for this entity in children younger than 8 years of age. Overall macrolides are extensively used worldwide, and this has led to the emergence of macrolide-resistant M. pneumoniae, which may be associated with severe clinical features and more extrapulmonary complications. This review focuses on the characteristics of M. pneumoniae infections in children, and exemplifies that simple clinical decision rules may help identifying children at high risk for CAP due to M. pneumoniae. This may aid physicians in prescribing appropriate first-line antibiotics, since current diagnostic tests for M. pneumoniae infection are not reliably predictive.
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Affiliation(s)
- Patrick M Meyer Sauteur
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, University Medical CenterRotterdam, Netherlands; Laboratory of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, University Medical CenterRotterdam, Netherlands; Division of Infectious Diseases and Hospital Epidemiology, and Children's Research Center, University Children's Hospital of ZurichZurich, Switzerland
| | - Wendy W J Unger
- Laboratory of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Netherlands
| | - David Nadal
- Division of Infectious Diseases and Hospital Epidemiology, and Children's Research Center, University Children's Hospital of Zurich Zurich, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, and Children's Research Center, University Children's Hospital of Zurich Zurich, Switzerland
| | - Cornelis Vink
- Erasmus University College, Erasmus University Rotterdam, Netherlands
| | - Annemarie M C van Rossum
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Netherlands
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Horvath T, Fischer U, Müller L, Ott S, Bassetti CL, Wiest R, Sendi P, Schefold JC. Mycoplasma-induced minimally conscious state. SPRINGERPLUS 2016; 5:143. [PMID: 27026840 PMCID: PMC4764598 DOI: 10.1186/s40064-016-1832-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/15/2016] [Indexed: 11/29/2022]
Abstract
Mycoplasma pneumoniae (M. pneumoniae) frequently causes community-acquired respiratory tract infection and often presents as atypical pneumonia. Following airborne infection and a long incubation period, affected patients mostly suffer from mild or even asymptomatic and self-limiting disease. In particular in school-aged children, M. pneumoniae is associated with a wide range of extrapulmonary manifestations including central nervous system (CNS) disease. In contrast to children, severe CNS manifestations are rarely observed in adults. We report a case of a 37 year-old previously healthy immunocompetent adult with fulminant M. pneumoniae-induced progressive encephalomyelitis who was initially able to walk to the emergency department. A few hours later, she required controlled mechanical ventilation for ascending transverse spinal cord syndrome, including complete lower extremity paraplegia. Severe M. pneumoniae-induced encephalomyelitis was postulated, and antimicrobial, anti-inflammatory and immunosuppressive therapy was applied on the intensive care unit. Despite early and targeted therapy using four different immunosuppressive strategies, clinical success was limited. In our patient, locked-in syndrome developed followed by persistent minimally conscious state. The neurological status was unchanged until day 230 of follow-up. Our case underlines that severe M. pneumoniae- related encephalomyelitis must not only be considered in children, but also in adults. Moreover, it can be fulminant and fatal in adults. Our case enhances the debate for an optimal antimicrobial agent with activity beyond the blood–brain barrier. Furthermore, it may underline the difficulty in clinical decision making regarding early antimicrobial treatment in M. pneumoniae disease, which is commonly self-limited.
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Affiliation(s)
- Thomas Horvath
- Department of Neurology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
| | - Lionel Müller
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
| | - Sebastian Ott
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
| | - Claudio L Bassetti
- Department of Neurology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
| | - Roland Wiest
- Department of Diagnostic and Interventional Neuroradiology, Bern University Hospital, 3010 Bern, Switzerland
| | - Parham Sendi
- Department of Infectious Diseases, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
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Brown RJ, Nguipdop-Djomo P, Zhao H, Stanford E, Spiller OB, Chalker VJ. Mycoplasma pneumoniae Epidemiology in England and Wales: A National Perspective. Front Microbiol 2016; 7:157. [PMID: 26909073 PMCID: PMC4754400 DOI: 10.3389/fmicb.2016.00157] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 01/29/2016] [Indexed: 11/13/2022] Open
Abstract
Investigations of patients with suspected Mycoplasma pneumoniae infection have been undertaken in England since the early 1970s. M. pneumoniae is a respiratory pathogen that is a common cause of pneumonia and may cause serious sequelae such as encephalitis and has been documented in children with persistent cough. The pathogen is found in all age groups, with higher prevalence in children aged 5–14 years. In England, recurrent epidemic periods have occurred at ~4-yearly intervals. In addition, low-level sporadic infection occurs with seasonal peaks from December to February. Voluntarily reports from regional laboratories and hospitals in England from 1975 to 2015 were collated by Public Health England for epidemiological analysis. Further data pertaining cases of note and specimens submitted to Public Health England from 2005 to 2015 for confirmation, molecular typing is included.
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Affiliation(s)
- Rebecca J Brown
- Public Health EnglandLondon, UK; Department of Child Health, University Hospital Wales, Cardiff University School of MedicineCardiff, UK
| | - Patrick Nguipdop-Djomo
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine London, UK
| | | | | | - O Brad Spiller
- Department of Child Health, University Hospital Wales, Cardiff University School of Medicine Cardiff, UK
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Yuan ZF, Chen B, Mao SS, Shen J, Yu YL, Gao F, Xia ZZ. Reversible bilateral striatal lesions following Mycoplasma pneumoniae infection associated with elevated levels of interleukins 6 and 8. Brain Dev 2016; 38:149-53. [PMID: 25972305 DOI: 10.1016/j.braindev.2015.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 04/16/2015] [Accepted: 04/17/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reversible bilateral striatal necrosis associated with Mycoplasma pneumoniae (M. pneumoniae) infection is a rare neurological disease. The exact pathogenic mechanism remains unknown. PATIENT We report reversible bilateral striatal lesions with a favorable outcome secondary to M. pneumoniae infection in an 8-year-old Chinese girl. Cranial MRI showed abnormal signals in bilateral striatum, which disappeared 8 months later. To better understand the pathogenesis of this encephalopathy, we examined cytokines levels in serum and cerebrospinal fluid from this patient. The results revealed the concentrations of interleukin-6 and interleukin-8 increased significantly in serum (26 pg/mL and 66 pg/mL, respectively) and cerebrospinal fluid (122 pg/mL and 325 pg/mL, respectively), and were reduced markedly after the therapy. Intrathecal production of interleukin-6 and interleukin-8 is probably related to the pathogenesis of striatal lesions caused by M. pneumoniae. These cytokines may cause local vascular injury, and finally leading to local vascular occlusion. CONCLUSION Our results suggest that interleukin-6 and interleukin-8 may play important roles in the pathogenesis of this disease. This is the first report to describe the role of cytokines in this condition and relevant literature is reviewed. Our findings may lead to better understanding of the pathogenesis of M. pneumoniae-associated striatal lesions.
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Affiliation(s)
- Zhe-Feng Yuan
- Department of Neurology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Bo Chen
- Department of Rehabilitation Center, The Chinese People's Armed Police Forces Corps Hospital in Hangzhou, Hangzhou 310051, China
| | - Shan-Shan Mao
- Department of Neurology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310003, China.
| | - Jue Shen
- Department of Neurology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Yong-Lin Yu
- Department of Neurology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Feng Gao
- Department of Neurology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Zhe-Zhi Xia
- Department of Neurology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310003, China
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35
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Britton PN, Khoury L, Booy R, Wood N, Jones CA. Encephalitis in Australian children: contemporary trends in hospitalisation. Arch Dis Child 2016; 101:51-6. [PMID: 26475868 DOI: 10.1136/archdischild-2015-308468] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 09/23/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The clinical epidemiology of childhood encephalitis in Australia is inadequately understood. We aimed to describe recent trends in childhood encephalitis-related hospitalisation. STUDY DESIGN We identified encephalitis-related hospital admissions (2000-2012) in national datasets among children ≤14 years using ICD encephalitis codes. We calculated hospitalisation rates and analysed trends by year, age, gender, location, indigenous status and aetiology. RESULTS Rates of childhood encephalitis hospitalisations significantly declined over an 11-year period (2000-2012; average hospitalisation rate 3.2/100 000). Varicella encephalitis hospitalisations decreased significantly, associated with high levels of varicella vaccine coverage since 2006. Acute disseminated encephalomyelitis (ADEM) was the most common 'specified' cause of encephalitis hospitalisation (15%-17%), and its rate has significantly increased. The highest hospitalisation rates occurred in the <1 year age group (5.8/100 000) and varied by location (highest in Northern Territory). The majority (58.9%) of hospitalised encephalitis had no cause identified; this proportion was highest in the <1 year age group (77%). The most common specified infectious causes included: herpes simplex virus, enterovirus, bacterial meningoencephalitis and varicella. When aggregated, the proportion of childhood encephalitis coded as viral was 21.2%. CONCLUSION Hospitalisation of childhood encephalitis has slightly decreased in Australia. High rates of childhood immunisation have been associated with a reduction of varicella-associated encephalitis in Australian children. ADEM, an immune-mediated encephalitis, is the most common recognised cause of encephalitis in children. Young children (<1 year) have the highest admission rates. The high proportion of 'unspecified' encephalitis deaths and hospitalisations is an ongoing challenge.
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Affiliation(s)
- Philip N Britton
- Marie Bashir Institute for Infectious Diseases and Biosecurity Institute (MBI), University of Sydney, Westmead, New South Wales, Australia Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Westmead, New South Wales, Australia Departments of Infectious Diseases and Microbiology, and General Medicine, The Children's Hospital, Westmead, New South Wales, Australia
| | - Lynette Khoury
- Departments of Infectious Diseases and Microbiology, and General Medicine, The Children's Hospital, Westmead, New South Wales, Australia
| | - Robert Booy
- Marie Bashir Institute for Infectious Diseases and Biosecurity Institute (MBI), University of Sydney, Westmead, New South Wales, Australia Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Westmead, New South Wales, Australia Departments of Infectious Diseases and Microbiology, and General Medicine, The Children's Hospital, Westmead, New South Wales, Australia National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Nicholas Wood
- Marie Bashir Institute for Infectious Diseases and Biosecurity Institute (MBI), University of Sydney, Westmead, New South Wales, Australia Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Westmead, New South Wales, Australia Departments of Infectious Diseases and Microbiology, and General Medicine, The Children's Hospital, Westmead, New South Wales, Australia National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Cheryl A Jones
- Marie Bashir Institute for Infectious Diseases and Biosecurity Institute (MBI), University of Sydney, Westmead, New South Wales, Australia Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Westmead, New South Wales, Australia Departments of Infectious Diseases and Microbiology, and General Medicine, The Children's Hospital, Westmead, New South Wales, Australia
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Kumar S, Kapoor S, Saigal SR. Hemorrhagic encephalitis caused by Mycoplasma pneumoniae in an 11-year-old boy: A rare case report. Indian J Med Microbiol 2015; 33:463-4. [PMID: 26068367 DOI: 10.4103/0255-0857.158610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- S Kumar
- Department of Microbiology, Maulana Azad Medical College, New Delhi - 110 002, India
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37
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[Neurological symptoms due to Mycoplasma pneumoniae infection in nine children]. Arch Pediatr 2015; 22:699-707. [PMID: 26047743 DOI: 10.1016/j.arcped.2015.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 02/06/2015] [Accepted: 04/23/2015] [Indexed: 11/24/2022]
Abstract
Mycoplasma pneumoniae infection is common in children. Extrapulmonary symptoms usually reveal as neurological symptoms, mainly as encephalitis with significant morbidity and mortality. Various other neurological presentations have also been reported. We describe a cohort of nine children with neurological manifestations due to M. pneumoniae infection, including five cases of encephalitis, one of polyradiculoneuritis, one of ophthalmoplegia, one of optic neuritis, and one of myositis. Progression was variable from ad integrum recovery to severe brain damage. Diagnosis is usually confirmed by PCR and/or serological follow-up, but the latter is still insufficiently used in practice to systematically affirm the diagnosis. Therapeutic management is not clearly defined and long-term progression can be uncertain despite early antibiotic and/or anti-inflammatory treatments.
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38
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Bykowski J, Kruk P, Gold JJ, Glaser CA, Sheriff H, Crawford JR. Acute pediatric encephalitis neuroimaging: single-institution series as part of the California encephalitis project. Pediatr Neurol 2015; 52:606-14. [PMID: 25846458 DOI: 10.1016/j.pediatrneurol.2015.02.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 02/21/2015] [Accepted: 02/23/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Diagnosing pediatric encephalitis is challenging because of varied clinical presentation, nonspecific neuroimaging features, and rare confirmation of causality. We reviewed acute neuroimaging of children with clinically suspected encephalitis to identify findings that may correlate with etiology and length of stay. METHODS Imaging of 141 children with clinically suspected encephalitis as part of The California Encephalitis Project from 2005 to 2012 at a single institution was reviewed to compare the extent of neuroimaging abnormalities to patient age, gender, length of stay, and unknown, possible, or confirmed pathogen. Scan review was blinded and categorized by extent and distribution of abnormal findings. RESULTS Abnormal findings were evident on 23% (22/94) of computed tomography and 50% (67/134) of magnetic resonance imaging studies in the acute setting. Twenty children with normal admission computed tomography had abnormal findings on magnetic resonance imaging performed within 2 days. Length of stay was significantly longer among children with abnormal acute magnetic resonance imaging (P < 0.001) and correlated with increased complexity (Spearman rho = 0.4, P < 0.001) categorized as: no imaging abnormality, meningeal enhancement and/or focal nonenhancing lesion, multifocal lesions, confluent lesions, and lesions plus diffusion restriction, hemorrhage, or hydrocephalus. There was no correlation between neuroimaging findings and an identifiable pathogen (P = 0.8). CONCLUSION Abnormal magnetic resonance imaging findings are more common than abnormal computed tomography findings in pediatric encephalitis. Increasing complexity of magnetic resonance imaging findings correlated with disease severity as evidenced by longer length of stay, but were not specific for an identifiable pathogen using a standardized diagnostic encephalitis panel.
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Affiliation(s)
- Julie Bykowski
- Department of Radiology, University of California San Diego Health System, San Diego, California.
| | - Peter Kruk
- San Diego Imaging, Rady Children's Hospital, San Diego, California
| | - Jeffrey J Gold
- Division of Child Neurology, Department of Neurosciences, University of California San Diego Health System and Rady Children's Hospital, San Diego, California
| | - Carol A Glaser
- California Department of Public Health, Richmond, California
| | - Heather Sheriff
- California Department of Public Health, Richmond, California
| | - John R Crawford
- Division of Child Neurology, Department of Neurosciences, University of California San Diego Health System and Rady Children's Hospital, San Diego, California
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39
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Zhong A. Recent Progress in Mycoplasma pneumoniae Infection. INFECTION INTERNATIONAL 2015. [DOI: 10.1515/ii-2017-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractMycoplasma pneumoniae(Mp) is a definite respiratory pathogen affecting people of all ages. This organism is adsorbed on host cell surface through extreme adherent organelles, generating peroxide ions and possible exotoxins. Mp may directly invade host cells and cause latent infections. Induced immunoreactive injury is one of the main factors resulting in clinical symptoms of Mp infection. Polymerase chain reaction (PCR) and serological detection should be combined for diagnosis of Mp infection when nasopharyngeal and oropharyngeal specimens are simultaneously obtained and detected by PCR. The most reliable basis for diagnosis can be obtained with two serological tests in different courses of the disease. Culture methods also bear significance in diagnosing Mp infections andin vitrodrug sensitivity tests.
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40
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Pillai SC, Hacohen Y, Tantsis E, Prelog K, Merheb V, Kesson A, Barnes E, Gill D, Webster R, Menezes M, Ardern-Holmes S, Gupta S, Procopis P, Troedson C, Antony J, Ouvrier RA, Polfrit Y, Davies NWS, Waters P, Lang B, Lim MJ, Brilot F, Vincent A, Dale RC. Infectious and autoantibody-associated encephalitis: clinical features and long-term outcome. Pediatrics 2015; 135:e974-84. [PMID: 25802349 DOI: 10.1542/peds.2014-2702] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Pediatric encephalitis has a wide range of etiologies, clinical presentations, and outcomes. This study seeks to classify and characterize infectious, immune-mediated/autoantibody-associated and unknown forms of encephalitis, including relative frequencies, clinical and radiologic phenotypes, and long-term outcome. METHODS By using consensus definitions and a retrospective single-center cohort of 164 Australian children, we performed clinical and radiologic phenotyping blinded to etiology and outcomes, and we tested archived acute sera for autoantibodies to N-methyl-D-aspartate receptor, voltage-gated potassium channel complex, and other neuronal antigens. Through telephone interviews, we defined outcomes by using the Liverpool Outcome Score (for encephalitis). RESULTS An infectious encephalitis occurred in 30%, infection-associated encephalopathy in 8%, immune-mediated/autoantibody-associated encephalitis in 34%, and unknown encephalitis in 28%. In descending order of frequency, the larger subgroups were acute disseminated encephalomyelitis (21%), enterovirus (12%), Mycoplasma pneumoniae (7%), N-methyl-D-aspartate receptor antibody (6%), herpes simplex virus (5%), and voltage-gated potassium channel complex antibody (4%). Movement disorders, psychiatric symptoms, agitation, speech dysfunction, cerebrospinal fluid oligoclonal bands, MRI limbic encephalitis, and clinical relapse were more common in patients with autoantibodies. An abnormal outcome occurred in 49% of patients after a median follow-up of 5.8 years. Herpes simplex virus and unknown forms had the worst outcomes. According to our multivariate analysis, an abnormal outcome was more common in patients with status epilepticus, magnetic resonance diffusion restriction, and ICU admission. CONCLUSIONS We have defined clinical and radiologic phenotypes of infectious and immune-mediated/autoantibody-associated encephalitis. In this resource-rich cohort, immune-mediated/autoantibody-associated etiologies are common, and the recognition and treatment of these entities should be a clinical priority.
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Affiliation(s)
- Sekhar C Pillai
- Neuroimmunology Group, Institute of Neuroscience and Muscle Research at the Kids Research Institute, Children's Hospital at Westmead, University of Sydney, Australia; TY Nelson Department of Neurology and Neurosurgery and
| | - Yael Hacohen
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, England
| | - Esther Tantsis
- Neuroimmunology Group, Institute of Neuroscience and Muscle Research at the Kids Research Institute, Children's Hospital at Westmead, University of Sydney, Australia; TY Nelson Department of Neurology and Neurosurgery and
| | | | - Vera Merheb
- Neuroimmunology Group, Institute of Neuroscience and Muscle Research at the Kids Research Institute, Children's Hospital at Westmead, University of Sydney, Australia
| | | | - Elizabeth Barnes
- Statistics, the Children's Hospital at Westmead, Sydney, Australia; National Health Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Deepak Gill
- TY Nelson Department of Neurology and Neurosurgery and
| | | | - Manoj Menezes
- TY Nelson Department of Neurology and Neurosurgery and
| | | | - Sachin Gupta
- TY Nelson Department of Neurology and Neurosurgery and
| | | | | | - Jayne Antony
- TY Nelson Department of Neurology and Neurosurgery and
| | | | - Yann Polfrit
- Centre Hospitalier Territorial Magenta, Service Pediatric, Nouméa, New Caledonia
| | - Nicholas W S Davies
- Chelsea & Westminster Hospital, Department of Neurology, Imperial College Healthcare National Health Service Trust, London, England; and
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, England
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, England
| | - Ming J Lim
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, England; Evelina Children's Hospital, London, England
| | - Fabienne Brilot
- Neuroimmunology Group, Institute of Neuroscience and Muscle Research at the Kids Research Institute, Children's Hospital at Westmead, University of Sydney, Australia
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, England
| | - Russell C Dale
- Neuroimmunology Group, Institute of Neuroscience and Muscle Research at the Kids Research Institute, Children's Hospital at Westmead, University of Sydney, Australia; TY Nelson Department of Neurology and Neurosurgery and
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Olsen SJ, Campbell AP, Supawat K, Liamsuwan S, Chotpitayasunondh T, Laptikulthum S, Viriyavejakul A, Tantirittisak T, Tunlayadechanont S, Visudtibhan A, Vasiknanonte P, Janjindamai S, Boonluksiri P, Rajborirug K, Watanaveeradej V, Khetsuriani N, Dowell SF. Infectious causes of encephalitis and meningoencephalitis in Thailand, 2003-2005. Emerg Infect Dis 2015; 21:280-9. [PMID: 25627940 PMCID: PMC4313633 DOI: 10.3201/eid2102.140291] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Acute encephalitis is a severe neurologic syndrome. Determining etiology from among ≈100 possible agents is difficult. To identify infectious etiologies of encephalitis in Thailand, we conducted surveillance in 7 hospitals during July 2003-August 2005 and selected patients with acute onset of brain dysfunction with fever or hypothermia and with abnormalities seen on neuroimages or electroencephalograms or with cerebrospinal fluid pleocytosis. Blood and cerebrospinal fluid were tested for >30 pathogens. Among 149 case-patients, median age was 12 (range 0-83) years, 84 (56%) were male, and 15 (10%) died. Etiology was confirmed or probable for 54 (36%) and possible or unknown for 95 (64%). Among confirmed or probable etiologies, the leading pathogens were Japanese encephalitis virus, enteroviruses, and Orientia tsutsugamushi. No samples were positive for chikungunya, Nipah, or West Nile viruses; Bartonella henselae; or malaria parasites. Although a broad range of infectious agents was identified, the etiology of most cases remains unknown.
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Affiliation(s)
| | | | - Krongkaew Supawat
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Sahas Liamsuwan
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Tawee Chotpitayasunondh
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Somsak Laptikulthum
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Akravudh Viriyavejakul
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Tasanee Tantirittisak
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Supoch Tunlayadechanont
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Anannit Visudtibhan
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Punnee Vasiknanonte
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Supachai Janjindamai
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Pairoj Boonluksiri
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Kiatsak Rajborirug
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Veerachai Watanaveeradej
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Nino Khetsuriani
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
| | - Scott F. Dowell
- Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand (S.J. Olsen, S.F. Dowell)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.J. Olsen, A.P. Campbell, N. Khetsuriani, S.F. Dowell)
- Thailand Ministry of Health, Nonthaburi (K. Supawat)
- Queen Sirikit National Institute of Child Health, Bangkok (S. Liamsuwan, T. Chotpitayasunondh)
- Rajvithi Hospital, Bangkok (S. Laptikulthum)
- Prasat Neurological Institute of Thailand, Bangkok (A. Viriyavejakul, T. Tantirittisak)
- Ramathibodi Hospital, Bangkok (S. Tunlayadechanont, A. Visudtibhan)
- Prince Songkhla University Hospital, Hat Yai, Thailand (P. Vasiknanonte, S. Janjindamai)
- Hat Yai Hospital, Hat Yai (P. Boonluksiri, K. Rajborirug)
- Phramongkutklao Hospital, Bangkok (V. Watanaveeradej)
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42
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Britton PN, Dale RC, Booy R, Jones CA. Acute encephalitis in children: Progress and priorities from an Australasian perspective. J Paediatr Child Health 2015; 51:147-58. [PMID: 24953748 DOI: 10.1111/jpc.12650] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2014] [Indexed: 11/27/2022]
Abstract
Encephalitis is a complex neurological syndrome caused by inflammation of the brain that occurs with highest incidence in children. It is challenging to diagnose and manage due to the variety of aetiologies and non-specific clinical presentations. We discuss the recent progress in clinical case definitions; review recent, large, prospective epidemiological studies; and describe aetiologies. We emphasise infectious causes relevant to children in Australasia but also consider emerging immune-mediated syndromes responsive to immune therapies. We identify priorities for future research in children, given the potential for climate change and international travel to influence the emergence of infectious agents in our region.
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Affiliation(s)
- Philip N Britton
- Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), University of Sydney, Sydney, New South Wales, Australia
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43
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Karampatsas K, Patel H, Basheer SN, Prendergast AJ. Chronic meningitis with intracranial hypertension and bilateral neuroretinitis following Mycoplasma pneumoniae infection. BMJ Case Rep 2014; 2014:bcr-2014-207041. [PMID: 25538215 DOI: 10.1136/bcr-2014-207041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A previously well 12-year-old boy presented with a 2-week history of headache, nausea, vomiting and left-sided weakness. He subsequently developed meningism, right abducens nerve palsy, persistent papilloedema and reduced visual acuity in association with a bilateral macular star, consistent with neuroretinitis. Cerebrospinal fluid (CSF) examination indicated chronic meningitis and serological testing confirmed recent Mycoplasma pneumoniae infection, although PCR in CSF was negative. He was treated for aseptic meningitis with ceftriaxone, aciclovir, azithromycin and acetazolamide for intracranial hypertension, with gradual improvement in clinical condition and visual acuity over several weeks. This is the first report of M. pneumoniae chronic meningitis further complicated with bilateral neuroretinitis and intracranial hypertension. Evidence of central nervous system inflammation in the absence of direct infection suggests an immune-mediated pathophysiology. Although the use of macrolides with antibiotic and immunomodulatory activity might be beneficial, it was not possible to ascertain whether it influenced clinical recovery in this case.
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Affiliation(s)
| | - Himanshu Patel
- Department of Ophthalmology, The Royal London Hospital, Barts Health NHS Trust, London, UK Moorfields Eye Hospital, London, UK
| | - Sheikh N Basheer
- Department of Paediatric Neurology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Andrew J Prendergast
- Centre for Paediatrics, Blizard Institute, Queen Mary University of London, London, UK
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44
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Sasaki J, Chegondi M, Raszynski A, Totapally BR. Outcome of children with acute encephalitis and refractory status epilepticus. J Child Neurol 2014; 29:1638-44. [PMID: 24413358 DOI: 10.1177/0883073813513069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acute encephalitis in children is a life-threatening neurological emergency. However, little is reported about the outcome of this devastating illness in the United States. The authors retrospectively reviewed the charts of patients admitted to a regional pediatric intensive care unit with the diagnosis of acute encephalitis between 2006 and 2011. In 41 cases that met the inclusion criteria, the most common presenting symptoms were fever (65.9%), altered mental status (61%), and seizures (58.5%). Eight patients (19.5%) who presented with refractory status epilepticus had a longer median length of stay in the pediatric intensive care unit (46 vs. 4 days; P < .0001) and a significant worsening of Pediatric Cerebral Performance Category score on discharge by 2 or more points (odds ratio 20.38; 95% confidence interval, 2.89-143.52). All children survived to hospital discharge. In conclusion, children with acute encephalitis who present with refractory status epilepticus have a worse neurological outcome and a longer stay in the pediatric intensive care unit.
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Affiliation(s)
- Jun Sasaki
- Division of Critical Care Medicine, Miami Children's Hospital, Miami, FL, USA
| | | | - Andre Raszynski
- Division of Critical Care Medicine, Miami Children's Hospital, Miami, FL, USA Herberth Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Balagangadhar R Totapally
- Division of Critical Care Medicine, Miami Children's Hospital, Miami, FL, USA Herberth Wertheim College of Medicine, Florida International University, Miami, FL, USA
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45
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Adenot M, Frobert E, Blanchard G, Morel B, Perrot L, Floret D, Javouhey E. Clinical presentation of severe viral encephalitis with known causative agents in children: a retrospective study on 16 patients hospitalized in a pediatric intensive care unit (2008-2011). J Child Neurol 2014; 29:1508-18. [PMID: 24464514 DOI: 10.1177/0883073813513330] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A retrospective analysis was conducted in a French pediatric hospital in Lyon. Subjects were 16 patients diagnosed with acute viral encephalitis with identified causative agents who were admitted to the pediatric intensive care unit from 2008 to 2011. The median length of stay was 6 days. The outcome was favorable for 77% of the patients. Analysis of biological and clinical findings based on causative agents did not reveal clinical patterns or neurological findings specific to the causal viruses. Nevertheless, uncommon clinical pictures and severe neurological complications were highlighted, in particular for children with influenza-related encephalitis and herpes simplex encephalitis. This case series exemplifies the difficulties, even pitfalls, in establishing a diagnosis of encephalitis, especially in neonates. It points out significant differences in the clinical presentation of encephalitis in children compared with clinical pictures described in previously published large-scale studies on encephalitis mainly conducted in adults.
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Affiliation(s)
- Marc Adenot
- Pediatric Emergency and Intensive Care Unit, Hospices Civils de Lyon, Lyon, France
| | - Emilie Frobert
- Laboratoire de Virologie Est, Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, Lyon, France Virology and Human Pathology, EMR 4610, Faculté de Médecine RTH Laënnec, Université Claude Bernard Lyon 1, Lyon, France
| | - Gaëlle Blanchard
- Pediatric Neurology, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Lyon, France
| | - Benoit Morel
- Département d'Imagerie Pédiatrique et Foetale, Hôpital Femme-Mère-Enfant, Lyon, France
| | - Laurence Perrot
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - Daniel Floret
- Pediatric Emergency and Intensive Care Unit, Hospices Civils de Lyon, Lyon, France University Claude Bernard Lyon 1, France
| | - Etienne Javouhey
- Pediatric Emergency and Intensive Care Unit, Hospices Civils de Lyon, Lyon, France University Claude Bernard Lyon 1, France
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46
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Gorman MP, Rincon SP, Pierce VM. Case records of the Massachusetts General Hospital. Case 19-2014. A 19-year-old woman with headache, fever, stiff neck, and mental-status changes. N Engl J Med 2014; 370:2427-38. [PMID: 24941181 DOI: 10.1056/nejmcpc1400838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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47
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Antibody responses to Mycoplasma pneumoniae: role in pathogenesis and diagnosis of encephalitis? PLoS Pathog 2014; 10:e1003983. [PMID: 24945969 PMCID: PMC4055762 DOI: 10.1371/journal.ppat.1003983] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Hon KL, Leung ASY, Cheung KL, Fu AC, Chu WCW, Ip M, Chan PKS. Typical or atypical pneumonia and severe acute respiratory symptoms in PICU. CLINICAL RESPIRATORY JOURNAL 2014; 9:366-71. [PMID: 24720856 PMCID: PMC7162156 DOI: 10.1111/crj.12149] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 02/07/2014] [Accepted: 04/04/2014] [Indexed: 12/04/2022]
Abstract
Background and Aims Mycoplasma pneumoniae (MP) is a common childhood pathogen associated with atypical pneumonia (AP). It is often a mild disease and seldom results in paediatric intensive care (PICU) admission. In 2003, World Health Organization (WHO) coined the word SARS (severe acute respiratory syndrome) in patients with severe acute respiratory symptoms (sars) for an outbreak of AP in Hong Kong due to a novel coronavirus. In 2012, another outbreak of coronavirus AP occurred in the Middle East. Confusing case definitions such as MERS (Middle East respiratory syndrome) and SARI (severe acute respiratory infections) were coined. This paper aims to present a case of MP with sars, ARDS, pneumonia and pleural effusion during the MERS epidemics, and review the incidence and mortality of severe AP with MP. Methods We presented a case of MP with sars, acute respiratory distress syndrome (ARDS), pneumonia and pleural effusion during the MERS epidemics, and performed a literature review on the incidence and mortality of severe AP with MP requiring PICU care. Results In early 2013, an 11‐year‐old girl presented with sars, ARDS (acute respiratory distress syndrome), right‐sided pneumonia and pleural effusion. She was treated with multiple antibiotics. Streptococcus pneumoniae was not isolated in this girl with ‘typical’ pneumonia by symptomatology and chest radiography, but tracheal aspirate identified MP instead. The respiratory equations are computed with PaO2/FiO2 consistent with severe lung injury. Literature on the incidence and mortality of severe AP with MP requiring PICU care is reviewed. Six, 165 and 293 articles were found when PubMed (a service of the U.S. National Library of Medicine) was searched for the terms ‘mycoplasma’ and ‘ICU’, ‘mycoplasma’ and ‘mortality’, and ‘mycoplasma' and ‘severe’. Mortality and PICU admission associated with MP is general low and rarely reported. Experimental and clinical studies have suggested that the pathogenesis of lung injuries in MP infection is associated with a cell‐mediated immune reaction, and high responsiveness to corticosteroid therapy has been reported especially for severe disease. Management of severe mycoplasma infection in the PICU includes general cardiopulmonary support and specific antimicrobial treatment. Macrolide resistance genotypes have been detected. Conclusion We urge health organizations to refrain from the temptation of coining unnecessary new terminology to describe essentially the same conditions each and every time when outbreaks of AP occur.
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Affiliation(s)
- Kam Lun Hon
- Departments of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Agnes S Y Leung
- Departments of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kam Lau Cheung
- Departments of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Antony C Fu
- Departments of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Margaret Ip
- Department of Microbiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Paul K S Chan
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Arkilo D, Pierce B, Ritter F, Doescher JS, Frost M. Diverse seizure presentation of acute Mycoplasma pneumoniae encephalitis resolving with immunotherapy. J Child Neurol 2014; 29:564-6. [PMID: 23481447 DOI: 10.1177/0883073813480242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report 3 previously normal children that presented for evaluation of new onset seizures. Case 1, a 7-year-old female, presented with refractory left frontal lobe seizures associated with right arm simple motor seizures refractory to 6 antiepileptic medications at sufficient doses and levels. Case 2, a 15-year-old female, presented with left frontotemporal lobe seizures and nonconvulsive seizures, associated with neuropsychiatric symptoms refractory to 5 antiepileptic medications. Both patients received intravenous steroids and intravenous immunoglobulin. Case 3, an 11-year-old male, presented with a generalized tonic clonic seizure and worsening hallucinations responding to intravenous corticosteroids and 1 antiepileptic medication. All 3 patients had extensive infectious and metabolic evaluation and were found to be serum immunoglobulin M positive for mycoplasma pneumoniae. Despite their prolonged severe symptoms, all patients had virtually complete recovery with excellent seizure control after aggressive seizure management with immunotherapy and antiepileptic medication.
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50
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Li S, Li X, Wang Y, Yang J, Chen Z, Shan S. Global secretome characterization of A549 human alveolar epithelial carcinoma cells during Mycoplasma pneumoniae infection. BMC Microbiol 2014; 14:27. [PMID: 24507763 PMCID: PMC3922035 DOI: 10.1186/1471-2180-14-27] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 02/03/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Mycoplasma pneumoniae (M. pneumoniae) is one of the major etiological agents for community-acquired pneumonia (CAP) in all age groups. The early host response to M. pneumoniae infection relies on the concerted release of proteins with various biological activities. However, no comprehensive analysis of the secretory proteins has been conducted to date regarding the host response upon M. pneumoniae infection. RESULTS We employed the liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based label-free quantitative proteomic technology to identify and characterize the members of the human alveolar epithelial carcinoma A549 cell secretome during M. pneumoniae infection. A total of 256 proteins were identified, with 113 being differentially expressed (>1.5-fold change), among which 9 were only expressed in control cells, 10 only in M. pneumoniae-treated cells, while 55 were up-regulated and 39 down-regulated by M. pneumoniae. The changed expression of some of the identified proteins was validated by RT-PCR and immunoblot analysis. Cellular localization analysis of the secretome data revealed 59.38% of the proteins were considered as "putative secretory proteins". Functional analysis revealed that the proteins affected upon M. pneumoniae infection were mainly related to metabolic process, stress response, and immune response. We further examined the level of one up-regulated protein, IL-33, in clinical samples. The result showed that IL-33 levels were significantly higher in the plasma and bronchoalveolar lavage fluid (BALF) of M. pneumoniae pneumonia (MPP) patients. CONCLUSIONS The present study provided systematic information about the changes in the expression of secretory proteins during M. pneumoniae infection, which is useful for the discovery of specific biomarkers and targets for pharmacological intervention.
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Affiliation(s)
| | | | | | - Jun Yang
- Department of Pediatric Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China.
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