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Objective:To investigate the changes and clinical significance of neuron specific enolase (NSE) and S-100β protein levels in cerebrospinal fluid of children with viral encephalitis and meningitis.Methods:Sixty children with viral encephalitis and meningitis admitted to The Second Hospital of Jiaxing from February 2018 to December 2020 were included in the observation group. An additional 30 children without central nervous system diseases who concurrently received treatment in the same hospital were included in the control group. The value of NSE and S-100β protein levels in the diagnosis and treatment of viral encephalitis and meningitis in chiblren were analyzed.Results:NSE and S-100β protein levels in the observation group were (17.683 ± 1.321) μg/L and (1.755 ± 0.129) μg/L, respectively, which were significantly higher than (5.267 ± 0.907) μg/L and (0.827 ± 0.172) μg/L in the control group ( t = 46.25, 28.65, both P < 0.001). NSE and S-100β protein levels in children with mild viral encephalitis and meningitis were (15.219 ± 0.870) μg/L and (1.456 ± 0.113) μg/L, respectively, which were significantly lower than (19.893 ± 1.066) μg/L and (2.014 ± 0.085) μg/L in children with severe viral encephalitis and meningitis ( t = -18.69, -21.32, both P < 0.001). In children with viral encephalitis and meningitis, NSE and S-100β protein levels during the acute phase were (17.250 ± 1.188) μg/L and (1.683 ± 0.096) μg/L, respectively, which were significantly higher than (11.150 ± 0.971) μg/L and (1.147 ± 0.098) μg/L during the convalescence phase ( t = 30.79, 30.27, both P < 0.001). Conclusion:NSE and S-100β protein levels in cerebrospinal fluid of children with viral encephalitis and meningitis can help evaluate the severity of viral encephalitis and meningitis in children, providing important clinical application value for judging the development and prognosis of viral encephalitis and meningitis.
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Coronavirus-NL63 is a common respiratory virus, which often causes severe respiratory symptoms such as fever, cough, expectoration, pneumonia and so on. The damage of central nervous system is rare. A case of acute necrotizing encephalitis caused by respiratory coronavirus-NL63 infection with cognitive impairment as the first symptom is reported, finding of CT/magnetic resonance imaging scanning indicating necrosis combined with a striated encephalomalacia of the corpus callosum and bilateral cerebral hemispheres.
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Objective:To investigate the clinical characteristics, diagnosis, treatment and outcome of patients with human herpesvirus 7 (HHV-7) viral encephalitis after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods:The clinical manifestations, laboratory characteristics, diagnosis and treatment process and outcome of 3 patients with HHV-7 viral encephalitis after allo-HSCT in Hebei Yanda Lu Daopei Hospital from 2018 to 2020 were retrospectively analyzed, and the related literature was reviewed.Results:The clinical features of 3 patients with HHV-7 viral encephalitis after allo-HSCT included fever, headache, vomiting, apathy, etc., without specific symptoms or signs. The conventional white blood cell count in the cerebrospinal fluid was normal or slightly higher, mainly lymphocytes, and the cerebrospinal fluid protein was normal or slightly higher. The HHV-7 virus DNA in cerebrospinal fluid was positive, and the treatment with ganciclovir or foscarnet was effective. The prognosis was favorable in two mild cases, but one case with cerebral hemorrhage died eventually.Conclusions:HHV-7 viral encephalitis is a rare infection after allo-HSCT, and it can be easily misdiagnosed due to lack of typical symptoms and indications for routine laboratory tests. The detection of HHV-7 DNA in the cerebrospinal fluid can help confirm the diagnosis. Currently, there is no standard treatment programs, but ganciclovir and foscarnet are effective.
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RESUMO: Introdução: A encefalite viral é uma condição com altas taxas de morbimortalidade, e um melhor entendimento de sua epidemiologia pode colaborar para a construção de estratégias de prevenção e controle. Diante disso, este estudo se propôs a traçar um perfil epidemiológico para a encefalite viral no Brasil no ano de 2018 a partir de dados de internações hospitalares no Sistema Único de Saúde (SUS). Métodos: Estudo ecológico de análise espacial. Os dados estudados foram relativos às internações hospitalares por encefalite viral no SUS em 2018, estratificadas por unidade da federação (UF), sexo e faixa etária. A distribuição geográfica foi abordada exploratoriamente, já as variáveis sexo e faixa etária foram abordadas analiticamente. Resultados: Foram registradas 2075 internações, com taxa de 0,99/105 habitantes. As taxas para cada UF foram representadas a partir de um mapa colorimétrico, enquanto as taxas para cada sexo e faixa etária foram representadas em uma tabela comparativa univariada. Discussão: Observou-se ampla variação numérica das taxas de internação dentre as UF, sendo Pernambuco o estado com maior incidência (4,13/105 habitantes) e Paraíba o estado com menor (0,29/105 habitantes). Foi constatada associação significativa com o risco de internação hospitalar por encefalite viral para o sexo masculino e para as faixas etárias de 1 a 4 anos (RR: 3,28) e menores de 1 ano (RR: 6,02). Conclusão: UF, gênero e faixa etária foram determinantes importantes da taxa de internação hospitalar por encefalite viral. Todavia, carecem de estudos atuais no Brasil e no mundo para a melhor caracterização da epidemiologia da encefalite viral. (AU)
ABSTRACT: Introduction: Viral encephalitis is a condition with high morbidity and mortality rates, and a better understanding of its epidemiology may contribute to the construction of prevention and control strategies. For this reason, this study aimed to draw an epidemiological profile for viral encephalitis in Brazil in 2018 from data on hospitalizations in the Unified Health System (SUS). Methods: Ecological study of spatial analysis. The data studied were hospitalizations for viral encephalitis in SUS in 2018, stratified by federation unit (FU), gender, and age group. The geographical distribution was approached in an exploratory way, whereas gender and age variables were analytically addressed. Results: There were 2075 hospitalizations, with a rate of 0.99/105 inhabitants. The rates for each FU were represented in a colorimetric map, whereas the rates for each sex and age group were exemplified in a univariate comparative table. Discussion: There was a wide numerical variation in hospitalization rates among the FUs, with Pernambuco being the state with the highest incidence (4.13/105 inhabitants) and Paraíba with the lowest (0.29/105 inhabitants). A significant association was found with the risk of hospitalization for viral encephalitis for males and the ages from 1 to 4 years (RR: 3.28) and under one year (RR: 6.02). Conclusion: FU, gender, and age group were important determinants of the hospitalization rate due to viral encephalitis. However, current studies are needed in Brazil and worldwide to better characterize the epidemiology of viral encephalitis. (AU)
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Humans , Male , Female , General Surgery/statistics & numerical data , Emergency Service, Hospital , Hospitalization , Length of StayABSTRACT
To investigate the effect of high dose gamma globulin combined with naloxone in the treatment of severe viral encephalitis in children ,and its influence on nerve function and immune function.Methods From March 2012 to May 2017,103 children with viral encephalitis in the First People＇s Hospital of Wenling were randomly divided into observation group (53 cases) and control group (50 cases) according to the digital table.The control group was given routine treatment.The observation group was given naloxone combined with high dose gamma globulin on the basis of routine treatment.The therapeutic effect,clinical symptoms,serum neurological function and humoral immune function were compared between the two groups.Results The total effective rate of the observation group was significantly higher than that of the control group (92.45% vs.78.00%) (χ2 ＝4.319,P＜0.05).The clinical symptoms,signs disappearance time and hospitalization time of the observation group were significantly shorter than those of the control group [(2.17 ±0.56) d vs.(3.12 ±0.79) d;(2.25 ±0.31) d vs.( 3.87 ±0.93) d; (3.84 ±0.46)d vs.(5.31 ±0.69)d;(2.01 ±0.83)d vs.(3.86 ±1.21) d;(1.85 ±0.58) d vs.(2.79 ±0.77)d;(11.36 ±2.14)d vs.(13.05 ±1.85) d;(10.21 ±3.05) d vs.(13.85 ±3.72) d] ( t＝7.072,11.998,12.789, 9.093,7.024,4.276,5.444,all P＜0.05).After treatment,the serum NSE,S-100βand NGF levels of the two groups were significantly decreased [(12.64 ±1.22) ng／L vs.(18.95 ±2.15) ng／L, (0.85 ±0.24) ng／L vs. (1.69 ±0.35)ng／L,(0.17 ±0.05)ng／mL vs.(0.98 ±0.12)ng／mL,(16.38 ±1.38)ng／L vs.(19.04 ±2.78)ng／L, (1.22 ±0.30) ng／L vs.(1.70 ±0.41) ng／L,(0.33 ±0.10) ng／mL vs.(0.96 ±0.14) ng／mL] ( t ＝18.583, 14.010,45.361,6.239,6.878,25.58,all P＜0.05),and the serum neurological function indicators of the observation group were significantly lower than those of the control group ( t ＝14.592,6.931,10.358,all P ＜0.05).After treatment,the level of IgG in the two groups were significantly higher than those before treatment [(15.62 ±2.31)g／L vs.(9.12 ±1.74)g／L;(11.52 ±2.05)g／L vs.(8.97 ±1.56)g／L]( t＝16.363,6.999,all P＜0.05),and the IgG level in the observation group was significantly higher than that in the control group (P＜0.05).There were no signifi-cant changes in the levels of IgM in the two groups before and after treatment (all P＞0.05).Conclusion High-dose gamma globulin combined with naloxone can effectively improve the clinical efficacy of severe viral encephalitis
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Objective@#To investigate the effect of high dose gamma globulin combined with naloxone in the treatment of severe viral encephalitis in children, and its influence on nerve function and immune function.@*Methods@#From March 2012 to May 2017, 103 children with viral encephalitis in the First People's Hospital of Wenling were randomly divided into observation group (53 cases) and control group (50 cases) according to the digital table.The control group was given routine treatment.The observation group was given naloxone combined with high dose gamma globulin on the basis of routine treatment.The therapeutic effect, clinical symptoms, serum neurological function and humoral immune function were compared between the two groups.@*Results@#The total effective rate of the observation group was significantly higher than that of the control group (92.45% vs.78.00%)(χ2=4.319, P<0.05). The clinical symptoms, signs disappearance time and hospitalization time of the observation group were significantly shorter than those of the control group [(2.17±0.56)d vs.(3.12±0.79)d; (2.25±0.31)d vs.(3.87±0.93)d; (3.84±0.46)d vs.(5.31±0.69)d; (2.01±0.83)d vs.(3.86±1.21)d; (1.85±0.58)d vs.(2.79±0.77)d; (11.36±2.14)d vs.(13.05±1.85)d; (10.21±3.05)d vs.(13.85±3.72)d](t=7.072, 11.998, 12.789, 9.093, 7.024, 4.276, 5.444, all P<0.05). After treatment, the serum NSE, S-100β and NGF levels of the two groups were significantly decreased[(12.64±1.22)ng/L vs.(18.95±2.15)ng/L, (0.85±0.24)ng/L vs.(1.69±0.35)ng/L, (0.17±0.05)ng/mL vs.(0.98±0.12)ng/mL, (16.38±1.38)ng/L vs.(19.04±2.78)ng/L, (1.22±0.30)ng/L vs.(1.70±0.41)ng/L, (0.33±0.10)ng/mL vs.(0.96±0.14)ng/mL] (t=18.583, 14.010, 45.361, 6.239, 6.878, 25.58, all P<0.05), and the serum neurological function indicators of the observation group were significantly lower than those of the control group (t=14.592, 6.931, 10.358, all P<0.05). After treatment, the level of IgG in the two groups were significantly higher than those before treatment[(15.62±2.31)g/L vs.(9.12±1.74)g/L; (11.52±2.05)g/L vs.(8.97±1.56)g/L](t=16.363, 6.999, all P<0.05), and the IgG level in the observation group was significantly higher than that in the control group(P<0.05). There were no significant changes in the levels of IgM in the two groups before and after treatment (all P>0.05).@*Conclusion@#High-dose gamma globulin combined with naloxone can effectively improve the clinical efficacy of severe viral encephalitis in children, help to improve the clinical symptoms and signs of children, at the same time help to restore the nervous function of children and improve the humoral immune function, which is worthy of clinical application.
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Resumen Introducción. La encefalitis viral aguda se define como un proceso inflamatorio asociado a disfunción neurológica con desenlace fatal o daño grave permanente. En México no se han hecho estudios de identificación directa de los agentes etiológicos causales de la encefalitis viral aguda. Objetivo. Identificar mediante PCR en tiempo real los principales agentes virales causantes de encefalitis viral aguda en México. Materiales y métodos. Se obtuvo el líquido cefalorraquídeo de pacientes con sospecha de encefalitis viral que ingresaron al servicio de urgencias del Hospital Civil Fray Antonio Alcalde. Se extrajeron ácidos nucleicos para identificar los patógenos mediante PCR y PCR con transcripción inversa en tiempo real. Resultados. Se captaron un total de 66 pacientes entre el 2011 y el 2014. En 16 de los casos (24 %) se identificó el agente viral y se encontró que el principal agente causal fue el enterovirus, con ocho casos (50 %), seguido del virus del herpes simple (HSV: 37 %), con seis casos, y el citomegalovirus (CMV: 12,5 %), con dos casos. El promedio de edad fue de 25 años (0-70 años). Los casos positivos predominaron en los varones (63,3 %) y se estableció un predominio estacional en otoño (37,5 %). La mayoría de los pacientes presentó fiebre (48,4 %) o cefalea (36,3 %) y, en menor proporción, convulsiones, confusión y debilidad muscular (30,3 %) seguidas de desorientación (28,75 %) y apatía (25,7 %). En dos de los casos se observó el signo de Kerning (3 %) y en otros dos, el signo de Brudzinski (3 %). Conclusiones. La PCR en líquido cefalorraquídeo es una técnica de diagnóstico adecuada para la identificación de virus causales de encefalitis viral, lo cual permite prescribir los medicamentos específicos.
Abstract Introduction: Viral encephalitis is a well-known inflammatory process associated with neurological dysfunction that might derive into severe brain damage or a fatal outcome. In México there is no epidemiological data that describes the prevalence of viral agents responsible for acute encephalitis. Objective: To identify the main viral agents by real time PCR involved in acute encephalitis in Mexico. Materials and methods: We obtained cerebral spinal fluid (CSF) samples from all patients with suspected viral encephalitis admitted to the emergency service of the Hospital Civil de Guadalajara "Fray Antonio Alcalde". To identify pathogens, we performed nucleic acid extraction using real-time PCR and RT-PCR. Results: Sixty-six patients were diagnosed with acute encephalitis from 2011 to 2014. A definitive viral etiological diagnosis was established in 16 patients (24%); the main causative agents were enteroviruses in 50% of the 16 positive samples, followed by herpes simplex virus (37%) and cytomegaloviruses (12.5%). Patients with encephalitis were predominantly male (63.3%) and a seasonal predominance was observed during autumn (37.5%). The main clinical characteristics in the acute encephalitis phase were fever (48.45) and cephalea (36.3), followed by seizures, disorientation, and muscular weakness (30.3%). Kerning sign was present in two cases (3%) and other two cases presented Brudzinski's sign (3%). Conclusions: CSF PCR is a suitable diagnostic technique for the identification of viral encephalitis caused by viral infections that allows an appropriate antiviral therapeutic treatment.
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Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Young Adult , Encephalitis, Viral/virology , Encephalitis Viruses/isolation & purification , Time Factors , Acute Disease , Encephalitis, Viral/cerebrospinal fluid , Real-Time Polymerase Chain Reaction , MexicoABSTRACT
Objective To study the peripheral blood helper T cell 17 (Th17)/ regulatory T cell (Treg) balance and levels of related immune cytokines in children with enterovirus encephalitis. Methods One hundred and two children with enterovirus encephalitis from January 2014 to January 2017 were selected as enterovirus encephalitis group, and 100 healthy children who received physical examination during the same period were selected as healthy control group. The peripheral blood expressions of Th17 and Treg were detected by flow cytometry, and the Th17/Treg was calculated. The serum levels of interleukin (IL)-6, IL-17, IL-23, IL-4, IL-10 and transforming growth factor (TGF)-β were detected by enzyme-linked immunosorbent assay. Results The peripheral blood expression of Th17 and Th17/Treg in enterovirus encephalitis group were significantly higher than those in healthy control group (0.032 ± 0.006 vs. 0.024 ± 0.004 and 3.04 ± 0.61 vs. 1.99 ± 0.37), the peripheral blood expression of Treg was significantly lower than that in healthy control group (0.011 ± 0.002 vs. 0.013 ± 0.002), and there were statistical differences (P＜0.05). The serum levels of IL-6, IL-17 and IL-23 in enterovirus encephalitis group were significantly higher than those in healthy control group, the serum levels of IL-4, IL-10 and TGF-β were significantly lower than those in healthy control group, and there were statistical differences (P＜0.05). Conclusions The peripheral blood expression of Th17 is high, and the peripheral blood expression of Treg is low in children with enterovirus encephalitis. There is imbalance of Th17/Treg. The IL-17, IL-23, IL-4, IL-4, IL-10, TGF-β and other Th17 and Treg related immune cytokines may be involved in the pathogenesis of enterovirus encephalitis.
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The severe fever with thrombocytopenia syndrome virus (SFTSV),a new RNA virus,was discovered in recent years,which can lead to fever,thrombocytopenia and multiple organ dysfunction.Picks is the main media A case of a SFTSV-related encephalitis diagnosed by second-generation gene sequencing was reported here.The patient had fever,disturbance of consciousness,convulsions,with thrombocytopenia and enzymatic indicators increased significantly.After active anti-virus and supportive treatment,the prognosis was good.It is our aim to suggest that,in the epidemic season,when you meet thesimilar patients like this,you should consider the possibility of SFTSV-related encephalitis.Virus nucleic acid detection and second-generation gene sequencing technology are helpful for timely diagnosis and treatment and reducing mortality of the disease.
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Resumen El citomegalovirus (CMV) es uno de los microorganismos oportunistas con mayor prevalencia en pacientes inmunocomprometidos, aunque su reactivación ha descendido después de la introducción de la terapia antirretroviral altamente activa (Highly Active Antiretroviral Therapy, HAART). En las coinfecciones, la encefalitis se ha reportado como una de las condiciones más frecuentes. Se presenta el caso de un paciente adulto joven con infección por virus de la inmunodeficiencia humana (HIV) que tuvo un rápido deterioro neurológico evidenciado en síntomas y signos clínicos clásicos del síndrome de Wernicke-Korsakoff y que no presentaba factores de riesgo para deficiencia de tiamina. En las imágenes de la resonancia magnética cerebral, se detectaron hallazgos típicos del síndrome, y se identificó citomegalovirus (CMV) en el líquido cefalorraquídeo. Con el tratamiento específico para el CMV, se logró el control de los síntomas, aunque hubo secuelas neurológicas que mejoraron. Este es uno de los pocos casos reportados a nivel mundial de síndrome de Wernicke secundario a encefalitis por citomegalovirus.
Abstract Cytomegalovirus (CMV) is one of the opportunistic microorganisms with the highest prevalence in immunocompromised patients. Reactivation has decreased after the introduction of highly active antiretroviral therapy (HAART). Encephalitis has been reported in the coinfection as one of the most frequent presentations. We present the case of a young adult patient with HIV infection and rapid neurological deterioration due to classic clinical symptoms and signs of the Wernicke-Korsakoff syndrome, with no risk factors for thiamine deficiency, with images by nuclear magnetic resonance typical of the syndrome, and identification of cytomegalovirus in cerebrospinal fluid. The specific treatment for CMV managed to control the symptoms with neurological sequelae in progression towards improvement. This is one of the few cases reported in the literature of Wernicke syndrome secondary to cytomegalovirus encephalitis.
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Adult , Humans , Male , AIDS-Related Opportunistic Infections/complications , Cytomegalovirus Infections/complications , Encephalitis, Viral/complications , Korsakoff Syndrome/etiology , Antiviral Agents/therapeutic use , Respiratory Insufficiency/etiology , Magnetic Resonance Imaging , Tracheostomy , Gastrostomy , Deglutition Disorders/surgery , Deglutition Disorders/etiology , Ganciclovir/therapeutic use , Cerebrospinal Fluid/virology , AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/virology , Cytomegalovirus Infections/cerebrospinal fluid , Cytomegalovirus Infections/drug therapy , Encephalitis, Viral/cerebrospinal fluid , Encephalitis, Viral/drug therapy , Abducens Nerve Diseases/etiology , Cytomegalovirus/isolation & purification , Diplopia/etiology , Latent Tuberculosis/complicationsABSTRACT
Objective@#To investigate human enterovirus (HEV) infection and clinical characteristics of viral encephalitis patients in Pingdingshan, Henan Province.@*Methods@#Cerebrospinal fluid specimens and epidemiological information were collected from 274 viral encephalitis patients in the departments of pediatrics and neurology in hospitals in Pingdingshan, Henan Province, from April 2011 to August 2012. Patients with bacterial infections were excluded from the study. Demographic information was collected by questionnaires and clinical information was mainly obtained from hospital examinations. Viral RNA was extracted using magnetic bead extraction. Real-time RT-PCR was then performed for HEV, CV-A16, and EV-A71 testing. SPSS statistical software was statistical analyses. Significant differences were determined using the chi-squared test (P<0.05).@*Results@#Among 274 cases of viral encephalitis, 180 cases (65.7%) were male and 94 cases were female (34.3%). The median age was 2.17 years. Approximately 61.3% (168) of patients were younger than 3 years of age. A total of 107 (39.1%), 2 (0.7%), and 42 (15.3%) cases were positive for HEV, CV-A16, and EV-A71, respectively. Eleven patients were younger than 6 months of age and one patient was co-infected with HEV and EV-A71. In the<3, 3-5, 6-15, and>15 years old age groups, HEV infections comprised 31.5% (53/168), 52.9% (18/34), 53.0% (35/66), and 16.7% (1/6) (χ2=13.10, P=0.003), respectively. The EV-A71 infection rates were 17.9% (30/168), 23.5% (8/34), 6.1% (4/66), and 0 (χ2=8.04, P=0.045), respectively. The other enterovirus (OEV) infection rates were 12.5% (21/168), 29.4% (10/34), 48.5% (32/66), and 16.7% (1/6) (χ2=35.19, P<0.001), respectively. The rate of vomiting in OEV and EV-A71 infected patients was 73% (44/60) and 26% (11/42), respectively, while the frequency of skin rash in OEV and EV-A71 infected patients was 32% (19/60) and 79% (33/42), respectively. Approximately 95% (99/104) of patients infected with HEV had a fever, and the breathing rhythm change rate was 19% (20/104), which was lower than that of patients without HEV infection (36.8% (60/163)) (χ2=9.35, P=0.002).@*Conclusion@#In Pingdingshan, HEV was a major causative agent of viral encephalitis and the rate of OEV infection was high, especially in children aged 3-15 years old. Fever was a common clinical symptom of patients infected with HEV. Patients infected with OEV primarily exhibited vomiting symptoms and EV-A71 infected patients showed skin rash.
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RESUMEN Niña de dos años con fiebre y síntomas catarrales que presenta convulsiones focales de hemicuerpo derecho, las cuales persisten adicionándose signos de hipertensión endocraneana. Se identifica Influenza AH1N1 mediante reacción de cadena de polimerasa en hisopado nasofaríngeo. Paciente evoluciona favorablemente con medidas de soporte. No recibió Oseltamivir.
ABSTRACT A 2-year-old girl presented with fever, catarrhal symptoms, and focal right hemispheric seizures that persisted and led to signs of intracranial hypertension. An influenza A H1N1 infection was confirmed via polymerase chain reaction analysis of a nasopharyngeal swab. The patient, who was not treated with oseltamavir, has responded favorably to supportive measures.
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Child, Preschool , Female , Humans , Brain Diseases/virology , Influenza, Human/complications , Influenza A Virus, H1N1 Subtype , FeverABSTRACT
Objective To investigate the clinical outcome and treatment characteristics of viral encephalitis with bilateral thalamic damage so as to improve its prognosis.Methods Twelve cases of viral encephalitis with bilateral thalamic damage were collected during September 2012 to June 2013 by head MRI.These cases were retrospectively studied with the data of medical history,physical examination,laboratory and brain function monitoring and treatment.The relationship between treatment and prognosis was studied during 2 years of follow-up.Results All patients began with the rapid onset,accompanied by fever,coma,and convulsions.Delirium and involuntary movement occurred during the recovery period.Six cases(50.0％) received ventilator assisted ventilation.In the acute phase,electroencephalogram (EEG) showed diffuse slow wave and 4 cases(33.3％) had status epilepticus on EEG.Ten cases discharged from hospital had long-term oral anti epileptic drugs,which lasted 6 months in 3 cases,1 year in 4 cases,and 2 years in 3 cases for maintaining EEG stability.Head MRI indicated white matter demyelination besides the gray matter damage within the thalamus.All 12 patients underwent methylprednisolone impact treatment and 6 cases had effective reversal within 1 week of onset with better tolerance,and the other 6 cases received treatment in subacute stage and 5 of them accelerated recovery and 1 case had sense improvement,but died after giving up therapy.After 3 months courses,8 cases(66.7％) got gross motor and swallowing function recovered to normal,and 3 cases had left unilateral limb movement disorder.After 2 years of follow-up,11 cases had normal motor,intelligence returned to normal in 9 cases,and 2 cases had mild mental retardation.Conclusions Viral encephalitis complicated with bilateral thalamic damage is characterized by acute onset,serious manifestations,idiopathic progress;in the subacute stage it is most likely to develop white matter demyelination.The key to control the disease is to block the inflammatory immune response quickly,and give patients large dose methylprednisolone treatment can effectively curb the progress of the disease.In the sub acute phase,it can promote the recovery,safe and effective.The long-term prognosis will be good with the reasonable treatment at early stage of the disease.
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Objective To discuss the etiology and clinical characteristics of human rhinovirus (HRV) as pathogen of central nervous system infection .Methods Two hundred and five cerebrospinal fluid (CSF) specimens were collected from children with fever and convulsions who were admitted to the pediatric intensive care unit with suspicion of central nervous system infection from June 2011 to December 2012 .Genome Lab Genetic Analysis System (GeXP) was applied to detect HRV from CSF .Specimens with positive results were amplified by nested reverse transcription‐polymerase chain reaction and followed by gene sequencing . Clinical data of HRV positive cases were analyzed . Results Of the 205 CSF specimens ,7 samples were positive for HRV ,which were composed of 2 HRV‐A ,1 HRV‐B and 4 HRV‐C (including 1 HRV‐Ca) .There were 6 boys and 1 girl among the 7 positive cases for HRV .Six children were less than 3 years old ,except one was 9 years old .The onset time was mainly concentrated between September and October . The main clinical manifestations were fever and convulsions . The clinical diagnosis before the pathogen confirmation included viral encephalitis ,epilepsy ,febrile convulsion ,benign infantile convulsions with mild gastroenteritis (CwG ) and hand‐foot‐and‐mouth disease ( HFMD ) . Although the disease severity of the 7 cases varied ,all ended with favorable prognosis .Conclusions HRV is one of pathogens of viral central nervous system infection .All types of HRV can cause central nervous system infection ,among which HRV‐C accounts for the majority .The clinical manifestations of HRV central nervous system infection could mimic febrile convulsion ,CwG and HFMD .
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Objective To investigate the clinical efficacy and safety of intravenous immunoglobulin and interferon in the treatment of hand foot and mouth disease complicated with viral encephalitis .Methods 80 cases of hand foot and mouth disease complicated with viral encephalitis were randomly divided into the three groups according to the random number table .27 cases in the control group were given comprehensive symptomatic treatment ,27 cases in the study group 1 were given gamma globulin ,and 26 cases in the study group 2 were given interferon .The clinical efficacy,improvement of disease ,incidence of adverse reactions of the three groups were compared .Results Defer-vescence time ,seizure control time ,time of skin rash subsided ,time of psychiatric symptoms relieved and the average hospitalization time in the study 1 group were (3.65 ±0.28)d,(4.04 ±0.33)d,(3.86 ±0.27)d,(5.83 ±0.36)d and (7.53 ±0.83)d,which were significantly less than those in the control group (t=8.43,8.58,9.15,9.80,8.96, all P0.05).The incidence rate of adverse reaction among the three groups showed no sta-tistically significant difference (χ2 =2.17,P>0.05).Conclusion Intravenous immunoglobulin and interferon have significant effect in the treatment of hand foot mouth disease complicated with viral encephalitis , which can quickly improve symptoms ,shorten treatment time and have high safety and good clinical application value .
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Objective To explore the prominent clinical features and the prognosis of corpus callosum solitary lesions cases in children.Methods There were 16 cases with corpus callosum solitary lesions receiving treatment at our hospital from January to December 2013.All of the clinical features were collected and retrospectively analyzed.Results The 16 cases aged 1 year to 13 years with an average age of (3.44 ± 3.65) years.The causes of the disease included the viral encephalitis,convulsions,and rotavirus infection.The most prevalent disorders were convulsions (10 cases),gastrointestinal symptoms (8 cases),fever (8 cases),positive cervical resistance (6 cases),fatigue (5 cases),altered states of consciousness (2 cases),headache (1 case),and dizziness (1 case).Corpus callosum lesions lasted for 13-50 days,with an average of (28.8 ± 10.2) days.Cranial magnetic resonance showed the splenium of the corpus callosum with isolated oval lesions,low signal on T1 weighted images and apparent diffusion coefficient images,high signal on T2 weighted images and diffusion weighted images.Conclusions The splenium of the corpus callosum lesions of children occur in a lower rate than adults with the etiology including intracranial infection,convulsions and rotavirus infection.Main clinical manifestations include fever,convulsions and gastrointestinal symptoms (nausea,diarrhea,etc).The cases followed-up showed the lesions and symptoms are reversible,and the prognosis is good.
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Objective To observe the clinical efficacy of ganciclovir in treatment of children with viral encephalitis.Methods 80 children with viral encephalitis were randomly divided into observation group and control group.All patients received the comprehensive treatment including anti-spasm,dehydration,control of body temperature,decreased intracranial pressure and drugs of improving brain metabolism.40 children in the observation group received intravenous ganciclovir.40 patients in the control group received intravenous ribavirin.The clinical effect of the two groups was compared.Results The total effective rate of observation group was 92.5％,that of the control group was 70.0％,the difference was statistically significant (x2 =6.721,P ＜ 0.05).In the observation group,the main clinical symptoms including fever,headache,vomiting,convulsions and the disappearance time of unconsciousness were significantly shorter than the control group(t =5.270,9.730,5.749,5.903,5.421,all P ＜ 0.05).The incidence rate of adverse reactions in the observation group was 7.5％,which was lower than 17.5％ in the control group,but the difference was not statistically significant (all P ＞ 0.05).Conclusion Ganciclovir in the treatment of children with viral encephalitis can improve clinical symptoms in a short time,and adverse reactions are mild,which can be used as the ideal choice for treatment of children with viral encephalitis.
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Objetivo: describir la frecuencia, y el comportamiento clínico y de laboratorio de las infecciones por citomegalovirus (CMV), virus Epstein-Barr (EBV) y virus herpes simplex 1 y 2 (HSV 1 y HSV 2) en el sistema nervioso central tanto en pacientes inmunocomprometidos como inmunocompetentes. Metodología: se analizaron 204 líquidos cefalorraquídeos con el uso de la reacción en cadena de la polimerasa (PCR, de su sigla en inglés) en tiempo real como herramienta diagnóstica molecular para la detección de infección. Resultados: un 16% de los líquidos cefalorraquídeos es positivo para alguno de los virus estudiados, el EBV se detectó en el 22.8% de los casos positivos y se ubica por encima de las infecciones ocasionadas por HSV y CMV. El 61.9% de los pacientes con resultado positivo tenía algún tipo de inmunocompromiso. onclusiones: la utilización de la PCR en tiempo real permite establecer el agente causal de infección en el sistema nervioso central y es de gran ayuda en los pacientes inmunocomprometidos en los que las variaciones clínicas y de laboratorio no son concluyentes. Esto permitiría la implementación de una terapia específica.
Objective: To describe the frequency and the clinical and laboratory characteristics of infections with cytomegalovirus (CMV), Epstein-Barr (EBV) and herpes simplex virus 1 and 2 (HSV 1 and HSV 2) in central nervous system in both immunocompetent and immunocompromised patients. Methods: A total of 204 cerebrospinal fluid samples were tested for CMV, EBV or HSV 1 and 2 using real time PCR as a molecular diagnostic tool for detection of infection. Results: Sixteen percent of cerebrospinal fluid was positive for at least one of the viruses, and Epstein Barr virus was detected in 22.8% of cases, which is above the infections caused by HSV and CMV. 61.9% of positive patients had some form of immune compromise. Conclusions: The use of real-time PCR identifies the causative agent of infection in the central nervous system and is of great help in immunocompromised patients where clinical and laboratory variations are inconclusive; this will also help to implement a specific therapy.
Objetivo: descrever a frequência, e o comportamento clínico e de laboratório das infecções por citomegalovírus (CMV), vírus Epstein-Barr (EBV) e vírus herpes simplex 1 e 2 (HSV 1 e HSV 2) no sistema nervoso central tanto em pacientes imuno-comprometidos como imuno-competentes. Metodologia: analisaram-se 204 líquidos cefalorraquídianos utilizando a reação em corrente da polimerase (PCR, de sua sigla em virilhas) em tempo real como ferramenta diagnostica molecular para a detecção de infecção. Resultados: um 16% dos líquidos cefalorraquídianos foram positivos para algum dos vírus estudados, o EBV se detectou no 22.8% dos casos positivos localizando-se acima das infecções ocasionadas por HSV e CMV. O 61.9% dos pacientes com resultado positivo tinha algum tipo de imuno-compromisso. Conclusões: a utilização da PCR em tempo real permite estabelecer o agente causal de infecção no sistema nervoso central sendo de grande ajuda nos pacientes inmunocomprometidos onde as variações clínicas e de laboratório não são concludentes e isto permitiria a implementação de uma terapia específica.
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Humans , Cytomegalovirus , Encephalitis, Viral , Epstein-Barr Virus Infections , Cerebrospinal Fluid , Meningitis, Aseptic , Polymerase Chain Reaction , SimplexvirusABSTRACT
Objective To analyze retrospectively the risk factors and predictors of post-encephalitic epilepsy (PEE) and refractory epilepsy in patients with encephalitis.Methods In a hospital based study,the patients with encephalitis were reviewed retrospectively between the January of 1995 and December of 2010.Related factors were evaluated including age,sex,seizure types,neuroimaging,electroencephalogram(EEG) in intermittent period,clinical symptoms,consciousness level,initial seizure and steroid hormone therapy,etc.Results 237 patients with encephalitis were enrolled,whose median age was 26.3 (range 15-57) years old.PEE occurred in 103 (43.46％) patients; and 67 of whom had partial seizure.Significant risk factors for PEE included age (OR =3.72,95％ CI 2.70-5.25,P =0.018),disturbance of consciousness level(OR =5.37,95％ CI 2.43-13.03,P =0.012),cortical lesion in imaging (OR =11.42,95％ CI 5.94-31.27,P =0.000),spike discharges in EEG (OR =18.04,95％ CI 7.30-48.38,P =0.000) and initial seizures in acute phase (OR =32.68,95％ CI 9.62-97.59,P =0.000).The refractory epilepsy occurred in 6t patients.The significant risk factors of refractory PEE included focal seizures(OR =4.09,95％ CI 2.14-9.10,P =0.021),status epilepticus (OR =4.48,95％ CI 1.89-8.07,P =0.017) and poor controlled seizure (OR =6.17,95％ CI 3.52-11.34,P =0.001) during acute phase,multifocal spikes discharge in EEG(OR =5.53,95％ CI 2.91-10.07,P =0.006),cortical lesion in neuroimaging(OR =2.33,95％ CI 1.37-7.72,P =O.028),however,early steroid hormone therapy (OR =2.19,95％ CI 1.11-4.87,P =0.037) and longer time to initial seizure (OR =4.40,95％ CI 3.19-11.62,P =0.014) could significantly reduced the incidence of refractory epilepsy in PEE patients.Conclusion Our data indicated that PEE occur in 43.46％ patients especially in younger patients with disturbance of consciousness level,cortical lesion in imaging,spike discharges in EEG and initial seizures in acute phase.And the risk factors for refractory PEE are also discussed.
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ObjectiveTo investigate the significance of cerebrospinal fluid(CSF) S-100B protein and vascular endothelial growth factor (VEGF) levels in the pathogenesis of brain injury of viral encephalitis.MethodsForty-two patients with viral encephalitis (viral encephalitis group) and 40 patients with other disease at the corresponding time period(control group) were involved in this study.CSF (routine,biochemistry and cytology) was detected,and the levels of S-100B protein and VEGF in CSF were detected by ABC-ELISA method.ResultsWhite blood cell count was (0-584) × 106/L in viral encephalitis group,and (0-200) × 106/L in control group.The levels of protein and glucose in CSF had no significant difference between two groups (P＞ 0.05),and the level of chloride in CSF in viral encephalitis group was significantly lower than that in control group[ ( 110.10 ± 31.22 ) mmol/L vs.( 123.80 ± 6.32 ) mmol/L ] (P =0.006).In viral encephalitis group,cytological examination showed that mixed type cytological reaction was in 6 cases (14.3％,6/42).The level of S-100B protein in viral encephalitis group [25.04-47.97 (28.37 ± 6.09) ng/L] was significantly higher than that in control group[ 25.04-29.64(26.03 ± 0.90) ng/L ] (t =2.462,P =0.018).The level of VEGF in viral encephalitis group[88.84～143.77(96.24 ± 13.38) ng/L] was significantly higher than that in control group [89.15～96.18 (90.67 ± 1.71 ) ng/L] (t =2.673,P =0.011 ).ConclusionsThe high levels of S-100B protein and VEGF in CSF could support the viral encephalitis diagnosis.Tracking the levels of S-100B protein and VEGF in CSF dynamically have noticeable effect on checking the condition of viral encephalitis patients.