Outcome of Encephalitis in Pediatric Intensive Care Unit

Sadarangani has been an investigator on research grants from Pfizer, Merck and VBI Vaccines but has received no personal payments, with all monies paid to his institution. Mrs Nickless has no disclosures. Dr Kelly receives salary support from the NIHR Oxford Biomedical Research Centre. Dr Pollard has previously conducted studies on behalf of Oxford University funded by vaccine manufacturers, but currently does not undertake industry funded clinical trials. AJP chairs the UK Department of Health's (DH) Joint Committee on Vaccination and Immunisation (JCVI) and is a member of the World Health Organization's (WHO) Strategic Advisory Group of Experts.

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“…However contrary to data from the same study, 9 we found no difference in the sex distribution of survivors and non-survivors.…”

Section: Discussioncontrasting

confidence: 99%

“…Requirement for invasive ventilation and vasoactive treatment was higher in non-survivors than survivors, in keeping with a previous Hong Kong study. 9 This finding possibly reflects a more severe clinical course in non-survivors compared with survivors.…”

Section: Discussionmentioning

confidence: 98%

A Population-based Observational Study of Childhood Encephalitis in Children Admitted to Pediatric Intensive Care Units in England and Wales

Iro

Sadarangani

Nickless

et al. 2019

Pediatric Infectious Disease Journal

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“…A majority of patients (>60%) surviving HSE suffer neurological disturbances that can include loss of smell (anosmia) and speech (aphasia), anxiety, and learning and memory impairments that can be severe despite antiviral treatment [ 3 , 46 ]. In contrast, ~70% of neonates surviving HSV1 infection suffer permanent neurological impairment, exhibiting diverse symptoms including motor abnormalities such as hemiparesis and spastic quadriplegia, delayed speech, visual impairment or blindness, recurring seizures, and microencephally [ 47 , 48 ]. The pathophysiological mechanisms responsible for neurologic dysfunction following HSV1 CNS infection are largely unknown.…”

Section: Discussionmentioning

confidence: 99%

Effects of Acyclovir and IVIG on Behavioral Outcomes after HSV1 CNS Infection

Ramakrishna

Golub

Chiang

et al. 2017

Behavioural Neurology

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Herpes simplex virus 1 (HSV) encephalitis (HSE) has serious neurological complications, involving behavioral and cognitive impairments that cause significant morbidity and a reduced quality of life. We showed that HSE results from dysregulated central nervous system (CNS) inflammatory responses. We hypothesized that CNS inflammation is casually involved in behavioral abnormalities after HSE and that treatment with ACV and pooled human immunoglobulin (IVIG), an immunomodulatory drug, would improve outcomes compared to mice treated with phosphate buffered saline (PBS) or ACV alone. Anxiety levels were high in HSV-infected PBS and ACV-treated mice compared to mice treated with ACV + IVIG, consistent with reports implicating inflammation in anxiety induced by lipopolysaccharide (LPS) or stress. Female, but not male, PBS-treated mice were cognitively impaired, and unexpectedly, ACV was protective, while the inclusion of IVIG surprisingly antagonized ACV's beneficial effects. Distinct serum proteomic profiles were observed for male and female mice, and the antagonistic effects of ACV and IVIG on behavior were paralleled by similar changes in the serum proteome of ACV- and ACV + IVIG-treated mice. We conclude that inflammation and other factors mediate HSV-induced behavioral impairments and that the effects of ACV and IVIG on behavior involve novel mechanisms.

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“…Encephalitis is an inflammatory condition of the brain with multiple etiologies [1][2]. Autoimmune encephalitis syndromes (AESs) describe a basket of encephalitis entities associated with antibodies against the neuronal cell surface or synaptic proteins [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Autoimmune Encephalitis in Children: From Suspicion to Diagnosis

Hon

Leung²,

Au³

et al. 2021

Cureus

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There are several well-described and studied autoimmune diseases that affect different organ systems, and a limited number of these affect the central nervous system. Autoimmune encephalitis represents a disease with a wide spectrum of clinical manifestations and different levels of severity, from mild cognitive impairment to complex encephalopathy. Immune-mediated encephalitis refers to a diverse and rare group of conditions in children associated with nonspecific symptomatology, altered mental state, and recalcitrant seizures. Infectious etiology must be excluded. Immune-mediated encephalitis syndromes could be associated with paraneoplastic or primarily autoimmune mechanisms. The newest scientific advantages have concluded that autoimmune encephalitis may be further divided into different groups of diseases depending on the immune response; examples are antibodies to cell surface proteins, antibodies to intracellular synaptic proteins, T-cell response with antibodies to intracellular antigens, among others. Treatment consists of supportive therapy, ranging from supplemental oxygen, fluid restriction to mechanical circulatory support. Specific treatment includes immunoglobulin infusion, plasmapheresis, and pulse steroid treatment. Prognosis is poor if specific treatment is not timely instituted. The diagnosis of autoimmune encephalitis could be challenging to clinicians due to its diverse clinical features, which can mimic a variety of other pathologic processes. Screening for cancer and proper management that includes immune therapy are fundamental, although some patients will need immune suppression for weeks or months as autoimmune encephalitis may relapse; therefore, follow-up is always necessary.

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Outcome of Encephalitis in Pediatric Intensive Care Unit

Abstract: Encephalitis is associated with significant mortality despite intensive care. Over 25 % case died and 55 % of survivors had moderate-to-severe neurodevelopmental impairments. There appeared to be no emerging outbreaks of encephalitis during the 15-y study period.

Cited by 16 publications

References 19 publications

A Population-based Observational Study of Childhood Encephalitis in Children Admitted to Pediatric Intensive Care Units in England and Wales

A Population-based Observational Study of Childhood Encephalitis in Children Admitted to Pediatric Intensive Care Units in England and Wales

Effects of Acyclovir and IVIG on Behavioral Outcomes after HSV1 CNS Infection

Autoimmune Encephalitis in Children: From Suspicion to Diagnosis

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