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

Iro, Mildred A; Sadarangani, Manish; Nickless, Alecia; Kelly, Dominic F.; Pollard, Andrew J.

doi:10.1097/inf.0000000000002280

Cited by 3 publications

(7 citation statements)

References 13 publications

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“…Previous studies have demonstrated that viral encephalitis etiology is linked to a worse prognosis, influencing patient outcomes. [19][20][21][22][23] Our study revealed nonsignificant impacts on mortality from factors such as age group, admission to the PICU, and the occurrence of status epilepticus episodes. This deviates from the findings of a previous study by Hatachi et al, which noted unfavorable outcomes associated with PICU admission within 2 days.…”

Section: Discussionmentioning

confidence: 59%

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Outcome and Prognostic Factors of Pediatric Encephalitis in Thailand

Saengow,

Praphaphanthasak

2024

Journal of Child Science

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Encephalitis, a severe central nervous system infection, poses significant morbidity and mortality risks. Etiologically, this condition can arise from infections or immune-mediated mechanisms, with varying causative agents across regions. Despite limited studies on pediatric encephalitis in Thailand, our retrospective cohort study aimed to discern the characteristics, outcomes, and prognostic factors influencing clinical results. We examined patients under 15 years of age admitted to Maharat Nakhon Ratchasima Hospital from January 1, 2007 to December 31, 2022, recording baseline data encompassing clinical manifestations, etiology, investigations, and treatments. The study defined outcomes in terms of morbidity, subsequent epilepsy incidence, and mortality rates evaluated via the modified Rankin Scale. Among 183 enrolled patients (age range 5 days to 15 years, mean age 7.4 years), males comprised 54.1%. Viral encephalitis (35.52%) and immune-mediated encephalitis (22.4%) emerged as the prevailing etiologies, with herpes simplex, dengue, and influenza virus as prominent viral pathogens. Anti-N-methyl-D-aspartame receptor encephalitis (56.1%) led among immune-mediated cases. Initially, 94.53% of patients displayed moderate-to-severe disability, while 45.7% exhibited clinical improvement within 6 months. Subsequent epilepsy ensued in 38.8% of cases, with an overall mortality rate of 19%, notably higher in viral encephalitis instances. Our findings underscore a predilection for viral pathogens in pediatric encephalitis cases, contributing to inferior prognoses. This study accentuates the necessity of understanding etiological patterns and prognostic markers to enhance clinical outcomes in this vulnerable population segment.

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Section: Discussionmentioning

confidence: 59%

“…Previous studies have demonstrated that viral encephalitis etiology is linked to a worse prognosis, influencing patient outcomes. 19 20 21 22 23…”

Section: Discussionmentioning

confidence: 99%

Outcome and Prognostic Factors of Pediatric Encephalitis in Thailand

Saengow,

Praphaphanthasak

2024

Journal of Child Science

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“…This is the largest study evaluating severe encephalitis in a PICU. In comparison to population-based observational studies,11 we were able to collect detailed aetiological information not only on encephalitis but also on its main differential diagnoses.…”

Section: Discussionmentioning

confidence: 99%

“…The burden of encephalitis is still substantial, with neurological impairment in over 50% of cases,9 10 and death in 10% 3 11…”

Section: Introductionmentioning

confidence: 99%

Severe encephalitis: aetiology, management and outcomes over 10 years in a paediatric intensive care unit

Palmas¹,

Duke²

2023

Arch Dis Child

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ObjectiveTo describe the characteristics, differential diagnoses, management and outcomes of severe encephalitis in children.DesignA 10-year retrospective cohort study in children admitted to a tertiary paediatric intensive care unit (PICU) with suspected encephalitis. One to 6 months’ follow-up data were compared between different categories.ParticipantsPatients from 0 to 17 years of age with acute encephalopathy and one or more of fever, seizure, focal neurological findings, cerebrospinal fluid abnormalities, EEG/neuroimaging consistent with encephalitis.Main outcome measuresEpidemiology, clinical features, outcomes and risk factor analysis.Results175 children with encephalitis required intensive care unit (ICU) admission over 10 years. The median age was 4.5 months (IQR 1.6–54.8). The leading cause was enterovirus (n=49, 28%), followed by parechovirus, influenza, herpes simplex virus (HSV), human herpesvirus-6 (HHV-6),Streptococcus pneumoniae, acute-disseminated encephalomyelitis and anti-N-methyl-D-aspartate-receptor-associated encephalitis. Immune-mediated encephalitis had higher prevalence in females, older age and longer duration of encephalopathy. Mechanical ventilation was required by 74 children (42%); haemodynamic support by 28 children (16%), 3 received extracorporeal membrane oxygenation (ECMO) support. Eleven patients died (case fatality rate 6.3%): five with HHV-6, two enterovirus, two influenza, one HSV, one human-metapneumovirus. At follow-up, 34 children had mild or moderate disability, and six severe disability. In a multivariable logistic regression model, three factors were associated with severe disability or death: age <2 years old (OR 8.2, CI 1.0 to 67.2), Herpesviridae aetiology (OR 14.5, CI 1.2 to 177.3) and length of intubation (OR 1.005, CI 1.00 to 1.01).ConclusionsEncephalitis has a varied aetiology and causes death or severe disability in 1 in every 10 children requiring intensive care.

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“…An estimated 4 to 10 children per 100,000 are hospitalized with encephalitis every year (2)(3)(4) and it is associated with mortality rates of 2 to 31% (5)(6)(7). In a retrospective analysis of encephalitis cases in England and Wales in children, the annual mortality rate was 0.07 (95% CI: 0.05-0.08) per 100,000 population aged between 0-17 years (8). Amongst 7,298 children in the United States admitted with encephalitis between 2004 and 2013, 2,933 patients (40%) required treatment in a paediatric intensive care unit, and had an overall median length of hospital stay of 16 days (4).…”

Section: Introductionmentioning

confidence: 99%

A Cost of Illness Analysis of Children with Encephalitis Presenting to A Major Hospital in Vietnam

Huong,

Toan,

Khanh

et al. 2024

Preprint

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Background . Encephalitis is a significant global health problem, especially in children. Knowledge of its economic burden is essential for policymakers in prioritizing the development and implementation of interventions but remains limited. Methods . An observational study was prospectively conducted at a major children’s hospital in Ho Chi Minh City, Vietnam, from 2020 to 2022. Data on direct medical costs, direct non-medical costs and productivity costs were collected alongside demographic information, clinical features, diagnosis, severity, and outcomes of study participants. This was used to undertake a cost of illness analysis from a societal perspective. Results . Data were collected from a total of 164 pediatric patients. The mean cost of illness per case was estimated at US$2,820.43 (95% confidence interval (CI), US$2,431.96–US$3,208.91), of which productivity costs accounted for US$434.04 (95% CI, US$362.48–US$505.60). The direct costs were the main cost driver, accounting for 84.6% of the total cost of illness (US$2,386.38 (95%CI: US$2,033.91–US$2,738.85)). The cost of illness was higher in more severe patients, patients with sequelae, and ventilated patients. On average 51.8% of direct medical costs attributed to hospitalisation (US$960.09) resulted in out-of-pocket payments from the patient’s family. Conclusions . The results showed that the cost of illness of encephalitis in children is considerable. The results will be useful for policymakers in prioritizing resources for the development and implementation of intervention strategies to reduce the burden of pediatric encephalitis.

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

Cited by 3 publications

References 13 publications

Outcome and Prognostic Factors of Pediatric Encephalitis in Thailand

Outcome and Prognostic Factors of Pediatric Encephalitis in Thailand

Severe encephalitis: aetiology, management and outcomes over 10 years in a paediatric intensive care unit

A Cost of Illness Analysis of Children with Encephalitis Presenting to A Major Hospital in Vietnam

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