Febrile status epilepticus due to respiratory syncytial virus infection

Uda, Kazuhiro; Kitazawa, Katsuhiko

doi:10.1111/ped.13300

Cited by 12 publications

(9 citation statements)

References 32 publications

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“…The olfactory receptor (OR13C5) gene is also involved in RSV pathogenicity, since the olfactory nerve connects the nasal cavity with the central nervous system and thus could be used as a shortcut by RSV (136). This could explain neurological symptoms produced by RSV such as encephalitis, apnea, or seizures, that occur in at least 2% of RSV-infected people (137, 138), and likely cause serious and permanent neurological sequelae (139). SNPs in human leukocyte antigen (HLA) HLA-DQA1 and in HLA-DPB1 genes have been associated with the development of bronchiolitis and several types of asthma (140–142).…”

Section: Host Components Contributing To Rsv Pathogenesismentioning

confidence: 99%

Host Components Contributing to Respiratory Syncytial Virus Pathogenesis

et al. 2019

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Respiratory syncytial virus (RSV) is the most prevalent viral etiological agent of acute respiratory tract infection. Although RSV affects people of all ages, the disease is more severe in infants and causes significant morbidity and hospitalization in young children and in the elderly. Host factors, including an immature immune system in infants, low lymphocyte levels in patients under 5 years old, and low levels of RSV-specific neutralizing antibodies in the blood of adults over 65 years of age, can explain the high susceptibility to RSV infection in these populations. Other host factors that correlate with severe RSV disease include high concentrations of proinflammatory cytokines such as interleukins (IL)-6, IL-8, tumor necrosis factor (TNF)-α, and thymic stromal lymphopoitein (TSLP), which are produced in the respiratory tract of RSV-infected individuals, accompanied by a strong neutrophil response. In addition, data from studies of RSV infections in humans and in animal models revealed that this virus suppresses adaptive immune responses that could eliminate it from the respiratory tract. Here, we examine host factors that contribute to RSV pathogenesis based on an exhaustive review of in vitro infection in humans and in animal models to provide insights into the design of vaccines and therapeutic tools that could prevent diseases caused by RSV.

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Section: Host Components Contributing To Rsv Pathogenesismentioning

confidence: 99%

Host Components Contributing to Respiratory Syncytial Virus Pathogenesis

et al. 2019

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“…The seven studies that were not suitable for prevalence‐of‐intubation pooling had cohorts that consisted entirely of those that were intubated, making a calculation of prevalence impossible . A comprehensive listing of the 46 articles with a description of study characteristics, prevalence‐bias assessment, and intubation prevalence are shown in Table S1 …”

Section: Resultsmentioning

confidence: 99%

Review article: Emergency endotracheal intubation in non‐traumatic brain pathologies: A systematic review and meta‐analysis

Fouche

Stein

Jennings

et al. 2019

Emerg Medicine Australasia

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Endotracheal intubation is an advanced airway procedure performed in the ED and the out-ofhospital setting for acquired brain injuries that include non-traumatic brain pathologies such as stroke, encephalopathies, seizures and toxidromes. Controlled trial evidence supports intubation in traumatic brain injuries, but it is not clear that this evidence can be applied to nontraumatic brain pathologies. We sought to analyse the impact of emergency intubation on survival in non-traumatic brain pathologies and also to quantify the prevalence of intubation in these pathologies. We conducted a systematic literature search of Medline, Embase and the Cochrane Library. Eligibility, data extraction and assessment of risk of bias were assessed independently by two reviewers. A bias-adjusted metaanalysis using a quality-effects model pooled prevalence of intubation in non-traumatic brain pathologies. Forty-six studies were included in this systematic review. No studies were suitable for meta-analysis the primary outcome of survival. Thirtynine studies reported the prevalence of intubation in non-traumatic brain pathologies and a meta-analysis showed that emergency intubation was used in 12% (95% CI 0-33) of pathologies. Endotracheal intubation was used commonly in haemorrhagic stroke 79% (95% CI 47-100) and to a lesser extent for seizures 18% (95% CI 10-27) and toxidromes 25% (95% CI 6-48). This systematic review shows that there is no high-quality clinical evidence to support or refute emergency intubation in non-traumatic brain pathologies. Our analysis shows that intubation is commonly used in non-traumatic brain pathologies, and the need for rigorous evidence is apparent.

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“…They authors reported the cases of 9 patients, of which 4 (44%) were complicated by cardiac arrest, and 2 of the patients died [5]. Uda and Kitazawa [8] reported that the RSV-positive status epilepticus group required more ventilator care and antiepileptic drug treatment than did the RSV-negative status epilepticus group, and nearly one-third of them developed encephalopathy and profound neurological sequelae. In the present study, encephalopathy with seizure was rare and observed in only one patient.…”

Section: Discussionmentioning

confidence: 99%

“…As in other common viral infections, RSV may be associated with neurological manifestations, including seizures, encephalopathy, extraocular movement disorder, and central apnea [3-8]. Although the pathogenesis of the neurologic complications are not fully understood, the possible contributions of immune-related cytokine responses, less well-proven direct invasion of virus particles, and brain stem-related mechanisms for respiratory control have been recognized [3,5,9-11].…”

Section: Introductionmentioning

confidence: 99%

Respiratory syncytial virus-associated seizures in Korean children, 2011–2016

Cha

Choi

et al. 2019

Korean J Pediatr

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Purpose Respiratory syncytial virus (RSV) infection can cause various neurological complications. This study aimed to investigate the RSV-associated neurologic manifestations that present with seizures. Methods We retrospectively reviewed the medical records of patients aged less than 15 years with laboratory-confirmed RSV infections and seizures between January 2011 and December 2016 in a regional hospital in South Korea. Results During this period, 1,193 patients with laboratory-confirmed RSV infection were identified. Of these, 35 (35 of 1,193, 2.93%; boys, 19; girls, 16; mean age: 20.8±16.6 months) presented with seizure. Febrile seizure was the most common diagnosis (27 of 35, 77.1%); simple febrile seizures in 13 patients (13 of 27, 48.1%) and complex febrile seizures in 14 (14 of 27, 51.9%). Afebrile seizures without meningitis or encephalopathy were observed in 5 patients (5 of 35, 14.3%), seizures with meningitis in 2 (2 of 35, 5.7%), and seizure with encephalopathy in 1 (1 of 35, 2.9%) patient. Lower respiratory symptoms were not observed in 8 patients. In a patient with encephalopathy, brain diffusion-weighted magnetic resonance imaging revealed transient changes in white matter, suggesting cytotoxic edema as the mechanism underlying encephalopathy. Most patients recovered with general management, and progression to epilepsy was noted in only 1 patient. Conclusion Although febrile seizures are the most common type of seizure associated with RSV infection, the proportion of patients with complex febrile seizures was higher than that of those with general febrile seizures. Transient cytotoxic edema may be a pathogenic mechanism in RSV-related encephalopathy with seizures.

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Febrile status epilepticus due to respiratory syncytial virus infection

Abstract: RSV infection in the absence of bronchiolitis can initially present as febrile status epilepticus and subsequently develop into acute encephalopathy with profound neurological sequelae.

Cited by 12 publications

References 32 publications

Host Components Contributing to Respiratory Syncytial Virus Pathogenesis

Host Components Contributing to Respiratory Syncytial Virus Pathogenesis

Review article: Emergency endotracheal intubation in non‐traumatic brain pathologies: A systematic review and meta‐analysis

Respiratory syncytial virus-associated seizures in Korean children, 2011–2016

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