Neonatal parechovirus leucoencephalitis- radiological pattern mimicking hypoxic-ischemic encephalopathy

Amarnath, Chandramouli; Mary, T. Helen; Periakarupan, A.; Kathirvelu, Gopinathan; Philson, J.

doi:10.1016/j.ejrad.2015.11.038

Cited by 32 publications

(23 citation statements)

References 17 publications

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“…However, 82% of children imaged with MRI had white matter abnormalities, indicating acute brain injury. The MRI appearances found were similar to those previously described, with a predominance of white matter lesions . The long‐term prognosis in these children is uncertain, and adverse neurodevelopmental outcomes have been described, including within this cohort .…”

Section: Discussionsupporting

confidence: 81%

Paediatric intensive care admissions during the 2015–2016 Queensland human parechovirus outbreak

McKenna

Joseph

Sargent

et al. 2019

J Paediatrics Child Health

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Aim: The human parechovirus (HPeV) has emerged as a pathogen causing sepsis-like presentations in young infants, but there is a lack of data on HPeV presentations requiring intensive care support. We aimed to characterise the clinical presentation, disease severity, management and outcome of a population-based cohort of children with microbiologically confirmed HPeV infection requiring admission to paediatric intensive care units (PICUs) in Queensland, Australia during a recent outbreak. Methods: This was a multicentre retrospective study of children admitted to PICU between 1 January 2015 and 31 December 2016 with confirmed HPeV infection. Results: Thirty infants (median age 20 days) with HPeV genotype 3 were admitted to PICU, representing 16% of all children with HPeV admitted to hospital and 6.4% of non-elective PICU admissions in children <1 year of age. Children requiring PICU admission were younger than children admitted to hospital (P = 0.001). Apnoea, haemodynamic instability with tachycardia and seizures represented the main reasons for PICU admission. Eleven children (37%) required mechanical ventilation for a median duration of 62 h, 22 (73%) received fluid boluses and 7 (23%) were treated with vasoactive agents for a median duration of 53 h. Median length of stay was 2.62 days. A total of 24 children (80%) fulfilled sepsis criteria, 14 (47%) severe sepsis and 7 (23%) septic shock criteria. Eight (27%) had abnormal brain magnetic resonance imaging. No patient died. Conclusions: We confirm that HPeV infection is an important cause of sepsis-like syndrome in infants with substantial associated morbidity. Optimal management and long-term outcomes require further investigation.

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Section: Discussionsupporting

confidence: 81%

Paediatric intensive care admissions during the 2015–2016 Queensland human parechovirus outbreak

McKenna

Joseph

Sargent

et al. 2019

J Paediatrics Child Health

View full text Add to dashboard Cite

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“…More recent attention has been focused on the development of white matter damage in young infants (11,(110)(111)(112). HPeV white matter lesions are indistinguishable from those reported for enterovirus infections and hypoxic-ischemic encephalopathy and vary from diffuse signal intensity changes and punctate white matter lesions to cysts within the white matter (79,(110)(111)(112). In a study of 19 young infants with severe HPeV infections, intracranial hemorrhage was detected by ultrasound in three preterm neonates (81).…”

Section: Central Nervous Systemmentioning

confidence: 99%

Human Parechovirus: an Increasingly Recognized Cause of Sepsis-Like Illness in Young Infants

2018

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Human parechovirus (HPeV) is increasingly being recognized as a potentially severe viral infection in neonates and young infants. HPeV belongs to the family and is currently divided into 19 genotypes. HPeV-1 is the most prevalent genotype and most commonly causes gastrointestinal and respiratory disease. HPeV-3 is clinically the most important genotype due to its association with severe disease in younger infants, which may partly be explained by its distinct virological properties. In young infants, the typical clinical presentation includes fever, severe irritability, and rash, often leading to descriptions of "hot, red, angry babies." Infants with severe central nervous system (CNS) infections are at an increased risk of long-term sequelae. Considering the importance of HPeV as a cause of severe viral infections in young infants, we recommend that molecular diagnostic techniques for early detection be included in the standard practice for the investigation of sepsis-like illnesses and CNS infections in this age group.

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“…33,34 Other infectious encephalitides, such as equine viral encephalitis and neonatal leukoencephalitis due to parechovirus, also have distinctive imaging characteristics. 35,36 In ADEM, the presence of MRI abnormalities strongly supports the diagnosis and constitutes a part of the diagnostic criteria. 6 Patients with ADEM frequently develop extensive, diffuse white matter lesions, often with involvement of the deep gray matter structures, such as the basal ganglia or thalami.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 91%

Autoimmune Encephalitis in Children

Armangué

2017

J Pediatr Neurol

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The causes of encephalitis are numerous, and extensive investigations for infectious agents and other etiologies are often negative. The discovery that many of these encephalitis are immune mediated has changed the approach to the diagnosis and treatment of these disorders. Moreover, the broad spectrum of symptoms including, psychosis, catatonia, alterations of behavior and memory, seizures, abnormal movements, and autonomic dysregulation usually requires a multidisciplinary treatment approach. This review focuses in several forms of encephalitis that occur in children, and for which an autoimmune etiology has been demonstrated (eg, anti-Nmethyl-D-aspartate receptor encephalitis) or is strongly suspected (eg, Rasmussen encephalitis, limbic encephalitis, opsoclonus-myoclonus). The authors also review several disorders that may be immune mediated, such as the rapid onset obesity with hypothalamic dysfunction, hypoventilation and autonomic dysregulation (ROHHAD) syndrome and some encephalopathies with fever and status epilepticus. Recognition of novel immune-mediated encephalitis is important because some of these disorders are highly responsive to immunotherapy. Keywords autoimmune; encephalitis; limbic; anti-NMDA receptor; NMDA Encephalitis refers to an inflammatory disorder of the brain resulting in altered mental status, seizures, or focal neurologic deficits, usually accompanied by signs of inflammation in the cerebrospinal fluid and magnetic resonance imaging (MRI) findings ranging from normal to extensive abnormalities. The causes of encephalitis are numerous, and most patients undergo extensive testing for infectious etiologies without discovery of a causative agent. A study by the California Encephalitis Project, a center focused in the epidemiology and etiology of encephalitis, found that 63% of the patients remained without an etiology after a battery of tests for 16 potential infectious agents. 1 The recent discovery that several

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Neonatal parechovirus leucoencephalitis- radiological pattern mimicking hypoxic-ischemic encephalopathy

Cited by 32 publications

References 17 publications

Paediatric intensive care admissions during the 2015–2016 Queensland human parechovirus outbreak

Paediatric intensive care admissions during the 2015–2016 Queensland human parechovirus outbreak

Human Parechovirus: an Increasingly Recognized Cause of Sepsis-Like Illness in Young Infants

Autoimmune Encephalitis in Children

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