Understanding the etiology and epidemiology of meningitis and encephalitis: now and into the future

Redenbaugh, Vyanka; Flanagan, Eoin P.

doi:10.1016/j.lanwpc.2021.100380

Cited by 4 publications

(3 citation statements)

References 9 publications

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“… 21 Therefore, active suspicion and testing for autoimmune encephalitis are necessary in Korean children with encephalitis. 21 22 …”

Section: Discussionmentioning

confidence: 99%

Aetiology and Prognosis of Encephalitis in Korean Children: A Retrospective Single-Centre Study, 2005–2020

Kim,

Baek

et al. 2024

Yonsei Med J

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Purpose Encephalitis is a heterogeneous syndrome that occurs in childhood and is not rare. However, epidemiological studies of encephalitis based on the International Encephalitis Consortium (ICS) and expert recommendations are lacking. We investigated the aetiology and prognosis of encephalitis in Korean children. Materials and Methods This retrospective study included children aged <19 years hospitalised for encephalitis at Severance Children’s Hospital between 2005 and 2020. The 2013 ICS criteria were used to diagnose encephalitis, and causality was classified according to the site from which the specimen was obtained. Neurological sequelae were categorised using the modified Rankin Scale (mRS) score. Results In total, 551 children were included, with 7% classified as possible, 77% as probable, and 15% as proven cases. A cause was identified in 42% of the cases (n=222), with viruses being the most common (42%), followed by bacteria (38%) and autoimmune encephalitis (12%). In cases of proven/probable encephalitis (n=65), bacteria accounted for 52%, followed by viruses (25%) and autoimmune encephalitis (22%). In cases with a single pathogen, the anti-N-methyl-D-aspartate receptor autoantibody (n=14) was the most common, followed by Group B streptococcus (n=13), herpes simplex virus (n=11), enterovirus (n=4), and others. Approximately 37% of patients had severe sequelae (mRS score ≥3) at discharge, which decreased to 31% 6 months after discharge. Conclusion This large-scale study showed that autoimmune and infectious causes accounted for a significant proportion of encephalitis in Korean children. Further studies are needed to determine whether early targeted treatment following early diagnosis leads to a favourable prognosis in these populations.

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“… 21 Therefore, active suspicion and testing for autoimmune encephalitis are necessary in Korean children with encephalitis. 21 22 …”

Section: Discussionmentioning

confidence: 99%

Aetiology and Prognosis of Encephalitis in Korean Children: A Retrospective Single-Centre Study, 2005–2020

Kim,

Baek

et al. 2024

Yonsei Med J

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“…Acute viral encephalitis is far from being a rare occurrence. According to the Centers for Disease Control and Prevention (CDC), approximately 20,000 cases of acute viral encephalitis are reported annually in the United States alone, with a case fatality ratio (CFR) ranging between 5 and 20% [63], 7.3 encephalitis hospitalizations per 100,000 people from 2000 to 2010 [63,64], and with around half of incident cases that do not reach a definitive diagnosis [64][65][66][67]. Although rare, BoDV-1 encephalitis was characterized as a very severe condition.…”

Section: Summary Of Main Findingsmentioning

confidence: 99%

“…Despite the overall features of human BoDV-1 encephalitis, we were able to describe a severe clinical condition, with progressive loss of consciousness and coma, with the eventual death of affected patients within 4 to 10 weeks since the onset of clinical symptoms, and no specific features could be reconciled with BoDV-1 infection. In most reported cases, the onset of BoDV-1 (meningo)encephalitis was associated with very common, unspecific features, such as an influenza-like illness, fever > 38 • , and headache, a typical presentation for viral (meningo)encephalitis [63][64][65][66][67]. Cases of BoDV-1 encephalitis were then associated with a quite heterogeneous combination of signs and symptoms, including (but not limited to) convulsions, delirium, confusion, stupor or coma, aphasia or mutism, hemiparesis with asymmetry of tendon reflexes and Babinski sign, involuntary movements, ataxia and myoclonic jerks, nystagmus, ocular palsies, and facial weakness.…”

Section: Summary Of Clinical Featuresmentioning

confidence: 99%

Clinical Features of BoDV-1 Encephalitis: A Systematic Review

Riccò,

Corrado,

Marchesi

et al. 2023

Zoonotic Diseases

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Human cases of fatal encephalitis caused by Borna disease virus 1 (BoDV-1) have been increasingly reported. We envisaged the present systematic review in order to provide a comprehensive summary of clinical features associated with BoDV-1 encephalitis. Systematic research of four databases (PubMed, EMBASE, MedRxiv, BioRxiv) was performed during July 2023, and corresponding clinical and epidemiological data were collected and analyzed. A total of 37 BoDV-1 encephalitis cases from 15 different study cases and two countries (Germany, No. 35; France, No. 2) were detected, and their features were summarized (case fatality ratio, 91.9%). Age distribution followed a “U-shaped” distribution, with a first peak in individuals younger than 14 years (18.9%) and the second one in subjects older than 50 years (43.2%). Environmental risk factors were irregularly reported, but 17 out of 37 cases either lived in rural areas or reported repeated outdoor activities (45.9%). Interaction with pets and livestock was reported in eight cases (21.6%), stressing the zoonotic potential of BoDV-1 infections. Moreover, 16.2% of cases were reported among recipients of solid organ transplantations (five kidneys; one liver). Overall survival in children/adolescents vs. adults (≥18 years) was not significantly different (Hazard Ratio 0.878; 95% Confidence Interval from 0.366 to 2.105). Magnetic Resonance Imaging identified the involvement of basal ganglia, mostly of the caudate nucleus (42.4%) and thalamus (33.3%). Cerebrospinal fluid was often characterized by pleocytosis (78.4%). On the other hand, no distinctive clinical features were identified: initial symptoms were specific and included headache, fever, and confusion. In conclusion, BoDV-1 infection can result in fatal encephalitis, whose actual burden still remains unascertained. As the epidemiology of BoDV-1 is similarly elusive, encephalitis cases of unclear cause should be routinely tested for bornaviruses.

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Diagnostic performance of metagenomic next-generation sequencing for the detection of pathogens in cerebrospinal fluid in pediatric patients with central nervous system infection: a systematic review and meta-analysis

He,

Xiong,

et al. 2024

BMC Infect Dis

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Background Detecting pathogens in pediatric central nervous system infection (CNSI) is still a major challenge in medicine. In addition to conventional diagnostic patterns, metagenomic next-generation sequencing (mNGS) shows great potential in pathogen detection. Therefore, we systematically evaluated the diagnostic performance of mNGS in cerebrospinal fluid (CSF) in pediatric patients with CNSI. Methods Related literature was searched in the Web of Science, PubMed, Embase, and Cochrane Library. We screened the literature and extracted the data according to the selection criteria. The quality of included studies was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool and the certainty of the evidence was measured by the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) score system. Then, the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odd’s ratio (DOR), and area under the curve (AUC) of the summary receiver operating characteristic curve (sROC) were estimated in Stata Software and MetaDisc. Subgroup analyses were performed to investigate the potential factors that influence the diagnostic performance. Results A total of 10 studies were included in the meta-analysis. The combined sensitivity was 0.68 (95% confidence interval [CI]: 0.59 to 0.76, I2 = 66.77%, p < 0.001), and the combined specificity was 0.89 (95% CI: 0.80 to 0.95, I2 = 83.37%, p < 0.001). The AUC of sROC was 0.85 (95% CI, 0.81 to 0.87). The quality level of evidence elevated by the GRADE score system was low. Conclusions Current evidence shows that mNGS presents a good diagnostic performance in pediatric CNSI. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.

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Understanding the etiology and epidemiology of meningitis and encephalitis: now and into the future

Cited by 4 publications

References 9 publications

Aetiology and Prognosis of Encephalitis in Korean Children: A Retrospective Single-Centre Study, 2005–2020

Aetiology and Prognosis of Encephalitis in Korean Children: A Retrospective Single-Centre Study, 2005–2020

Clinical Features of BoDV-1 Encephalitis: A Systematic Review

Diagnostic performance of metagenomic next-generation sequencing for the detection of pathogens in cerebrospinal fluid in pediatric patients with central nervous system infection: a systematic review and meta-analysis

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