Affiliation:
1. Departments of Nursing
2. Emergency Medicine
3. Occupational Therapy
4. Pediatrics, National Cheng Kung University and Hospital, Tainan, Taiwan
Abstract
OBJECTIVES. Several large outbreaks of enterovirus 71 infections have occurred in Taiwan during the past decade. Brainstem encephalitis was the most common neurologic complication. This study was designed to determine the long-term cognitive and motor outcomes of children with enterovirus 71 brainstem encephalitis.
METHODS. We conducted a prospective follow-up study of children who met the case definition for enterovirus 71 brainstem encephalitis. Subjects were stratified into isolated brainstem encephalitis (stage II), autonomic nervous system dysregulation (stage IIIa), and pulmonary edema (stage IIIb). The subjects and their parents or guardians were interviewed using structured questionnaires and received comprehensive cognitive and neurologic examinations. Motor coordination, visual-motor skill, and intellectual ability were evaluated.
RESULTS. Follow-up studies were conducted in 63 previously healthy children with enterovirus 71 brainstem encephalitis (49 stage II, 7 stage IIIa, and 7 stage IIIb). The mean time to follow-up was 2.8 ± 1.0 years (range: 1.4–4.9 years). Boys outnumbered girls by 3 to 2. The mean age at diagnosis was 2.4 ± 1.4 years (range: 0.3–7.1 years). The most common abnormal neurologic findings on admission were altered consciousness (47.6%), followed by abnormal activities of daily living (52.4%), cerebellar dysfunction (17.5%), and cranial nerve palsy (15.9%). At follow-up, 51 of 63 children had no detectable deficits. Among the remaining 12 children, 3 died during the follow-up. The remaining 9 children (14.3%) had residual deficits. Two of these with stage IIIb disease continued to have severe motor and respiratory failure.
CONCLUSIONS. Residual defects were still present in a significant proportion of children with enterovirus 71 brainstem encephalitis at >2 years after their hospitalization. Children with stage II disease were most likely to have residual cerebellar defects. Those with stage IIIb disease continued to have severe respiratory and motor impairment. Long-term follow-up of this cohort is needed to determine the ultimate prognosis.
Publisher
American Academy of Pediatrics (AAP)
Subject
Pediatrics, Perinatology, and Child Health
Reference22 articles.
1. Cherry JD. Enteroviruses: Polioviruses (poliomyelitis), coxsackievirus, echoviruses, and enteroviruses. In: Feign RD, Cherry JD, eds. Textbook of Pediatric Infectious Diseases. 5th ed. Philadelphia, PA: Saunders; 2004:1984–2027
2. Schmidt NJ, Lennett EH, Ho HH. An apparently new enterovirus isolated from patients with disease of central nervous system. J Infect Dis. 1974;129:304–309
3. Nagy G, Takatsy S, Kukan E, Mihaly I, Domok I. Virological diagnosis of enterovirus type 71 infections: experiences gained during an epidemic of acute CNS diseases in Hungary in 1978. Arch Virol. 1982;71:217–227
4. Melnick JL, Schmidt NJ, Mirkovic RR, Chumakov MP, Lavrova IK, Voroshiloba MK. Identification of Bulgarian strain 258 of enterovirus 71. Intervirology. 1980;12:297–302
5. Lum LCS, Wong KT, Lam SK, et al. Fatal enterovirus 71 encephalomyelitis. J Pediatr. 1998;133:795–798
Cited by
81 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献