Clinical features and factors of unfavorable outcomes for non-polio enterovirus infection of the central nervous system in northern Taiwan, 1994-2003
Tsou-Tong Yang, Li-Min Huang, Chun-Yi Lu, Chuan-Liang Kao, Wang-Tso Lee, Ping-Ing Lee, Chun-Min Chen, Fu-Yuan Huang, Chin-Yun Lee, Luan-Yin Chang
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei; Department and Graduate Institute of Medical Technology, College of Medicine, National Taiwan University, Taipei; and Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
Received: June 21, 2005 Revised: July 25, 2005 Accepted: August 28, 2005
This study investigated the clinical manifestations and outcomes of central nervous system (CNS) infection by enteroviruses. Cases with CNS involvement among all enterovirus-culture-positive cases from January 1995 to June 2003 were retrospectively reviewed. Among 1028 enterovirus-culture-positive cases, there were 333 cases involving the CNS. Of these, the ratio of male to female subjects was 1.78, and the mean (± standard deviation) age was 6.83 ± 5.9 years; 21 were premature neonates, and 10 failed to thrive. Disease entities included 282 cases of aseptic meningitis (84.7%), 44 cases of encephalitis (13.2%), and 7 cases of encephalomyelitis/polio-like syndrome (2.1%). Of these cases, 97.9% (326/333) had fever with peak body temperature at 38.9ºC, 85% had headache and vomiting, 70% had meningeal signs, 64% had neck stiffness, 16.6% (55/333) had change of consciousness, 5.4% (18/333) had seizures and 5.2% (17/333) had myoclonic jerks. Mannitol was administered in 77.2% of patients (257/333), along with intravenous immunoglobulin in 6.6% (22/333). Twelve cases received ventilator support. One patient died of hand-foot-and-mouth disease, encephalitis plus cardiopulmonary failure, and 2 premature neonates died of hepatic failure, disseminated intravascular coagulation, sepsis-like syndrome and myocarditis. Eighteen had neurologic sequelae, including 7 with limb weakness, 5 with epilepsy, 2 with sixth cranial nerve palsy, 3 with cerebral palsy, 4 with psychomotor retardation, 2 with spasticity, and 1 with hearing loss. Factors associated with unfavorable outcomes (death or sequelae) included younger age (p=0.0003), higher peak white blood cell count (WBC) [p=0.0009] and skin rash (p=0.005). Younger age and higher peak WBC were poor prognostic factors of severe enterovirus CNS infection. Death was related to neonatal enterovirus infection and enterovirus 71 infection in young children.
Central nervous system viral infection, enterovirus, pulmonary edema, risk factors, viral encephalitis, viral meningitis
J Microbiol Immunol Infect 2005;38:417-424.