Outbreak of brainstem encephalitis associated with enterovirus-A71 in Catalonia, Spain (2016): a clinical observational study in a children's reference centre in Catalonia

被引:57
作者
Casas-Alba, D. [1 ]
de Sevilla, M. F. [1 ,2 ,3 ]
Valero-Rello, A. [2 ,4 ]
Fortuny, C. [1 ,2 ,3 ]
Garcia-Garcia, J. -J. [1 ,2 ,3 ]
Ortez, C. [5 ]
Muchart, J. [6 ]
Armangue, T. [5 ]
Jordan, I. [2 ,3 ,7 ]
Luaces, C. [8 ]
Barrabeig, I. [9 ]
Gonzalez-Sanz, R. [10 ]
Cabrerizo, M. [10 ]
Munoz-Almagro, C. [2 ,3 ,8 ,11 ]
Launes, C. [1 ,2 ,3 ]
机构
[1] Univ Barcelona, Hosp St Joan de Deu, Dept Paediat, Barcelona, Spain
[2] Inst Recerca St Joan de Deu, Paediat Infect Dis Res Grp, Esplugas de Llobregat, Spain
[3] CIBERESP, CIBER Epidemiol & Salud Publ, Madrid, Spain
[4] Hosp St Joan de Deu, Dept Mol Microbiol, Esplugas de Llobregat, Spain
[5] Univ Barcelona, Hosp St Joan de Deu, Dept Paediat Neurol, Barcelona, Spain
[6] Univ Barcelona, Hosp St Joan de Deu, Dept Diagnost Imaging, Barcelona, Spain
[7] Univ Barcelona, Hosp St Joan de Deu, Paediat Intens Care Unit, Barcelona, Spain
[8] Univ Barcelona, Hosp St Joan de Deu, Emergency Dept, Barcelona, Spain
[9] Publ Hlth Agcy Catalonia, Barcelona South, Epidemiol Surveillance Unit Hlth Reg, Lhospitalet De Llobregat, Spain
[10] Inst Publ Hlth Carlos III, Natl Ctr Microbiol, Enterovirus Unit, Madrid, Spain
[11] Univ Int Catalunya, Sch Med, Barcelona, Spain
关键词
Brainstem; Encephalitis; Enterovirus; EV-A71; Molecular epidemiology; Types; MR-IMAGING FINDINGS; MOUTH-DISEASE; MOLECULAR EPIDEMIOLOGY; PULMONARY-EDEMA; NERVOUS-SYSTEM; RISK-FACTORS; SEVERE HAND; FOOT; INFECTION; MANAGEMENT;
D O I
10.1016/j.cmi.2017.03.016
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Objectives: To describe the characteristics of an outbreak of brainstem encephalitis and encephalomyelitis related to enterovirus (EV) infection in Catalonia (Spain), a setting in which these manifestations were uncommon. Methods: Clinical and microbiological data were analysed from patients with neurological symptoms associated with EV detection admitted to a reference paediatric hospital between April and June 2016. Results: Fifty-seven patients were included. Median age was 27.7 months (p25-p75 17.1-37.6). Forty-one (72%) were diagnosed with brainstem encephalitis, seven (12%) with aseptic meningitis, six (11%) with encephalitis, and three (5%) with encephalomyelitis (two out of three with cardiopulmonary failure). Fever, lethargy, and myoclonic jerks were the most common symptoms. Age younger than 12 months, higher white-blood-cell count, and higher procalcitonin levels were associated with cardiopulmonary failure. Using a PAN-EV real-time PCR, EV was detected in faeces and/or nasopharyngeal aspirate in all the patients, but it was found in cerebrospinal fluid only in patients with aseptic meningitis. EV was genotyped in 47 out of 57 and EV-A71 was identified in 40 out of 47, being the only EV type found in patients with brainstem symptoms. Most of the detected EV-A71 strains were subgenogroup C1. Intravenous immunoglobulins were used in 34 patients. Eight cases (14%) were admitted to the intensive care unit. All the patients but three, those with encephalomyelitis, showed a good clinical course and had no significant sequelae. No deaths occurred. Conclusions: The 2016 outbreak of brainstem encephalitis in Catalonia was associated with EV-A71 subgenogroup C1. Despite the clinical manifestations of serious disease, a favourable outcome was observed in the majority of patients. (C) 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:874 / 881
页数:8
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