Background

Adenovirus is a major pathogen causing febrile illness among children. It may also cause acute encephalitis/encephalopathy. This study aimed to elucidate the clinical features of adenovirus-associated encephalitis/encephalopathy (AdVE) among children in Japan.

Methods

A nationwide survey of children with AdVE was conducted. An initial survey was distributed among pediatricians to obtain information about children with AdVE treated between January 2014 and March 2019. A second survey was used to obtain the clinical information of children with AdVE from hospitals that responded to the initial survey and those identified from a literature search of the reported cases. We collected demographic data and information about symptoms of infection, neurological symptoms, laboratory parameters, treatment, and outcomes. Outcomes were determined using the Pediatric Cerebral Performance Category Score.

Results

Clinical information was available for 23 children with a median age of 39 months. Two had preexisting neurological disorders and six had a history of febrile seizures. The outcome was good in 15 patients and poor in eight patients. Serum lactate dehydrogenase, glucose, and ammonia levels were higher among children with a poor outcome compared to those with a good outcome. Clinically mild encephalitis/encephalopathy with a reversible splenial lesion was the most common type (n = 8), followed by acute encephalopathy with biphasic seizures and late reduced diffusion (n = 7).

Conclusion

A prior history of febrile seizures was frequent in children with AdVE. Several different subtypes of acute encephalopathy were seen in children with AdVE, and the outcome was poor in those with acute encephalopathy with biphasic seizures and late reduced diffusion and hemorrhagic shock and encephalopathy syndrome. Elevated lactate dehydrogenase, glucose, and ammonia levels on admission were found to correlate with a poor outcome.

中文翻译：

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日本全国腺病毒相关脑炎/脑病调查

 背景

腺病毒是引起儿童发热性疾病的主要病原体。它还可能引起急性脑炎/脑病。本研究旨在阐明日本儿童腺病毒相关脑炎/脑病（AdVE）的临床特征。

 方法

对患有 AdVE 的儿童进行了一项全国性调查。在儿科医生中进行了初步调查，以获取 2014 年 1 月至 2019 年 3 月期间接受治疗的 AdVE 儿童的信息。第二次调查用于从对初步调查做出回应的医院以及从文献中确定的信息中获取 AdVE 儿童的临床信息检索举报病例。我们收集了人口统计数据以及有关感染症状、神经系统症状、实验室参数、治疗和结果的信息。结果是使用儿科大脑表现类别评分来确定的。

 结果

可获得 23 名中位年龄为 39 个月的儿童的临床信息。两人有先前存在的神经系统疾病，六人有热性惊厥史。 15 名患者的结果良好，8 名患者的结果较差。与预后良好的儿童相比，预后不良的儿童的血清乳酸脱氢酶、葡萄糖和氨水平较高。临床上伴有可逆性压部病变的轻度脑炎/脑病是最常见的类型 (n = 8)，其次是伴有双相性癫痫发作和晚期弥散减少的急性脑病 (n = 7)。

 结论

AdVE 儿童常有热性惊厥病史。在患有 AdVE 的儿童中观察到几种不同亚型的急性脑病，并且患有双相性癫痫发作和晚期弥散减少以及失血性休克和脑病综合征的急性脑病患者的预后较差。研究发现入院时乳酸脱氢酶、葡萄糖和氨水平升高与不良预后相关。