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Ma Y, Liu L, Chen F, Zhan W, Li M, Su Y. Acute necrotizing encephalopathy infected with the SARS-CoV-2 in children: Case series and literature review of clinical outcomes with the use of Tocilizumab. Eur J Paediatr Neurol 2024; 52:67-75. [PMID: 39106789 DOI: 10.1016/j.ejpn.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/17/2024] [Accepted: 07/19/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND AND OBJECTIVE Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes acute necrotizing encephalopathy (ANE), which has a high mortality rate and severe sequelae. This study aimed to identify ANE early and evaluate the usefulness of tocilizumab in ANE treatment. METHODS We retrospectively included eight paeefediatric ANE cases infected with SARS-CoV-2 at Xi'an Children's Hospital, China, from December 1, 2022 to May 1, 2023. A literature search was performed using the PUBMED, SPRING, SCOPUS, and EMBASE databases. This study included eleven patients. Clinical characteristics, laboratory test results, imaging features, and treatment options were analysed. RESULTS Eight of the 19 cases (42 %) died, one (5 %) recovered, and nine (47 %) improved with residual neurological dysfunction. Eighteen patients presented with fever, with 56 % having ≥40 °C. Twelve patients (63 %) presented with dysfunction consciousness. Eight (42 %) patients experienced frequent convulsions. All eight patients in our hospital had elevated procalcitonin levels (mean: 21.32 ng/mL, range: 0.10-89.40 ng/mL). Alanine aminotransferase levels were elevated (mean: 632.81 U/L, range: 13.00-2251.00 U/L) in six patients. Seven patients showed elevated uric acid levels(mean: 396.50 μmol/L, range: 157.00-660.00 μmol/L). Brain imaging indicated that all the patients had symmetrical injuries to the bilateral thalami, accompanied by symmetrical injuries in the cerebrum, cerebellum, basal ganglia, and brain stem. Compared with the classical treatment (n = 9), the combination with tocilizumab (n = 6) showed a statistically difference in mortality (p = 0.028 < 0.05). CONCLUSION The typical clinical manifestations of ANE in children with SARS-CoV-2 infection are acute onset with high fever, frequent convulsions and rapidly worsening disturbance of consciousness. Tocilizumab treatment could reduces mortality in ANE.
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Affiliation(s)
- Yingge Ma
- Department of Emergency, Xi'an Children's Hospital (Xi'an Jiaotong University Affiliated Children's Hospital), China
| | - Lin Liu
- Department of Emergency, Xi'an Children's Hospital (Xi'an Jiaotong University Affiliated Children's Hospital), China
| | - Fang Chen
- Department of Emergency, Xi'an Children's Hospital (Xi'an Jiaotong University Affiliated Children's Hospital), China
| | - Wenjuan Zhan
- Department of Emergency, Xi'an Children's Hospital (Xi'an Jiaotong University Affiliated Children's Hospital), China
| | - Mingyue Li
- Department of Emergency, Xi'an Children's Hospital (Xi'an Jiaotong University Affiliated Children's Hospital), China.
| | - Yufei Su
- Department of Emergency, Xi'an Children's Hospital (Xi'an Jiaotong University Affiliated Children's Hospital), China.
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Tang L, Guo Y, Shu C, Peng X, Qiu S, Li R, Liu P, Wei H, Liao S, Du Y, Guo D, Gao N, Zeng QL, Liu X, Ji F. Neurological manifestations and risk factors associated with poor prognosis in hospitalized children with Omicron variant infection. Eur J Pediatr 2024; 183:2353-2363. [PMID: 38429545 DOI: 10.1007/s00431-024-05495-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/03/2024]
Abstract
There are increasing reports of neurological manifestation in children with coronavirus disease 2019 (COVID-19). However, the frequency and clinical outcomes of in hospitalized children infected with the Omicron variant are unknown. The aim of this study was to describe the clinical characteristics, neurological manifestations, and risk factor associated with poor prognosis of hospitalized children suffering from COVID-19 due to the Omicron variant. Participants included children older than 28 days and younger than 18 years. Patients were recruited from December 10, 2022 through January 5, 2023. They were followed up for 30 days. A total of 509 pediatric patients hospitalized with the Omicron variant infection were recruited into the study. Among them, 167 (32.81%) patients had neurological manifestations. The most common manifestations were febrile convulsions (n = 90, 53.89%), viral encephalitis (n = 34, 20.36%), epilepsy (n = 23, 13.77%), hypoxic-ischemic encephalopathy (n = 9, 5.39%), and acute necrotizing encephalopathy (n = 6, 3.59%). At discharge, 92.81% of patients had a good prognosis according to the Glasgow Outcome Scale (scores ≥ 4). However, 7.19% had a poor prognosis. Eight patients died during the follow-up period with a cumulative 30-day mortality rate of 4.8% (95% confidence interval (CI) 1.5-8.1). Multivariate analysis revealed that albumin (odds ratio 0.711, 95% CI 0.556-0.910) and creatine kinase MB (CK-MB) levels (odds ratio 1.033, 95% CI 1.004-1.063) were independent risk factors of poor prognosis due to neurological manifestations. The area under the curve for the prediction of poor prognosis with albumin and CK-MB was 0.915 (95%CI 0.799-1.000), indicating that these factors can accurately predict a poor prognosis. Conclusion: In this study, 32.8% of hospitalized children suffering from COVID-19 due to the Omicron variant infection experienced neurological manifestations. Baseline albumin and CK-MB levels could accurately predict poor prognosis in this patient population. What is Known: • Neurological injury has been reported in SARS-CoV-2 infection; compared with other strains, the Omicron strain is more likely to cause neurological manifestations in adults. • Neurologic injury in adults such as cerebral hemorrhage and epilepsy has been reported in patients with Omicron variant infection. What is New: • One-third hospitalized children with Omicron infection experience neurological manifestations, including central nervous system manifestations and peripheral nervous system manifestations. • Albumin and CK-MB combined can accurately predict poor prognosis (AUC 0.915), and the 30-day mortality rate of children with Omicron variant infection and neurological manifestations was 4.8%.
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Affiliation(s)
- Li Tang
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, No. 69 Xi Ju Yuan Alley, Xi'an, 710003, Shaanxi, China
| | - Yuxin Guo
- Department of Infectious Diseases, the Second Affiliated Hospital Xi'an Jiaotong University, No.157 Xi Wu Road, Xi'an, 710004, Shaanxi, China
| | - Chang Shu
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, No. 69 Xi Ju Yuan Alley, Xi'an, 710003, Shaanxi, China
| | - Xiaokang Peng
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, No. 69 Xi Ju Yuan Alley, Xi'an, 710003, Shaanxi, China
| | - Sikai Qiu
- Department of Infectious Diseases, the Second Affiliated Hospital Xi'an Jiaotong University, No.157 Xi Wu Road, Xi'an, 710004, Shaanxi, China
| | - Ruina Li
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, No. 69 Xi Ju Yuan Alley, Xi'an, 710003, Shaanxi, China
| | - Pan Liu
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, No. 69 Xi Ju Yuan Alley, Xi'an, 710003, Shaanxi, China
| | - Huijing Wei
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, No. 69 Xi Ju Yuan Alley, Xi'an, 710003, Shaanxi, China
| | - Shan Liao
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, No. 69 Xi Ju Yuan Alley, Xi'an, 710003, Shaanxi, China
| | - Yali Du
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, No. 69 Xi Ju Yuan Alley, Xi'an, 710003, Shaanxi, China
| | - Dandan Guo
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, No. 69 Xi Ju Yuan Alley, Xi'an, 710003, Shaanxi, China
| | - Ning Gao
- Department of Infectious Diseases, the Second Affiliated Hospital Xi'an Jiaotong University, No.157 Xi Wu Road, Xi'an, 710004, Shaanxi, China
| | - Qing-Lei Zeng
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, No. 1, Eastern Jianshe Road, Zhengzhou, 450052, Henan, China.
| | - Xiaoguai Liu
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, No. 69 Xi Ju Yuan Alley, Xi'an, 710003, Shaanxi, China.
| | - Fanpu Ji
- Department of Infectious Diseases, the Second Affiliated Hospital Xi'an Jiaotong University, No.157 Xi Wu Road, Xi'an, 710004, Shaanxi, China.
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University) Ministry of Education of China, Xi'an, China.
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
- Shaanxi Provincial Clinical Medical Research Center of Infectious Diseases, Xi'an, Shaanxi, China.
- Key Laboratory of Surgical Critical Care and Life Support (Xi'an Jiaotong University), Ministry of Education, Shaanxi, China.
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Choi YY, Lee HY, Lim MK, Kang YH. MRI Findings of COVID-19 Associated Acute Necrotizing Encephalopathy in Two Pediatric Patients: Case Report and Literature Review. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:682-690. [PMID: 38873375 PMCID: PMC11166599 DOI: 10.3348/jksr.2023.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/03/2023] [Accepted: 08/21/2023] [Indexed: 06/15/2024]
Abstract
Acute necrotizing encephalopathy (ANE) is a rare immune-mediated complication of a viral infection commonly involving the bilateral thalamus and has been reported mainly in children. Here, we describe the MRI findings of coronavirus disease 2019 (COVID-19)-associated ANE in two pediatric patients, including a 7-year-old girl with fever and mental change, and a 6-year-old girl with fever and generalized seizures. Brain MRI revealed symmetrical T2 fluid attenuated inversion recovery high-signal intensity lesions in the bilateral thalamus with central hemorrhage. In one patient, the thalamic lesions showed a trilaminar pattern on the apparent diffusion coefficient map. This report emphasizes the importance of creating awareness regarding these findings in patients with COVID-19, particularly in children with severe neurological symptoms. Furthermore, it provides a literature review of several documented cases of COVID-19 presenting with bilateral thalamic hemorrhagic necrosis, suggesting a diagnosis of ANE.
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Zheng S, Chen H, Xu W, Li H, Chen Z, Li J, Tao E. Case report: unprecedented case of infantile cerebral infarction following COVID-19 and favorable outcome. Front Immunol 2024; 15:1357307. [PMID: 38590518 PMCID: PMC10999532 DOI: 10.3389/fimmu.2024.1357307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/12/2024] [Indexed: 04/10/2024] Open
Abstract
The 2019 novel coronavirus, SARS-CoV-2, was highly prevalent in China as of December 2022, causing a range of symptoms, predominantly affecting the respiratory tract. While SARS-CoV-2 infection in children is generally mild, severe cases, especially in infants, are rare. We present a case of a previously healthy 7-month-old infant who developed cerebral infarction and coagulation dysfunction three days after COVID-19 onset. Clinically, the infant had weakness in the left limbs and pinpoint bleeding spots. A cranial magnetic resonance imaging showed ischemic strokes in the right basal ganglia and thalamus. Laboratory tests indicated thrombocytopenia and coagulation dysfunction. Inflammatory cytokines like interleukin-10 were elevated, with increased CD3+, CD4+, and CD8+ T lymphocytes but decreased CD3- CD16+ CD56+ natural killer cells. Treatment included mannitol, dexamethasone, oral aspirin, and vitamins B1 and B6 for reducing intracranial pressure, antiinflammation, anticoagulation, and nerve support, respectively. During the recovery phase, rehabilitation therapy focused on strength training, fine motor skills, and massage therapy. The infant gradually improved and successfully recovered. While rare, such cases can lead to severe complications. These combined efforts were instrumental in achieving significant functional recovery in the patient, demonstrating that even in severe instances of pediatric cerebral infarction due to COVID-19, positive outcomes are attainable with early and comprehensive medical response.
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Affiliation(s)
- Shuhong Zheng
- Graduate School, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Children’s Rehabilitation, Wenling Maternal and Child Health Hospital, Wenling, Zhejiang, China
| | - Hairui Chen
- Department of Children’s Rehabilitation, Wenling Maternal and Child Health Hospital, Wenling, Zhejiang, China
| | - Weiwei Xu
- Department of Children’s Rehabilitation, Wenling Maternal and Child Health Hospital, Wenling, Zhejiang, China
| | - Haifeng Li
- Department of Rehabilitation, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang, China
| | - Zhongyu Chen
- Department of Radiology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Jianhua Li
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Enfu Tao
- Department of Neonatology and Neonatal Intensive Care Unit, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang, China
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Zhu H, Zhu S, Wang Q, Wang L, Jiang Q, Hu Y, Huang Y, Zeng L, Luo Z. Acute Necrotizing Encephalopathy Associated with SARS-CoV-2 Infection in Children. Ann Indian Acad Neurol 2024; 27:222-225. [PMID: 38751924 PMCID: PMC11093163 DOI: 10.4103/aian.aian_912_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 02/07/2024] [Accepted: 02/22/2024] [Indexed: 05/18/2024] Open
Affiliation(s)
- Hui Zhu
- Department of Pediatrics, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, Sichuan, China
| | - Shuyao Zhu
- Department of Pediatrics, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, Sichuan, China
| | - Qiyan Wang
- Department of Radio-Diagnosis, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, Sichuan, China
| | - Lijuan Wang
- Department of Pediatrics, The Fifth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Qiong Jiang
- Department of Pediatrics, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, Sichuan, China
| | - Yuhang Hu
- Department of Pediatric Intensive Care Medicine, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, Sichuan, China
| | - Yu Huang
- Department of Pediatrics, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, Sichuan, China
| | - Lan Zeng
- Department of Medical Genetics and Prenatal Diagnosis, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, Sichuan, China
| | - Zemin Luo
- Department of Pediatrics, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, Sichuan, China
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Chang YJ, Huang CG, Shie SS, Lin JJ, Chen CJ. Clinical features and virologic lineages of COVID-19-associated encephalitis in Taiwanese children during early epidemic wave of omicron in 2022: Report from a medical center. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024; 57:48-54. [PMID: 37926632 DOI: 10.1016/j.jmii.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 09/08/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND A surge of encephalitis was reported in children during the early wave of the omicron epidemic in Taiwan. Information on the COVID-19-associated encephalitis, including epidemiologic features and factors of unfavorable outcomes, remained unclear. METHODS A total of 128 hospitalized Taiwanese children with laboratory-confirmed COVID-19 were enrolled between April 01, 2022, and May 31, 2022. The information on demographics and clinical features was abstracted from the medical records. Virologic lineages were determined by sequences of the spike protein. Factors associated with encephalitis and unfavorable outcomes were identified by comparisons to children without encephalitis and with favorable outcomes, respectively. RESULTS The leading syndromes associated with COVID-19 in hospitalized children were febrile seizure (20, 15.7%), fever as the solitary symptom (18, 14.1%), and croup syndrome (14, 10.9%). Encephalitis was diagnosed in nine (7.03%) children. When compared to the three leading syndromes, children with encephalitis were at older ages, had greater rates of hypotension, PICU admissions, use of inotropic agents (P < .001 for all above comparisons), mortality (P = .008), and longer hospital stays (P = .016), but not the underlying comorbidities (P = .376). Unfavorable outcomes were identified in 3 (33.3%) of 9 encephalitis cases and associated with a lower Glasgow coma scale, hypotension, and higher C-reactive protein (P < .05 for all). BA.2.3.7 was the dominant sublineage in children with or without encephalitis. CONCLUSIONS Omicron BA.2.3.7 can cause fulminant and lethal encephalitis in healthy children. Depressed consciousness and hypotension at presentation were significant risks of unfavorable outcomes for pediatric COVID-19-associated encephalitis.
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Affiliation(s)
- Yi-Jung Chang
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 333 Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou-Chang Gung Memorial Hospital, Taiwan; Department of Medical Biotechnology and Laboratory Science, Graduate Institute of Biomedical Sciences, Chang Gung University, Taiwan
| | - Shian-Sen Shie
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jainn-Jim Lin
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 333 Taoyuan, Taiwan
| | - Chih-Jung Chen
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan.
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Lee VW, Kam KQ, Mohamed AR, Musa H, Anandakrishnan P, Shen Q, Palazzo AF, Dale RC, Lim M, Thomas T. Defining the Clinicoradiologic Syndrome of SARS-CoV-2 Acute Necrotizing Encephalopathy: A Systematic Review and 3 New Pediatric Cases. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200186. [PMID: 38086061 PMCID: PMC10758947 DOI: 10.1212/nxi.0000000000200186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/02/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND AND OBJECTIVES We characterize clinical and neuroimaging features of SARS-CoV-2-related acute necrotizing encephalopathy (ANE). METHODS Systematic review of English language publications in PubMed and reference lists between January 1, 2020, and June 30, 2023, in accordance with PRISMA guidelines. Patients with SARS-CoV-2 infection who fulfilled diagnostic criteria for sporadic and genetic ANE were included. RESULTS From 899 articles, 20 cases (17 single case reports and 3 additional cases) were curated for review (50% female; 8 were children). Associated COVID-19 illnesses were febrile upper respiratory tract infections in children while adults had pneumonia (45.6%) and myocarditis (8.2%). Children had early neurologic deterioration (median day 2 in children vs day 4 in adults), seizures (5 (62.5%) children vs 3 of 9 (33.3%) adults), and motor abnormalities (6 of 7 (85.7%) children vs 3 of 7 (42.9%) adults). Eight of 12 (66.7%) adults and 4 (50.0%) children had high-risk ANE scores. Five (62.5%) children and 12 (66.7%) adults had brain lesions bilaterally and symmetrically in the putamina, external capsules, insula cortex, or medial temporal lobes, in addition to typical thalamic lesions of ANE. Hypotension was only seen in adults (30%). Hematologic derangements were common: lymphopenia (66.7%), coagulopathy (60.0%), or elevated D-dimers (100%), C-reactive protein (91.7%), and ferritin (62.5%). A pathogenic heterozygous c/.1754 C>T variant in RANBP2 was present in 2 children: one known to have this before SARS-CoV-2 infection, and a patient tested because the SARS-CoV-2 infection was the second encephalopathic illness. Three other children with no prior encephalopathy or family history of encephalopathy were negative for this variant. Fifteen (75%) received immunotherapy (with IV methylprednisolone, immunoglobulins, tocilizumab, or plasma exchange): 6 (40.0%) with monotherapy and 9 (60.0%) had combination therapy. Deaths were in 8 of 17 with data (47.1%): a 2-month-old male infant and 7 adults (87.5%) of median age 56 years (33-70 years), 4 of whom did not receive immunotherapy. DISCUSSION Children and adults with SARS-CoV-2 ANE have similar clinical features and neuroimaging characteristics. Mortality is high, predominantly in patients not receiving immunotherapy and at the extremes of age.
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Affiliation(s)
- Vanessa W Lee
- From the Children's Neurosciences (V.W.L., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Infectious Disease Service (K.Q.K.), Department of Paediatrics, KK Women's and Children's Hospital; SingHealth Duke-NUS Paediatrics Academic Clinical Program (ACP) (K.Q.K., T.T.), KK Women's and Children's Hospital, Singapore; Paediatric Neurology Unit (A.R.M., H.M., P.A.), Hospital Tunku Azizah, Kuala Lumpur; Department of Paediatrics (H.M.), Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang; Department of Immunology (Q.S.), School of Basic Medical Sciences, Fujian Medical University; Department of Obstetrics (Q.S.), Fujian Maternity and Child Health Hospital, Fuzhou, China; Department of Biochemistry (A.F.P.), University of Toronto, Ontario, Canada; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney; Clinical School (R.C.D.), The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia; Department Women and Children's Health (M.L.), School of Life Course Sciences (SoLCS), King's College London, United Kingdom; and Neurology Service (T.T.), Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Kai Qian Kam
- From the Children's Neurosciences (V.W.L., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Infectious Disease Service (K.Q.K.), Department of Paediatrics, KK Women's and Children's Hospital; SingHealth Duke-NUS Paediatrics Academic Clinical Program (ACP) (K.Q.K., T.T.), KK Women's and Children's Hospital, Singapore; Paediatric Neurology Unit (A.R.M., H.M., P.A.), Hospital Tunku Azizah, Kuala Lumpur; Department of Paediatrics (H.M.), Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang; Department of Immunology (Q.S.), School of Basic Medical Sciences, Fujian Medical University; Department of Obstetrics (Q.S.), Fujian Maternity and Child Health Hospital, Fuzhou, China; Department of Biochemistry (A.F.P.), University of Toronto, Ontario, Canada; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney; Clinical School (R.C.D.), The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia; Department Women and Children's Health (M.L.), School of Life Course Sciences (SoLCS), King's College London, United Kingdom; and Neurology Service (T.T.), Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Ahmad R Mohamed
- From the Children's Neurosciences (V.W.L., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Infectious Disease Service (K.Q.K.), Department of Paediatrics, KK Women's and Children's Hospital; SingHealth Duke-NUS Paediatrics Academic Clinical Program (ACP) (K.Q.K., T.T.), KK Women's and Children's Hospital, Singapore; Paediatric Neurology Unit (A.R.M., H.M., P.A.), Hospital Tunku Azizah, Kuala Lumpur; Department of Paediatrics (H.M.), Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang; Department of Immunology (Q.S.), School of Basic Medical Sciences, Fujian Medical University; Department of Obstetrics (Q.S.), Fujian Maternity and Child Health Hospital, Fuzhou, China; Department of Biochemistry (A.F.P.), University of Toronto, Ontario, Canada; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney; Clinical School (R.C.D.), The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia; Department Women and Children's Health (M.L.), School of Life Course Sciences (SoLCS), King's College London, United Kingdom; and Neurology Service (T.T.), Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Husna Musa
- From the Children's Neurosciences (V.W.L., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Infectious Disease Service (K.Q.K.), Department of Paediatrics, KK Women's and Children's Hospital; SingHealth Duke-NUS Paediatrics Academic Clinical Program (ACP) (K.Q.K., T.T.), KK Women's and Children's Hospital, Singapore; Paediatric Neurology Unit (A.R.M., H.M., P.A.), Hospital Tunku Azizah, Kuala Lumpur; Department of Paediatrics (H.M.), Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang; Department of Immunology (Q.S.), School of Basic Medical Sciences, Fujian Medical University; Department of Obstetrics (Q.S.), Fujian Maternity and Child Health Hospital, Fuzhou, China; Department of Biochemistry (A.F.P.), University of Toronto, Ontario, Canada; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney; Clinical School (R.C.D.), The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia; Department Women and Children's Health (M.L.), School of Life Course Sciences (SoLCS), King's College London, United Kingdom; and Neurology Service (T.T.), Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Poorani Anandakrishnan
- From the Children's Neurosciences (V.W.L., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Infectious Disease Service (K.Q.K.), Department of Paediatrics, KK Women's and Children's Hospital; SingHealth Duke-NUS Paediatrics Academic Clinical Program (ACP) (K.Q.K., T.T.), KK Women's and Children's Hospital, Singapore; Paediatric Neurology Unit (A.R.M., H.M., P.A.), Hospital Tunku Azizah, Kuala Lumpur; Department of Paediatrics (H.M.), Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang; Department of Immunology (Q.S.), School of Basic Medical Sciences, Fujian Medical University; Department of Obstetrics (Q.S.), Fujian Maternity and Child Health Hospital, Fuzhou, China; Department of Biochemistry (A.F.P.), University of Toronto, Ontario, Canada; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney; Clinical School (R.C.D.), The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia; Department Women and Children's Health (M.L.), School of Life Course Sciences (SoLCS), King's College London, United Kingdom; and Neurology Service (T.T.), Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Qingtang Shen
- From the Children's Neurosciences (V.W.L., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Infectious Disease Service (K.Q.K.), Department of Paediatrics, KK Women's and Children's Hospital; SingHealth Duke-NUS Paediatrics Academic Clinical Program (ACP) (K.Q.K., T.T.), KK Women's and Children's Hospital, Singapore; Paediatric Neurology Unit (A.R.M., H.M., P.A.), Hospital Tunku Azizah, Kuala Lumpur; Department of Paediatrics (H.M.), Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang; Department of Immunology (Q.S.), School of Basic Medical Sciences, Fujian Medical University; Department of Obstetrics (Q.S.), Fujian Maternity and Child Health Hospital, Fuzhou, China; Department of Biochemistry (A.F.P.), University of Toronto, Ontario, Canada; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney; Clinical School (R.C.D.), The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia; Department Women and Children's Health (M.L.), School of Life Course Sciences (SoLCS), King's College London, United Kingdom; and Neurology Service (T.T.), Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Alexander F Palazzo
- From the Children's Neurosciences (V.W.L., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Infectious Disease Service (K.Q.K.), Department of Paediatrics, KK Women's and Children's Hospital; SingHealth Duke-NUS Paediatrics Academic Clinical Program (ACP) (K.Q.K., T.T.), KK Women's and Children's Hospital, Singapore; Paediatric Neurology Unit (A.R.M., H.M., P.A.), Hospital Tunku Azizah, Kuala Lumpur; Department of Paediatrics (H.M.), Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang; Department of Immunology (Q.S.), School of Basic Medical Sciences, Fujian Medical University; Department of Obstetrics (Q.S.), Fujian Maternity and Child Health Hospital, Fuzhou, China; Department of Biochemistry (A.F.P.), University of Toronto, Ontario, Canada; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney; Clinical School (R.C.D.), The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia; Department Women and Children's Health (M.L.), School of Life Course Sciences (SoLCS), King's College London, United Kingdom; and Neurology Service (T.T.), Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Russell C Dale
- From the Children's Neurosciences (V.W.L., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Infectious Disease Service (K.Q.K.), Department of Paediatrics, KK Women's and Children's Hospital; SingHealth Duke-NUS Paediatrics Academic Clinical Program (ACP) (K.Q.K., T.T.), KK Women's and Children's Hospital, Singapore; Paediatric Neurology Unit (A.R.M., H.M., P.A.), Hospital Tunku Azizah, Kuala Lumpur; Department of Paediatrics (H.M.), Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang; Department of Immunology (Q.S.), School of Basic Medical Sciences, Fujian Medical University; Department of Obstetrics (Q.S.), Fujian Maternity and Child Health Hospital, Fuzhou, China; Department of Biochemistry (A.F.P.), University of Toronto, Ontario, Canada; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney; Clinical School (R.C.D.), The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia; Department Women and Children's Health (M.L.), School of Life Course Sciences (SoLCS), King's College London, United Kingdom; and Neurology Service (T.T.), Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Ming Lim
- From the Children's Neurosciences (V.W.L., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Infectious Disease Service (K.Q.K.), Department of Paediatrics, KK Women's and Children's Hospital; SingHealth Duke-NUS Paediatrics Academic Clinical Program (ACP) (K.Q.K., T.T.), KK Women's and Children's Hospital, Singapore; Paediatric Neurology Unit (A.R.M., H.M., P.A.), Hospital Tunku Azizah, Kuala Lumpur; Department of Paediatrics (H.M.), Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang; Department of Immunology (Q.S.), School of Basic Medical Sciences, Fujian Medical University; Department of Obstetrics (Q.S.), Fujian Maternity and Child Health Hospital, Fuzhou, China; Department of Biochemistry (A.F.P.), University of Toronto, Ontario, Canada; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney; Clinical School (R.C.D.), The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia; Department Women and Children's Health (M.L.), School of Life Course Sciences (SoLCS), King's College London, United Kingdom; and Neurology Service (T.T.), Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Terrence Thomas
- From the Children's Neurosciences (V.W.L., M.L.), Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre; Infectious Disease Service (K.Q.K.), Department of Paediatrics, KK Women's and Children's Hospital; SingHealth Duke-NUS Paediatrics Academic Clinical Program (ACP) (K.Q.K., T.T.), KK Women's and Children's Hospital, Singapore; Paediatric Neurology Unit (A.R.M., H.M., P.A.), Hospital Tunku Azizah, Kuala Lumpur; Department of Paediatrics (H.M.), Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang; Department of Immunology (Q.S.), School of Basic Medical Sciences, Fujian Medical University; Department of Obstetrics (Q.S.), Fujian Maternity and Child Health Hospital, Fuzhou, China; Department of Biochemistry (A.F.P.), University of Toronto, Ontario, Canada; Kids Neuroscience Centre (R.C.D.), The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney; Clinical School (R.C.D.), The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia; Department Women and Children's Health (M.L.), School of Life Course Sciences (SoLCS), King's College London, United Kingdom; and Neurology Service (T.T.), Department of Paediatrics, KK Women's and Children's Hospital, Singapore
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8
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Cimolai N. COVID-19 among infants: key clinical features and remaining controversies. Clin Exp Pediatr 2024; 67:1-16. [PMID: 38013408 PMCID: PMC10764668 DOI: 10.3345/cep.2023.00794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/11/2023] [Accepted: 09/19/2023] [Indexed: 11/29/2023] Open
Abstract
Infants aged <1 year represent a seemingly more susceptible pediatric subset for infections. Despite this, coronavirus disease 2019 (COVID-19) infection has not been proven as more serious in this age group (outside the very early neonatal period) than in others. Indeed, a considerable number of asymptomatic infections have been recorded, and the symptoms and morbidity associated with COVID- 19 differ minimally from those of other respiratory viral infections. Whether due to an abundance of caution or truly reduced susceptibility, infections in infants have not raised the same profile as those in other age groups. In addition to direct severe acute respiratory syndrome coronavirus 2 diagnostic tests, laboratory markers that differentiate COVID-19 from other viral infections lack specificity in infants. Gastrointestinal presentations are common, and the neurological complications of infection mirror those of other respiratory viral infections. There have been relatively few reports of infant deaths. Under appropriate precautions, breastfeeding in the context of maternal infections has been associated with tangible but infrequent complications. Vaccination during pregnancy provides protection against infection in infants, at least in the early months of life. Multi-inflammatory syndrome in children and multi-inflammatory syndrome in neonates are commonly cited as variants of COVID-19; however, their clinical definitions remain controversial. Similarly, reliable definitions of long COVID in the infant group are controversial. This narrative review examines the key clinical and laboratory features of COVID-19 in infants and identifies several areas of science awaiting further clarification.
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Affiliation(s)
- Nevio Cimolai
- Faculty of Medicine, The University of British Columbia and Children’s and Women’s Health Centre of British Columbia, Vancouver, Canada
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9
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Li J, Huo F, Wang S, Fan Y, Wu J, Zhang Z, Liu S, Wang Q. Recurrent infection triggered encephalopathy syndrome in a pediatric patient with RANBP2 mutation and severe acute respiratory syndrome coronavirus 2 infection. Pediatr Investig 2023; 7:290-296. [PMID: 38050538 PMCID: PMC10693665 DOI: 10.1002/ped4.12406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/31/2023] [Indexed: 12/06/2023] Open
Abstract
Introduction Acute necrotizing encephalopathy (ANE), a fatal subtype of infection-triggered encephalopathy syndrome (ITES), can be triggered by many systemic infections. RANBP2 gene mutations were associated with recurrent ANE. Case presentation Here we report a 1-year-old girl with recurrent ITES and RANBP2 mutation. She was diagnosed with influenza-associated encephalopathy and made a full recovery on the first episode. After severe acute respiratory syndrome coronavirus 2 infection, the patient presented with seizures and deteriorating mental status. Brain magnetic resonance imaging revealed necrotic lesions in bilateral thalami and pons. Methylprednisolone, immunoglobulin, and interleukin 6 inhibitors were administered. Her consciousness level was improved at discharge. Nineteen cases of 2019 coronavirus disease-related ANE have been reported, of which 22.2% of patients died and 61.1% had neurologic disabilities. RANBP2 gene mutation was found in five patients, two of whom developed recurrent ITES. Conclusion Patients with RANBP2 mutations are at risk for recurrent ITES, may develop ANE, and have a poor prognosis after relapse.
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Affiliation(s)
- Jiaqi Li
- Emergency DepartmentBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingChina
| | - Feng Huo
- Emergency DepartmentBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingChina
| | - Shuo Wang
- Emergency DepartmentBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingChina
| | - Yimu Fan
- Emergency DepartmentBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingChina
| | - Jie Wu
- Emergency DepartmentBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingChina
| | - Zhezhe Zhang
- Emergency DepartmentBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingChina
| | - Shuangjun Liu
- Emergency DepartmentBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingChina
| | - Quan Wang
- Emergency DepartmentBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingChina
- Pediatric Intensive Care UnitBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingChina
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10
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Geng C, Zhao W, Wang Z, Wu J, Jiang D, Jiang N, Liu M, Yao M, Guan H. Acute necrotizing encephalopathy associated with COVID-19: case series and systematic review. J Neurol 2023; 270:5171-5181. [PMID: 37695531 DOI: 10.1007/s00415-023-11915-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 09/12/2023]
Abstract
Acute necrotizing encephalopathy (ANE) is a rare neurological complication related to COVID-19. Here we present a case series of six Chinese cases with ANE associated with COVID-19 and review all reported cases in the literature. A total of six cases with ANE related to COVID-19 were enrolled in this study. Clinical manifestations, neuroimaging data, treatment and outcomes of these patients were analyzed. A literature review was performed in Pubmed and Embase and 25 cases with clinical and neuroimaging data were collected and analyzed. Among our six cases, the age of onset ranged from 15 to 56 years, with a male-to-female ratio of nearly 1:1. All patients presented with reduced consciousness. Elevated interleukin 6 in serum and/or cerebrospinal fluid (CSF) was detected in four patients. Two patients improved clinically after intravenous methylprednisolone and intravenous immunoglobulin (IVIG). Based on the literature review, the majority of cases were from Europe and the United States (60%). Two age peaks at 10-20 years (20%) and 50-60 years (28%) were observed. Two cases were found with a heterozygous Thr585Met mutation. The mortality of ANE caused by COVID-19 was 42%. The use of IVIG in combination with other immunotherapies was related to better outcome (P = 0.041) and both two patients who received Tocilizumab survived. This is the first Chinese case series about ANE associated with COVID-19. Elevated serum and CSF interlukin-6 were found in certain cases. The mortality and morbidity rates remained high although prompt immunotherapy could improve the outcomes.
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Affiliation(s)
- Chang Geng
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Weili Zhao
- Department of Neurology, Chifeng Hospital, Inner Mongolia, China
| | - Zhijun Wang
- Department of Neurology, Shanxi Baiqiuen Hospital, Shanxi, China
| | - Jin Wu
- Department of Neurology, Ordos Central Hospital, Inner Mongolia, China
| | - Dongxiao Jiang
- Department of Neurology, Weihai Central Hospital Affiliated to Medical College of Qingdao University, Shandong, China
| | - Nan Jiang
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Mange Liu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Ming Yao
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Hongzhi Guan
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
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11
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Bloomquist RF, Goodbee M, Fowler TE, Prosser A. COVID-19-associated vestibular neuritis in an infant. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:e213-e214. [PMID: 36965508 PMCID: PMC9998288 DOI: 10.1016/j.jcjo.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/22/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023]
Affiliation(s)
| | - Mya Goodbee
- Medical College of Georgia, Augusta University, Augusta, GA
| | | | - Andrea Prosser
- Medical College of Georgia, Augusta University, Augusta, GA.
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12
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Lin X, Wang Y, Li X, Abdalla M, Zhang F, Dong C, Lu W, Liu X, Zhang J, Ma K, Ma X, Jiang Q. Acute necrotizing encephalopathy in children with COVID-19: a retrospective study of 12 cases. Front Neurol 2023; 14:1184864. [PMID: 37602239 PMCID: PMC10433176 DOI: 10.3389/fneur.2023.1184864] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Background Acute necrotizing encephalopathy (ANE) is a devastating neurologic condition that can arise following a variety of systemic infections, including influenza and SARS-Cov-2. The clinical features of COVID-19-associated ANE in pediatric patients based on multi-case data have not yet been described and remain obscure. We reviewed 12 pediatric patients to better describe the clinical features of ANE with COVID-19. Methods We retrospectively collected and summarized the clinical features of ANE in children with COVID-19. Clinical data were collected from 12 children, including their general status, clinical symptoms, laboratory tests, and neuroimaging features. Results Among the subjects, 10 were over 5 years old and they accounted for 83.33%. A large percentage of those affected (66.67%) were females. The major manifestations included fever (100%), impaired consciousness (100%), and convulsions (75%). We determined that increased interleukin (IL)-6 and IL-10, and tumor necrosis factor-α and interferon gamma were not predictive of severe ANE and mortality in children with COVID-19 in this study. All children presented with abnormal neuroimaging with multiple and symmetrically distributed lesions, involving the thalamus, basal ganglia, cerebellum, and brain hemispheres. Eight of the 12 children died, resulting in a mortality rate of 66.67%, and 75% of these children were females. Importantly, we found the timely administration of mannitol after an acute onset of convulsions or disturbance of consciousness may be decreased the high mortality induced by ANE children with COVID-19. Conclusion COVID-19 associated with ANE in children is characterized by sudden symptom onset, rapid disease progression, and high mortality.
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Affiliation(s)
- Xia Lin
- PICU, Children’s Hospital Affiliated to Shandong University, Jinan, China
- PICU, Jinan Children’s Hospital, Jinan, China
- Shandong Provincial Clinical Research Center for Children’s Health and Disease, Jinan, China
| | - Ying Wang
- Shandong Provincial Clinical Research Center for Children’s Health and Disease, Jinan, China
- Research Institute of Pediatrics, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Research Institute of Pediatrics, Jinan Children’s Hospital, Jinan, China
| | - Xiaoying Li
- Shandong Provincial Clinical Research Center for Children’s Health and Disease, Jinan, China
- NICU, Children’s Hospital Affiliated to Shandong University, Jinan, China
- NICU, Jinan Children’s Hospital, Jinan, China
| | - Mohnad Abdalla
- Shandong Provincial Clinical Research Center for Children’s Health and Disease, Jinan, China
- Research Institute of Pediatrics, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Research Institute of Pediatrics, Jinan Children’s Hospital, Jinan, China
| | - Fan Zhang
- PICU, Children’s Hospital Affiliated to Shandong University, Jinan, China
- PICU, Jinan Children’s Hospital, Jinan, China
- Shandong Provincial Clinical Research Center for Children’s Health and Disease, Jinan, China
| | - Chunhua Dong
- PICU, Children’s Hospital Affiliated to Shandong University, Jinan, China
- PICU, Jinan Children’s Hospital, Jinan, China
- Shandong Provincial Clinical Research Center for Children’s Health and Disease, Jinan, China
| | - Weifeng Lu
- PICU, Children’s Hospital Affiliated to Shandong University, Jinan, China
- PICU, Jinan Children’s Hospital, Jinan, China
- Shandong Provincial Clinical Research Center for Children’s Health and Disease, Jinan, China
| | - Xia Liu
- Shandong Provincial Clinical Research Center for Children’s Health and Disease, Jinan, China
- Respiratory Interventional Department, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Respiratory Interventional Department, Jinan Children’s Hospital, Jinan, China
| | - Jian Zhang
- PICU, Children’s Hospital Affiliated to Shandong University, Jinan, China
- PICU, Jinan Children’s Hospital, Jinan, China
- Shandong Provincial Clinical Research Center for Children’s Health and Disease, Jinan, China
| | - Kang Ma
- PICU, Children’s Hospital Affiliated to Shandong University, Jinan, China
- PICU, Jinan Children’s Hospital, Jinan, China
- Shandong Provincial Clinical Research Center for Children’s Health and Disease, Jinan, China
| | - Xiang Ma
- Shandong Provincial Clinical Research Center for Children’s Health and Disease, Jinan, China
- Department of Respiratory Disease, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Department of Respiratory Disease, Jinan Children’s Hospital, Jinan, China
| | - Qin Jiang
- PICU, Children’s Hospital Affiliated to Shandong University, Jinan, China
- PICU, Jinan Children’s Hospital, Jinan, China
- Shandong Provincial Clinical Research Center for Children’s Health and Disease, Jinan, China
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13
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Hernández-Dehesa IA, Alvarez-Castro JA, Aguilar-Hidalgo KM, Santellán-Hernández JO, Castro-Soto F. Acute Necrotizing Encephalopathy Post SARS-CoV-2 Infection in an Adult Patient: Case Report. SN COMPREHENSIVE CLINICAL MEDICINE 2023; 5:149. [PMID: 37275566 PMCID: PMC10227787 DOI: 10.1007/s42399-023-01491-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/07/2023]
Abstract
To show the MRI findings in a rare case of acute necrotizing encephalopathy following SARS-CoV-2 infection in an adult patient. Acute necrotizing encephalopathy is a rare condition characterized by the presence of symmetrical multifocal lesions with predominantly thalamic involvement, as well as the brainstem and cerebellum. We describe the case of a 26-year-old male with a medical history of medulloblastoma that was disease-free after treatment and who tested positive in a PCR for SARS-CoV-2 in cerebrospinal fluid. Upon evaluation at the emergency department one week later, the patient was found to be awake, oriented, and focused and could maintain attention for periods of time. Mixed dysarthria persisted, characterized by being flaccid and hypokinetic. On magnetic resonance imaging, there were multiple hemorrhagic lesions with surrounding edema in the right thalamus with an extension to the posterior arm of the internal capsule, a smaller one in the left thalamus, and another expanded to the ipsilateral peduncle. Acute necrotizing encephalopathy presents a great clinical and diagnostic challenge, close clinical and radiological follow-up is essential, and magnetic susceptibility sequences (T2 or SWI) should be included in the diagnosis protocol.
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Affiliation(s)
| | - José Alfonso Alvarez-Castro
- Department of Oncological Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suarez”, Mexico City, Mexico
| | - Keren Magaly Aguilar-Hidalgo
- Department of Oncological Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suarez”, Mexico City, Mexico
| | - José Omar Santellán-Hernández
- Department of Oncological Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suarez”, Mexico City, Mexico
| | - Fernando Castro-Soto
- Department of Oncological Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suarez”, Mexico City, Mexico
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14
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Deb N, Roy P, Biswakarma A, Mary T, Mahajan S, Khan J, Shah A. Neurological Manifestations of Coronavirus Disease 2019 and Monkeypox in Pediatric Patients and Their Management: A State-of-the-Art Systematic Review. Pediatr Neurol 2023; 146:65-78. [PMID: 37441883 PMCID: PMC10195769 DOI: 10.1016/j.pediatrneurol.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/13/2023] [Accepted: 05/13/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND There is an increasing number of cases being reported of neurological manifestations of Coronavirus disease 2019 (COVID-19) infection and monkeypox, both during the course of the infection and as a presenting symptom. We aim to review the neurological manifestations of COVID-19 and monkeypox in pediatric patients and their management. METHODS We conducted a systematic review that included cohort studies and case series or reports involving a pediatric population of patients with a confirmed COVID-19 or monkeypox infection and their neurological manifestations. We searched the following electronic databases: PubMed, EMBASE, and Scopus. RESULTS From 1136 articles identified, 127 studies were included. Headache, stroke, Guillain-Barré syndrome, seizure, nerve palsies, and multisystem inflammatory syndrome in children were the most common neurological symptoms caused by COVID-19, whereas encephalitis was commonly seen in patients with monkeypox. Rare neurological manifestations of COVID-19 included cerebral venous sinus thrombosis, plexopathies, demyelinating disorders, encephalitis, etc., and rare neurological manifestations of monkeypox included headache. CONCLUSIONS Our review highlights the importance of investigating possible neurological manifestations and closely monitoring these patients to develop a better understanding of the treatment strategies that can be adopted.
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Affiliation(s)
- Novonil Deb
- North Bengal Medical College and Hospital, West Bengal, India
| | - Poulami Roy
- North Bengal Medical College and Hospital, West Bengal, India.
| | | | - Therese Mary
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangaluru, Karnataka, India
| | - Sanah Mahajan
- Government Medical College, Jammu, Jammu and Kashmir, India
| | - Javeria Khan
- Veer Narmad South Gujarat University, Surat, Gujarat, India
| | - Aatam Shah
- Veer Narmad South Gujarat University, Surat, Gujarat, India
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15
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Neuropathology of 30 deceased patients with COVID-19: a case series in Tehran, Iran. Ann Med Surg (Lond) 2023; 85:271-275. [PMID: 36845816 PMCID: PMC9949774 DOI: 10.1097/ms9.0000000000000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/25/2022] [Indexed: 02/28/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect the nervous system and result in neurological symptoms. The most common feature of central nervous system involvement is hypoxia and congestion. This study aimed to evaluate the histopathology of cerebral tissue in deceased patients with coronavirus disease 2019 (COVID-19). Methods In a case series study, we took cerebral samples of 30 deceased patients with COVID-19 through supraorbital bone from January to May 2021. The samples were fixed in a formalin solution, stained with haematoxylin-eosin dyes and studied by two expert pathologists. The Ethics Committee of AJA University of Medical Sciences approved this study with code IR.AJAUMS.REC.1399.030. Results The mean age of the patients was 73.8 years, and the most common underlying disease was hypertension. Cerebral tissue samples showed hypoxic-ischaemic changes in 28 (93.3%), microhaemorrhage in six (20%), lymphocytic infiltration in five (16.7%) and thrombosis in three samples (10%). Conclusion Hypoxic-ischaemic change was the most common neuropathology in our patient. Our study showed that many patients with severe COVID-19 may develop central nervous system involvement.
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Farias LABG, da Silva FJC, Maia KM, Cavalcante KF, Damasceno LS. A fatal case of COVID-19-associated meningoencephalitis in a patient coinfected with influenza A. Rev Inst Med Trop Sao Paulo 2023; 65:e22. [PMID: 36946818 PMCID: PMC10027061 DOI: 10.1590/s1678-9946202365022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/03/2023] [Indexed: 03/22/2023] Open
Abstract
We report a case of COVID-19-associated meningoencephalitis with a fatal outcome in a male patient with concomitant influenza A, who had been hospitalized at the beginning of 2022, in the Northeastern region of Brazil. He died due to cardiopulmonary arrest after developing status epilepticus on the third day of hospitalization. The SARS-CoV-2 RNA was detected in cerebrospinal fluid and Influenza A was detected in the nasopharyngeal swab. Meningoencephalitis due to COVID-19 is a rare manifestation and physicians must be aware of this complication, mainly during the pandemic. In viral co-circulation situations, the possibility of respiratory coinfections should be remembered.
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Affiliation(s)
- Luís Arthur Brasil Gadelha Farias
- Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil
- Escola de Saúde Pública do Estado do Ceará, Programa de Residência Médica em Doenças Infecciosas, Fortaleza, Ceará, Brazil
| | - Francisco José Cândido da Silva
- Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil
- Escola de Saúde Pública do Estado do Ceará, Programa de Residência Médica em Doenças Infecciosas, Fortaleza, Ceará, Brazil
| | - Kelma Maria Maia
- Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil
| | | | - Lisandra Serra Damasceno
- Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil
- Universidade Federal do Ceará , Faculdade de Medicina, Programa de Pós-Graduação em Saúde Pública, Fortaleza, Ceará, Brazil
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17
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Rani Saggu S, Preethi L, Satapathy P, Manna S, Sai Tipirisetty E, Perween Afsar A, Ravindra K, Chakravarty K, Irfan FB, Sah R, Kumar Padhi B. Acute necrotizing encephalitis outbreak in India: A little-known disease among the adult population. Brain Behav Immun 2023; 107:383-384. [PMID: 36371011 DOI: 10.1016/j.bbi.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/02/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sofia Rani Saggu
- Department of Public Health Nutrition, Sam Higginbottom University of Agriculture Technologies and Sciences, Allahabad, India
| | - L Preethi
- Department of Pharmacy Practice, SRM College of Pharmacy, SRM Institute of Science and Technology, Tamil Nadu, India
| | - Prakasini Satapathy
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | - Khaiwal Ravindra
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamalesh Chakravarty
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Furqan B Irfan
- Department of Neurology and Ophthalmology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USAnstitute of Global Health, Michigan State University, East Lansing, MI, USA
| | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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18
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Casabianca M, Caula C, Titomanlio L, Lenglart L. Neurological consequences of SARS-CoV-2 infections in the pediatric population. Front Pediatr 2023; 11:1123348. [PMID: 36865695 PMCID: PMC9973732 DOI: 10.3389/fped.2023.1123348] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/16/2023] [Indexed: 02/16/2023] Open
Abstract
COVID-19 in the pediatric population is mostly asymptomatic. However, 1 out of 5 children presents non-specific neurologic symptoms such as headache, weakness, or myalgia. Furthermore, rarer forms of neurological diseases are increasingly being described in association to a SARS-CoV-2 infection. Encephalitis, stroke, cranial nerves impairment, Guillain-Barré syndrome or acute transverse myelitis have been reported and account for around 1% of pediatric COVID-19 cases. Some of these pathologies may occur during or after the SARS-CoV-2 infection. The pathophysiological mechanisms range from direct invasion of the central nervous system (CNS) by SARS-CoV-2 itself to postinfectious immune-mediated CNS inflammation. In most cases, patients presenting neurological pathologies related to SARS-CoV-2 infection are at greater risk of life-threatening complications and should be closely monitored. Further studies are needed to acknowledge the potential long-term neurodevelopmental consequences of the infection.
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Affiliation(s)
- Manon Casabianca
- Pediatric Emergency Department, APHP - Hopital Robert Debré, Paris Cité University, Paris, France
| | - Caroline Caula
- Pediatric Emergency Department, APHP - Hopital Robert Debré, Paris Cité University, Paris, France
| | - Luigi Titomanlio
- Pediatric Emergency Department, APHP - Hopital Robert Debré, Paris Cité University, Paris, France.,Pediatric Migraine and Neurovascular Diseases Unit, APHP - Hopital Robert Debré, Paris Cité University, Paris, France.,DHU Protect, INSERM U1141, Paris Cité University, Paris, France
| | - Léa Lenglart
- Pediatric Emergency Department, APHP - Hopital Robert Debré, Paris Cité University, Paris, France
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19
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Fulminant Encephalitis Caused by SARS-CoV-2 in a Two-Month-Old Infant. Indian J Pediatr 2023; 90:101. [PMID: 36441385 PMCID: PMC9702610 DOI: 10.1007/s12098-022-04404-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/04/2022] [Indexed: 11/29/2022]
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20
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[Clinical features of children with coronavirus disease 2019 complicated by acute encephalitis and related research advances]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:1301-1306. [PMID: 36544407 PMCID: PMC9785077 DOI: 10.7499/j.issn.1008-8830.2208033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic since the end of 2019. There is an increasing number of reports on nervous system symptoms, among which encephalitis is considered a serious neurological complication of COVID-19, but there are few reports of this complication in China. Acute encephalitis has severe symptoms. If it is not identified early and treated in time, the mortality is high and the prognosis is poor. During the current global epidemic, it is necessary to pay attention to the severe nervous system symptoms of COVID-19. Therefore, this article summarizes the clinical features of COVID-19 complicated by acute encephalitis through literature review and a detailed analysis of medical records, so as to provide a reference for clinicians to deal with the cases of COVID-19 complicated by acute encephalitis.
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21
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Islam MA, Cavestro C, Alam SS, Kundu S, Kamal MA, Reza F. Encephalitis in Patients with COVID-19: A Systematic Evidence-Based Analysis. Cells 2022; 11:cells11162575. [PMID: 36010650 PMCID: PMC9406394 DOI: 10.3390/cells11162575] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 11/26/2022] Open
Abstract
Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) predominantly infects the respiratory system, several investigations have shown the involvement of the central nervous system (CNS) along the course of the illness, with encephalitis being one of the symptoms. The objective of this systematic review was to evaluate the characteristics (clinical, neuro-radiological aspects, and laboratory features) and outcomes of encephalitis in COVID-19 patients. PubMed, Scopus, and Google Scholar databases were searched from 1 December 2019 until 21 July 2022 to identify case reports and case series published on COVID-19 associated with encephalitis. The quality of the included studies was assessed by the Joanna Briggs Institute critical appraisal checklists. This systematic review included 79 studies, including 91 COVID-19 patients (52.7% male) experiencing encephalitis, where 85.6% were adults (49.3 ± 20.2 years), and 14.4% were children (11.2 ± 7.6 years). RT-PCR was used to confirm 92.2% of the COVID-19 patients. Encephalitis-related symptoms were present in 78.0% of COVID-19 patients at the time of diagnosis. In these encephalitis patients, seizure (29.5%), confusion (23.2%), headache (20.5%), disorientation (15.2%), and altered mental status (11.6%) were the most frequently reported neurologic manifestations. Looking at the MRI, EEG, and CSF findings, 77.6%, 75.5%, and 64.1% of the patients represented abnormal results. SARS-CoV-2-associated or -mediated encephalitis were the most common type observed (59.3%), followed by autoimmune encephalitis (18.7%). Among the included patients, 66.7% were discharged (37.8% improved and 28.9% fully recovered), whereas 20.0% of the reported COVID-19-positive encephalitis patients died. Based on the quality assessment, 87.4% of the studies were of high quality. Although in COVID-19, encephalitis is not a typical phenomenon, SARS-CoV-2 seems like a neuropathogen affecting the brain even when there are no signs of respiratory illness, causing a high rate of disability and fatality.
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Affiliation(s)
- Md Asiful Islam
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Cinzia Cavestro
- Headache Centre, Department of Neurology, San Lazzaro Hospital, ASL CN2, 12051 Alba, CN, Italy
| | - Sayeda Sadia Alam
- Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
| | - Shoumik Kundu
- Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
| | - Mohammad Amjad Kamal
- Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu 610064, China
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 22230, Saudi Arabia
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh
- Enzymoics, 7 Peterlee Place, Novel Global Community Educational Foundation, Hebersham, NSW 2770, Australia
| | - Faruque Reza
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Kelantan, Malaysia
- Correspondence:
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22
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Gadani S, Cohen A. Acute Necrotizing Encephalitis as an Early Manifestation of COVID-19. Cureus 2022; 14:e27928. [PMID: 36120249 PMCID: PMC9464457 DOI: 10.7759/cureus.27928] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/05/2022] Open
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