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Brisca G, Marini C, Buratti S, Mariani M, Tortora D, Morana G, Pirlo D, Romanengo M, Cannizzaro G, Cordani R, Canzoneri F, Calevo MG, Nobili L, Franciotta D, Castagnola E, Moscatelli A, Mancardi MM. Acute pediatric encephalitis: etiology, course, and outcome of a 12-year single-center immunocompetent cohort. J Neurol 2023; 270:5034-5047. [PMID: 37400659 DOI: 10.1007/s00415-023-11847-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Encephalitis is an uncommon but severe disorder due to an inflammation of the brain parenchyma, usually diagnosed on clinical, laboratory, electroencephalographic, and neuroradiological features. New causes of encephalitis have been reported in recent years, so diagnostic criteria have changed over time. We report on a single-center experience of a pediatric Hospital, the hub of its region, over 12 years (2008-2021), with the evaluation of all children managed for acute encephalitis. METHODS We retrospectively reviewed clinical, laboratory, neuroradiological, and EEG data from the acute phase and outcome of all immunocompetent patients diagnosed with acute encephalitis. According to the newly proposed criteria for pediatric autoimmune encephalitis, we divided patients into infectious, definite autoimmune, probable autoimmune, and possible autoimmune, and performed a comparison between the different groups. RESULTS 48 patients (26 females, mean age 4.4 years), 19 with infections, and 29 with autoimmune encephalitis, were included. Herpes simplex virus 1 encephalitis was the most frequently identified etiology followed by anti-NMDA receptor encephalitis. Movement disorders at onset and a longer hospital stay were observed more frequently in autoimmune compared to infectious encephalitis (p p < 0.001 and p = 0.001, respectively). Among the autoimmune group, children who started immunomodulatory treatment earlier (within 7 days from onset) had more frequent complete functional recovery (p = 0.002). CONCLUSIONS Herpes virus and anti-NMDAR encephalitis are the most frequent etiologies within our cohort. Clinical onset and course are extremely variable. Since early immunomodulatory treatment was associated with a better functional outcome, our data confirm that a timely diagnostic classification in definite, probable, or possible autoimmune encephalitis can help the clinician in a successful therapeutic approach.
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Affiliation(s)
- Giacomo Brisca
- Intermediate Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - Chiara Marini
- Pediatrics 1, Maria Vittoria Hospital, ASL Città Di Torino, Turin, Italy
| | - Silvia Buratti
- Neonatal and Pediatric Intensive Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marcello Mariani
- Pediatric Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giovanni Morana
- Department of Neurosciences, University of Turin, Turin, Italy
| | - Daniela Pirlo
- Intermediate Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marta Romanengo
- Intermediate Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Ramona Cordani
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Francesca Canzoneri
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, Scientific Direction, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Lino Nobili
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Child Neuropsychiatry Unit, Department of Neurosciences, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Elio Castagnola
- Pediatric Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Moscatelli
- Intermediate Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Neonatal and Pediatric Intensive Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Margherita Mancardi
- Child Neuropsychiatry Unit, Department of Neurosciences, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Palkrit S, Bhakaney P, Kumbhare R, Vardhan V. Positive Impact of Inpatient Respiratory Rehabilitation in a Rare Case of Acute Necrotizing Encephalopathy. Cureus 2022; 14:e30408. [PMID: 36407176 PMCID: PMC9669518 DOI: 10.7759/cureus.30408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
Acute necrotizing encephalopathy, also known as acute necrotizing encephalopathy of childhood (ANEC) is a rare disorder characterized by respiratory or gastrointestinal infections, high fever, and rapid changes in consciousness and seizures. ANEC is a rare form of encephalopathy characterized by multiple bilateral brain lesions, primarily involving the thalami and putamina internal and external capsules, cerebellar white matter, and the brainstem segmentum. Here we present, a rare case of acute necrotizing encephalopathy in a pediatric patient, a 13-year-old boy, who was admitted with acute onset of fever. The fever was intermittent and high grade along with chills, rigor, and respiratory distress five days back. The chest x-ray showed heterogeneous opacities in bilateral lung fields. Thalami, brainstem, cerebellum, and white matter have all been shown to have a symmetric lesion in this disease on magnetic resonance imaging (MRI). Ventilation, immunoglobulin, and other supporting measures, as well as respiratory rehabilitation, were used to treat him. In pediatric intensive care units (PICU), physiotherapy is considered an important aspect of patient care. Respiratory rehabilitation included patients and their family member's counseling, airway clearance techniques, energy conservation methods, and adaptation to complex positions with the maintenance of oxygen saturation (SpO2). We conclude Respiratory rehabilitation with efficient family counseling is effective in the overall improvement of the patient’s condition with acute respiratory failure in acute necrotizing encephalopathy.
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Yang S, Kang Q, Hou Y, Wang L, Li L, Liu S, Liao H, Cao Z, Yang L, Xiao Z. Mutant BCL11B in a Patient With a Neurodevelopmental Disorder and T-Cell Abnormalities. Front Pediatr 2020; 8:544894. [PMID: 33194885 PMCID: PMC7641641 DOI: 10.3389/fped.2020.544894] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background: BCL11B encodes B-cell lymphoma/leukemia 11B, a transcription factor that participates in the differentiation and migration of neurons and lymphocyte cells. De novo mutations of BCL11B have been associated with neurodevelopmental disorder and immunodeficiency, such as immunodeficiency 49 (IMD49) and intellectual developmental disorder with speech delay, dysmorphic facies, and T-cell abnormalities (IDDSFTA). However, the pathogenesis of the neurodevelopmental disorder and T-cell deficiency is still mysterious. The strategy to distinguish these two diseases in detail is also unclear. Methods: A patient with unique clinical features was identified. Multiple examinations were applied for evaluation. Whole-exome sequencing (WES) and Sanger sequencing were also performed for the identification of the disease-causing mutation. Results: We reported a 17-month-old girl with intellectual disability, speech impairment, and delay in motor development. She presented with mild dysmorphic facial features and weak functional movement. MRI indicated the abnormal myelination of the white matter. Immunological analysis showed normal levels of RTEs and γδT cells but a deficiency of naive T cells. Genetic sequencing identified a de novo heterozygous frameshift mutation c.1192_1196delAGCCC in BCL11B. Conclusions: An IDDSFTA patient of East Asian origin was reported. The unreported neurological display, immunophenotype, and a novel disease-causing mutation of the patient extended the spectrum of clinical features and genotypes of IDDSFTA.
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Affiliation(s)
- Sai Yang
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | - Qingyun Kang
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | | | - Lili Wang
- Research Institute of Pediatrics, Hunan Children's Hospital, Changsha, China
| | - Liping Li
- Research Institute of Pediatrics, Hunan Children's Hospital, Changsha, China
| | - Shulei Liu
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | - Hongmei Liao
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | | | - Liming Yang
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | - Zhenghui Xiao
- Department of Neurology, Hunan Children's Hospital, Changsha, China.,Research Institute of Pediatrics, Hunan Children's Hospital, Changsha, China.,Hunan Provincial Key Laboratory of Children's Emergency Medicine, Hunan Children's Hospital, Changsha, China
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