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Wörner N, Rodrigo-García R, Antón A, Castellarnau E, Delgado I, Vazquez È, González S, Mayol L, Méndez M, Solé E, Rosal J, Andrés C, Casquero A, Lera E, Sancosmed M, Campins M, Pumarola T, Rodrigo C. Enterovirus-A71 Rhombencephalitis Outbreak in Catalonia: Characteristics, Management and Outcome. Pediatr Infect Dis J 2021; 40:628-633. [PMID: 34097655 PMCID: PMC8189429 DOI: 10.1097/inf.0000000000003114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Between April and June 2016, an outbreak of rhombencephalitis (RE) caused by enterovirus (EV) A71 was detected in Catalonia, Spain-the first documented in Western Europe. The clinical characteristics and outcome of patients with this condition differed from those reported in outbreaks occurring in Southeast Asia. METHODS Observational, multicenter study analyzing characteristics, treatment and outcome of patients with EV-A71 rhombencephalitis diagnosed in 6 publicly funded hospitals within the Catalonian Health Institute. A review of clinical characteristics, diagnosis, treatment and outcome of these patients was conducted. RESULTS Sixty-four patients met the clinical and virologic criteria for rhombencephalitis caused by EV-A71. All patients had symptoms suggesting viral disease, mainly fever, lethargy, ataxia and tremor, with 30% of hand-foot-mouth disease. Intravenous immunoglobulin therapy was given to 44/64 (69%) patients and methylprednisolone to 27/64 (42%). Six patients (9%) required pediatric intensive care unit admission. Three patients had acute flaccid paralysis of 1 limb, and another had autonomic nervous system (ANS) dysfunction with cardiorespiratory arrest. Outcome in all patients (except the patient with hypoxic-ischemic encephalopathy) was good, with complete resolution of the symptoms. CONCLUSIONS During the 2016 outbreak, rhombencephalitis without ANS symptoms was the predominant form of presentation and most patients showed no hand-foot-mouth disease. These findings contrast with those of other patient series reporting associated ANS dysfunction (10%-15%) and hand-foot-mouth disease (60%-80%). Complete recovery occurred in almost all cases. In light of the favorable outcome in untreated mild cases, therapies for this condition should be reserved for patients with moderate-severe infection. The main relevance of this study is to provide useful information for setting priorities, management approaches and adequate use of resources in future EV-A71 associated rhombencephalitis outbreaks.
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Affiliation(s)
- Núria Wörner
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Rocío Rodrigo-García
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Andrés Antón
- Department of Microbiology, Vall d’Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ester Castellarnau
- Department of Pediatrics, Joan XXIII University Hospital, Tarragona, Spain
| | - Ignacio Delgado
- Department of Pediatric Radiology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Èlida Vazquez
- Department of Pediatric Radiology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Sebastià González
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Lluís Mayol
- Department of Pediatrics, Josep Trueta University Hospital, Girona, Spain
| | - Maria Méndez
- Department of Pediatrics, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Eduard Solé
- Department of Pediatrics, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Jaume Rosal
- Department of Pediatrics, Verge de la Cinta Hospital, Tortosa, Spain
| | - Cristina Andrés
- Department of Microbiology, Vall d’Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
| | - Alejandro Casquero
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Esther Lera
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Mónica Sancosmed
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Magda Campins
- Vall d’Hebron Research Institute, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Preventive Medicine and Epidemiology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Tomàs Pumarola
- Department of Microbiology, Vall d’Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Rodrigo
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
- Faculty of Medicine at Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain. Carlos Rodrigo, MD, PhD, is currently at the Department of Pediatrics, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain
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