Pathogen Spectrum Of Viral Encephalitis In Children Hospitalized In Hebei Children's Hospital From 2015 To 2016

Objective: To characterize etiology of viral encephalitis in children in Shijiazhuang and demonstrate correlations of etiological material and clinical findings.Methods:1 We recruited 159 patients in Hebei Children's Hospital from October2015 to September 2016 diagnosed with viral encephalitis according to the diagnostic criteria in Xiao Er Shen Jing Xi Tong Ji Bing Ji Chu Yu Lin Chuang2 rd edition.Encephalitis caused by other infectious pathogens,infectionassociated encephalopathy,vascular disease,neoplastic,toxin-induced encephalopathy and metabolic encephalopathy were excluded.159 cerebrospinal fluid(CSF)specimens and 158 serum specimens were collected at the acute stage of the disease.General information including symptoms,signs,neuroimaging and neurophysiology results of all patients were also collected.2 Laboratory automatic station combined with real-time quantitative polymerase chain reaction(qPCR)was used to test the CSF and serum specimens of the patients.The virus tested by qPCR including Enterovirus(EV),Japanese encephalitis virus(JEV),Mumps virus(MuV),Herpes simplex virus1(HSV1),Herpes simplex virus2(HSV2),Varicella-zoster virus(VZV),EpsteinBarr virus(EBV),Human herpes virus 6(HHV6),Cytomegalovirus(CMV),Measles virus(MeV),Rubella virus(RuV),Tick-borne encephalitis virus(TBEV),Human immunodeficiency virus1(HIV1),West Nile virus(WNV),Adenovirus(AdV)and John Cunningham virus(JCV).Etiological decision was made based on qPCR analyses with Ct value below 35 being positive and above 35 being negative.3 In order to study the correlation of etiological results and clinical findings,patients were further tested by electroencephalogram(EEG)and magnetic resonance imaging(MRI).Statistical analyses were used to determine correlation.Results:1 Of the 159 patients,99 were males and 60 were females,sex ratio was1.65:1.The median age was 53(41-72)months.Minimal age was 2 months,maximal age was 14 years.154 patients had fever,125 had headache,117 had vomiting,7 had seizure,15 had lethargy,1 had unstable temper,2 had emotional or behavioral change,2 had stiff neck,3 had focal neurologic symptom,17 had stomachache,25 had respiratory symptoms and 1 had rash.The median time when CSF was collected was 4(2-5)days after diagnosis.The median white blood cell count per microliter in CSF was 96(51-239).The median protein concentration per microliter in CSF was 0.23(0.16-0.29)g.The median glucose concentration per microlitre in CSF was 3.19(2.9-3.58)mmol.123 patients had CSF lymphocytosis.The median proportion of white blood cells that are lymphocytes was 79.59%(54.11%-91.38%).7 patients had abnormal protein concentration in CSF.144 patients received MRI examination and 27 patients had abnormal results(brain parenchyma inflammation was seen in MRI).93 patients received EEG examination and 41 patients had abnormal results(widely and diffusivity slow waves was seen in EEG).2 Of the 159 patients,79 cases(49.69%)had positive qPCR result.67 cases were EV positive(55 cases were positive in CSF specimen,10 cases were positive in serum specimen,2 cases were positive in both CSF and serum specimens),6 cases were EV concurrent with EBV(2 cases EV and EBV were positive in CSF specimen,1 case EV was positive in CSF specimen with EBV positive in serum specimen,1 case EV was positive in serum specimen with EBV positive in CSF specimen,1 case EV and EBV were positive in serum specimen,1 case EV and EBV were positive in CSF specimen with EBV positive in serum specimen),4 cases were EBV positive(2 cases were positive in CSF specimen,2 cases were positive in serum specimen),1 case was HHV6positive(positive in CSF specimen),1 case was EV concurrent with HHV6(EV and HHV6 were positive in CSF specimen with EV positive in serum specimen).80 cases had negative qPCR result.The positive rate in CSF specimen was higher than in serum specimen.3 Neither age nor gender was a significant factor of the patients in different pathogen groups.Symptoms,signs and EEG results in different pathogen groups were not significantly different.Admission date in different pathogen groups were significantly different.Of all the encephalitis patients,EV encephalitis consists of a higher proportion between May and September.Patients with unknown pathogens had higher abnormal MRI rates compared to EV encephalitis.The white blood cell counts of CSF in different pathogen groups were not significant different.Conclusion:1 EV was the most common pathogen of viral encephalitis in children in Shijiazhuang from 2015 to 2016.EV encephalitis were most seen in hot months in children so it is important to strengthen the protection and prevention of EV encephalitis in children in hot months.EBV and HHV6 consists of a large proportion of the pathogen spectrum.2 The CSF specimen was better than the serum specimen when we test the common pathogen of viral encephalitis.If possible,both CSF specimen and serum specimen should be tested.3 Patients whose pathogen of viral encephalitis were unconfirmed were more likely to have an abnormal MRI result than EV encephalitis.So it is important to get a larger pathogen spectrum of viral encephalitis and make a further research of the patients whose pathogen were unconfirmed.