Clinical Features And Etiological Analysis Of 86 Children With Virul Encephalitis

ObjectiveViral encephalitis(VE)is very common in children and is an acute inflammation of the brain caused by viruses.Because the clinical manifestations,signs and examinations are not typical and lack of specificity,the diagnosis and treatment is not perfect.To analyze the clinical features and epidemiological characteristics of children with VE,to improve the level of diagnosis and treatment for clinicians,to let the children with VE get a timely diagnosis and more accurate treatment.MethodsFrom May 2015 to April 2017,we got 86 cases those were diagnosed with VE in the People's Hospital of XinTai.All the children with VE were treated with monitoring of body temperature,pulse,respiration,blood pressure,and evaluation consciousness,intake and output record.They were kept in bed in acute stage.Collected venous blood?cerebrospinal fluid and fecal specimens at acute stage for routine blood test and C reactive protein,cerebrospinal fluid routine,detecting EVs by RT-PCR in CSF and fecal?IgM antibody by ELISA in serum specimens,with examination of EEG and head CT or MRI.The children with convulsions and disturbance of consciousness were given oxygen inhalation.The children with convulsions were given Phenobarbital sodium and chloral hydrate.Those with high fever were given physical cooling and drug cooling.The.children with frequent vomiting or eating less were given fluid infusion maintenance of water and electrolyte balance.All the children with VE were given Mannitol injection to reduce brain edema,antiviral drugs such as ribavirin,or acyclovir,or Yanhuning.Erythromycin or erythromycin was given to those who were combined with Mycoplasma pneumonia infection.Immune globulin was given to those who were in a bad way.Very few children were given rehabilitation exercise in recovery period.Collected and retrospectively analyzed the clinical data of these 86 cases,including the time of onset,age,clinical features,blood routine and C reactive protein,EEG,CT or MRI of head and treatment,the virus detection in serum?fecal and CSF samples.And statistically compared the clinical situation of the children with VE,the detection positive rate of EV in serum?fecal and CSF.We divided the 86 cases into 4 groups,the infant group(under 1 year),children group(1-3 years old,including 3 year old),pre-school group(3-6 years old,including 6 year old)and school age group(>6 years old).The minimum age was 2 months and 14 years was the maximum age of onset.The common clinical symptoms were fever,cough,abdominal pain,diarrhea,headache,nausea,vomiting and convulsion;conscious disturbance,mental and behavioral abnormality,hemiplegic paralysis,meningeal irritation sign and neck stiffness were the signs.Head CT showed diffuse brain edema in the brain and MRI showed abnormal signals in different parts of the brain.Results1.The ratio was 1.39:1 between boys and girls in 86 cases of VE,and the 3-6 years old was the peak of disease.The peak time of incidence was from summer to autumn.2.The most common clinical manifestations of VE were fever(96.5%)?headache(79.1%)?nausea and vomiting(73.3%)?cough(29.1%)?somnolence(17.4%)?and convulsion(8.1%).The positive rate of CRP was 29.07%in the cases.The abnormal rate of EEG was 59.30%and 18.6%neurological imaging of the 86 children with VE was abnormal.3.The positive cases of virus antibody testing for EV-IgM by ELISA was 40 cases in 60 acute phase serum,including 16 cases of EV71,2 cases of CoxA 16 and 24 cases of other EVs.The positive rate of EV was 70.0%.4.The positive incidence of virus in CSF samples of 86 children was 43.02%(37/86);the positive detected rate of EV?EBV?MV?HHV-6?CMV?HSV-1?HSV-2 was separately 34.88%(30/86)?3.49%(3/86)?2.33%(2/86)?2.33%(2/86)?1.16%(1/86)?1.16%(1/86)?and 1.16%(1/86).5.The positive cases of virus testing for EV by RT-PCR was 75 cases in 86 acute phase fecal,including 42 cases of EV71,12 cases of CoxA 16 and 21 cases of other EVs.The positive rate of EV was 87.21%.6.There was no difference of clinical features between positive cases and negative cases.7.The positive rate of EVs in fecal by RT-PCR was higher than that of EV-IgM by ELISA in acute serum,which was higher than that by RT-PCR in cerebrospinal fluid.All these could provide evidence for etiological diagnosis of viral encephalitis in children..ConclusionThe clinical manifestations and examinations were lack of specificity.EV was the main pathogen in children with VE.The positive rate of EVs in fecal by RT-PCR was higher than that of EV-IgM by ELISA in acute serum,which was higher than that by RT-PCR in cerebrospinal fluid.All these could provide evidence for etiological diagnosis of viral encephalitis in children.