Pathogen Spectrum Of Viral Encephalitis In Children Hospitalized In Hebei Children's Hospital From May To December 2017

Objective: To investigate the pathogenic characteristics of viral encephalitis in children living in Hebei Province,and to study the relationship between pathogenic and clinical findings.Methods:1.A total of 399 children with viral encephalitis were randomly selected from the Department of Neurology,Children's Hospital of Hebei Province from May 2017 to December 2017.The diagnosis of the disease is based on the diagnostic criteria of the International Encephalitis Consortium.Except for trauma,metabolic disorders,bacteria,fungi,mycoplasma,chlamydia and other pathogens caused by encephalitis,systemic infection-related encephalopathy,cerebrovascular disease,brain tumors,metabolic encephalopathy,toxic encephalopathy,etc.A total of 399 cerebrospinal fluid samples were collected within 7 days of onset.2.Perform sample nucleic acid extraction using fully automated workstation which combines PCR system configuration and sample addition.The extracted nucleic acid was detected by real-time fluorescent quantitative PCR.The detected of RNA viruses included enterovirus(EV),Japanese encephalitis virus(JEV),rubella virus(Ru V),measles virus(Me V),mumps virus(Mu V),influenza A virus(Flu A)),influenza B virus(Flu B),respiratory syncytial virus(RSV).The detected DNA viruses include: herpes simplex virus type 1(HSV-1),herpes simplex virus type 2(HSV-2),varicella-zoster virus(VZV),EB virus(EBV),cytomegalovirus(CMV),human herpesvirus Type 6(HHV-6),adenovirus(Ad V).A sample with a Ct value below 35 was determined to be a pathogenic positive result,and a sample having a Ct value higher than 35 was detected by Sanger sequencing and confirmed by sangersequencing.3.The pathogen results were combined with clinical data for analysis.Statistical analysis was performed using SPSS statistical analysis software to study the epidemiological characteristics,clinical data characteristics and differences of different pathogenic viral encephalitis.Resluts:1.Out of 399 children with viral encephalitis,there were 259 males and140 females,with a male to female ratio of 1.85:1,a median age of 5 years and 1 month,a minimum age of 2 months,and a maximum age of 14 years.352 cases had digestive symptoms(nausea,vomiting,abdominal pain),accounting for 88.22%.385 cases of pharyngeal redness,accounting for96.49%.Seven patients had lower extremity motor dysfunction,one had unclear speech and lower extremity dyskinesia,one had bilateral left strabismus,and 14 had convulsive seizures,and one of them had TODD paralysis.Head MRI was performed in some of the 360 ??patients,ofwhich 43 were abnormal(head MRI showed inflammatory changes in the parenchyma or complied with viral encephalitis complications),and 317 were normal.328 patients underwent EEG or video EEG detection,of which 234 were normal,46 were abnormal(slow wave or spike,which was consistent with viral encephalitis EEG changes),and 48 were EEG.The median white blood cell count of cerebrospinal fluid in 399 children was 88×106/L,the extreme value was 1-1187×106/L,the interquartile range was 181×106/L;The median number of cerebrospinal fluid mononuclear cells was 53×106/L,the extreme value was 0-1023×106/L,the interquartile range was 118×106;the median number of cerebrospinal fluid polynuclear cells was 17×106/L,and the extreme value was 0-926×106/L,interquartile range 45×106/L;median glucose content of cerebrospinal fluid was 3.16 mmol/L,extreme value was2.04-6.89 mmol/L,interquartile range was 0.63 mmol/L;cerebrospinal fluid protein determination The number of digits was 0.25g/L,the extreme value was 0.08-1.76g/L,and the interquartile range was 0.17 g/L.The cerebrospinal fluid mononuclear cells in 304 children(mononuclear cell ratio >50%)accounted for 76.2%.The median mononuclear ratio was 76.9%,the extreme value was 0-1,and the interquartile range was 0.4;the median ratio of multinucleated cells was 23.0%,and the extreme value was 0-1;74 children had decreased cerebrospinal fluid glucose(less than 2.8mmol/L),accounting for 18.5%;61 cases of children with elevated cerebrospinal fluid protein(greater than 0.4g / L),accounting for 15.3%.2.The results showed that 80 of 399 samples were positive and the positive rate of was 20.05%.It included 22 cases of enterovirus,14 cases of human herpesvirus type 6,8 cases of adenovirus,7 cases of cytomegalovirus,7cases of herpes zoster virus,4 cases of influenza A virus,3 cases of mumps virus,2 cases of herpes simplex virus type 1,1 cases of herpes simplex virus type 2,4 cases of EB virus,.8 cases had concurrent infections:3 cases enterovirus concurrent with herpesvirus type 6,1 cases enterovirus concurrent with Japanese encephalitis virus,1cases herpes simplex virus type 2 concurrent with adenovirus,1 cases influenza A virus concurrent with herpesvirus type 6,1cases mumps virus concurrent with herpesvirus type 6,1 cases mumps virus concurrent with herpesvirus type 6,1 cases herpes simplex virus type 1concurrent with zoster virus.3.Children with EV viral encephalitis in Hebei Province were highly prevalent in May and June(P=0.016).HHV-6 virus encephalitis was more susceptible to infection than non-HHV-6 virus(P=0.016);MRI positive in different viral encephalitis was not statistically significant(P>0.05).The results of EEG of different viral encephalitis were P>0.05,which was not statistically significant.Conclusion:1.EV is the most common pathogen of children with viral encephalitis in Hebei Province from May to December 2017.EV encephalitis has a high incidence in May and June.2.Common pathogens of children with viral encephalitis in Hebei from May to December 2017 are: EV,HHV-6,Ad V,CMV,EBV,Flu A,Mu V,HSV-1,HSV-2 and Je V.3.In this study,patients with HHV-6 viral encephalitis may be more likely to be co-infected with other viruses.4.There was no significant difference in MRI results and EEG results between children with different pathogenic viral encephalitis in this group.