| Objective:Viral encephalitis(VE)is a common infectious disease of the central nervous system in children.However,due to complex and diverse clinical symptoms,few typical symptoms,lack of specificity,it is easy to miss diagnosis and misdiagnosis,which leads to untimely treatment and affecting the prognosis of children.Therefore,the purpose of this study is to analyze and summarize the pathogen and clinical characteristics of viral encephalitis in children,so as to provide reference for the early diagnosis and treatment.Method:1.In this study,children hospitalized for VE in the children's medical center of Hunan people's Hospital from September 2018 to August 2019 were taken as the research objects.The clinical diagnosis was based on the clinical symptoms,physical signs,laboratory examination,imaging and other results when they were hospitalized.2.The CSF of patients were collected after admission and CSF related tests(including routine biochemical tests,bacteria,fungi,tuberculosis culture and autoimmune encephalitis specific antibody tests)were completed.At the same time,12 kinds of viruses(including human enterovirus(EV),EB virus(EBV),cytomegalovirus(CMV),HSV-1,HSV-2,HHV-6,HHV-7,HHV-8,varicella zoster virus(VZV),Pe Vs,mumps virus and measles virus)in CSF were detected by multiplex fluorescent quantitative PCR.3.Record the results of CSF examination and make a comprehensive analysis based on the relevant clinical data.Result:1.Demographic information Among the 52 children with VE,there were 28 males and 24 females,and the ratio of male to female was 1.17:1.The age of onset ranged from 0.25 to 3.50 years and the average age of patients was 4.41± 3.52.Summer and autumn are the main seasons of onset.2.Detection results of cerebrospinal fluid pathogens The cerebrospinal fluid samples of 52 cases were detected by multiplex fluorescence quantitative PCR.The total detection rate was42.3%(22/52),of which EV was the highest,28.8%(15/52).The positive rates of other pathogens respectlly were 3.8%(2/52)for HSV-1,1.9%(1/52)for HSV-2,1.9%(1/52)for HHV-6,3.8%(2/52)for EBV and 1.9%(1/52)for CMV.Patients detected EV were classified as enterovirus group,patients detected HSV-1,HSV-2,HHV-6,EBV and CMV were classified as herpesvirus group,and patients without pathogens detection in CSF were classified as undetected pathogen group.3.Clinical data analysis3.1 The clinical symptoms and signs of 52 children and children with different pathogens infections:In this study,52 cases were all acute onset.The main clinical symptoms were fever(48 cases,92.3%)and neurological symptoms(vomiting,headache,dizziness,convulsions,disturbance of consciousness),as well ascough,diarrhea,abdominal pain and other system manifestations.Twelve cases had positive signs of the nervous system,including positive meningeal irritation(11 cases,21.2%)and increased muscle tone(2 cases,3.8%).The enterovirus group has more precursory symptoms of the digestive system and respiratory system,and less typical neurological symptoms;the herpesvirus group can have neurological symptoms early and the disease progresses rapidly.Among 52 cases,11(21.2%)had severe VE,,5 cases in herpesvirus group,accounting for 71.4%(5/7);3 cases in enterovirus group,accounting for 20.0%(3/15);3 cases in undetected pathogen group,accounting for 10.0%(3/30).The proportion of serious illness in herpesvirus group was higher than that in enterovirus group and undetected pathogen group(P <0.05).3.2 The results of routine laboratory examinations show:The total leukocyte count of 52 children fluctuated between 1.15×109/L~23.30×109/L,of which 3 cases(5.8%)decreased and 28 cases(53.8%)increased;The total number of white blood cells in theenterovirus group fluctuated from 3.19×109/L to 18.80×109/L,of which1 case(1.9%)decreased and 6 cases(11.5%)increased;Leukocytes in the herpesvirus group were abnormal,with a range of fluctuations ranging from 1.55×109/L to 16.40×109/L,of which 2 cases(3.8%)decreased and 5 cases increased(9.6%);Three of them(HSV-1,HHV-6,and EV infected respectlly)were less than 4.00×109/L,and the condition was severe.3 cases(no pathogen group detected)were greater than 20.00×109/L,2 cases had meningeal irritation,and CRP and PCT were at high values,and CSF did not have a positive report of bacterial infection(but the possibility of bacterial infection was not excluded).The value of CRP of 52 children fluctuated between 0.16mg/L and121.00 mg/L,and 23 of them(44.2%)increased.And the value of PCT fluctuated between 0.01?g/L and 9.20?g/L,with a median of 0.29?g/L,5cases(9.6%)were normal(<0.05?g/L),and 36 cases(69.2%)were between 0.05?g/L and 0.50?g/L,9 cases(17.3%)were between 0.50?g/L and 2.00?g/L,2 cases(3.8%)> 2.00?g/L.In the enterovirus group,the value of CRP was higher than normal in 8 cases(53.3%),of which the highest was 121.00mg/l.The value of PCT was also higher than 1.00ug/l in the same case and no bacterial infection was found,although the patient was severe VE.In the herpesvirus group,the value of CRP was higher than normal in 4 cases(57.1%),and the highest was 56.00mg/l(HSV-1)belong to asever VE case.Two cases(HSV-1,HHV-6 infected respectlly),had extremely high PCT but normal CRP,no bacterial infection was found.,who also had high fever accompanied with consciousness disorder and septic shock symptoms were found in the early stage.3.3 CSF check result prompt:No pathogenic bacteria were found in the centrifugation smear of 52 cases of CSF,and bacterial culture and special antibodies for autoimmune encephalitis were all negative.There were 7 cases of CSF with light red color(5 of them considered to be damaged),2 cases of CSF with light yellow color,43 cases of CSF with colorless and transparent color,2cases of CSF with blood appearance were all in the group without pathogen detection,and 3 cases of HSV had clear CSF appearance.There were 15 cases of CSF leukocyte abnormality in 52 cases,with a median of 30×106(10×106~500×106),the highest was t 500×106(HHV-6 infected),all of them were lymphocyte elevation.And the CSF leukocytes of enterovirus group were normal.The quantitative fluctuations of CSF protein in 52 patients ranged from 0.04 g/L to 1.80 g/L,and 7 patients(13.5%)increased.Among them,the CSF protein of CMV encephalitis was 1.80 g/L.The CSF sugars were mostly normal,and only 2 patients decreased 2.8mmol/L(no pathogens were detected);In 52 cases,ADA and LDH in CSF were normal,and chloride was not decreased.There were 41 abnormal cases(78.8%)withabnormal CSF pressure measurement.The median was 210 mm H2O(100~400mm H2O),and the highest was 400 mm H2O.3.4 EEG and imaging results show:Forty-five children had complete electroencephalogram(EEG)exam inations,of which 42 were abnormal(93.3%).The EEG showed different manifestations,mainly delta slow waves,and a few visible sharp waves,sharp-spur waves Spindle wave and other changes.EEG examination results in the enterovirus group: 14 cases were abnormal and 1 case was normal;6 cases in the herpesvirus group were abnormal in completing the EEG examination.31 cases were examined by magnetic resonance imaging(MRI)of the head,and 11 cases(35.5%)were abnormal,among which 4 cases in the enterovirus group were found to have abnormalities in the cerebral hemisphere,posterior horn of the right lateral ventricle,dentate nucleus area,and frontotemporal area;In the herpesvirus group,2cases found abnormal parts were the thalamus(HSV-1 infected)cerebellar sulcus(HHV-6 infected);5 cases in the undetected pathogen group found abnormal parts were the right pontine,frontal parietal lobe,frontotemporal region and cerebellum Brain sulcus(2 cases).CT scan of the head(22 cases),abnormal 3 cases(13.6%),the lesions were basal ganglia(HSV-1 infected),temporal lobe(undetected pathogen group),cerebral edema(undetected pathogen group).The abnormal rate of MRI was significantly higher than that of CT(P < 0.05).4.Diagnosis,Treatment,and Outcome52 patients with VE were treated with symptomatic supportive treatments such as oxygen inhalation,sedation,fever reduction,and intracranial pressure reduction according to their condition,and some were given antiviral,immunoglobulin,and glucocorticoid therapy,including tracheal intubation(4 cases),consider concomitant infections and give anti-bacterial infection treatment.Of the 52 children with VE,30 recovered,17 improved,and 3 had neurological sequelae(HHV-6,HSV-1,undetected pathogen group),including 2 children with unconsciousness(HHV-6,HSV-1.The consciousness gradually recovered on the 5th and 18 th day of admission,but related neurological sequelae remained.The 52 children with VE had a heat course of 3 to 15 days,with an average heat course of 7.70±2.81 days,and a hospital stay of 3 to 78 days.The average hospital stay was about 10.80±9.02 days;the average heat course of the enterovirus group was 7.00±2.45 days,the average hospital stay was 9.40 ± 5.75 days;the average heat course of the herpesvirus group was 10.29±3.64 days,and the average hospital stay was 25.86 ± 21.26 days.The heat course of herpesvirus group was significantly higher than that of enterovirus group(P <0.05).Conclusion:1.The rapid and feasible detection of CSF virus pathogens by multiple fluorescent quantitative PCR is conducive to the discovery of encephalitis etiology;2.Enterovirus is the main pathogen of viral encephalitis in children in this group and the clinical symptoms of herpesvirus infection are more serious than enterovirus;3.The EEG in children's viral encephalitis examination has a strong suggestiveness,the head MRI examination is better than CT at the beginning of the disease. |
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