Neurodevelopment and cognition in children after enterovirus 71 infection
Journal
New England Journal of Medicine
Journal Volume
356
Journal Issue
12
Pages
1226-1234
Date Issued
2007
Author(s)
Wu Y.-Y.
Hsia S.-H.
Fan T.-Y.
Lin K.-L.
Huang Y.-C.
Lin T.-Y.
Abstract
Background: Enterovirus 71 is a common cause of hand, foot, and mouth disease and encephalitis in Asia and elsewhere. The long-term neurologic and psychiatric effects of this viral infection on the central nervous system (CNS) are not well understood. Methods: We conducted long-term follow-up of 142 children after enterovirus 71 infection with CNS involvement - 61 who had aseptic meningitis, 53 who had severe CNS involvement, and 28 who had cardiopulmonary failure after CNS involvement. At a median follow-up of 2.9 years (range, 1.0 to 7.4) after infection, the children received physical and neurologic examinations. We administered the Denver Developmental Screening Test (DDST II) to children 6 years of age or younger and the Wechsler intelligence test to children 4 years of age or older. Results: Nine of the 16 patients with a poliomyelitis-like syndrome (56%) and 1 of the 5 patients with encephalomyelitis (20%) had sequelae involving limb weakness and atrophy. Eighteen of the 28 patients with cardiopulmonary failure after CNS involvement (64%) had limb weakness and atrophy, 17 (61%) required tube feeding, and 16 (57%) required ventilator support. Among patients who underwent DDST II assessment, delayed neurodevelopment was found in only 1 of 20 patients (5%) with severe CNS involvement and in 21 of 28 patients (75%) with cardiopulmonary failure (P<0.001 for the overall comparison). Children with cardiopulmonary failure after CNS involvement scored lower on intelligence tests than did children with CNS involvement alone (P = 0.003). Conclusions: Enterovirus 71 infection with CNS involvement and cardiopulmonary failure may be associated with neurologic sequelae, delayed neurodevelopment, and reduced cognitive functioning. Children with CNS involvement without cardiopulmonary failure did well on neurodevelopment tests. Copyright ? 2007 Massachusetts Medical Society.
SDGs
Other Subjects
article; aseptic meningitis; brain development; child; cognition; controlled study; Denver Developmental Screening Test; disease severity; Enterovirus infection; female; follow up; heart failure; human; intelligence test; lung insufficiency; major clinical study; male; neurologic examination; physical examination; postpoliomyelitis syndrome; priority journal
Publisher
Massachussetts Medical Society
Type
journal article