|Title:||Clinical Features and Factors of Unfavorable Outcomes for Non-Polio Enterovirus Infection of the Central Nervous System in Northern Taiwan, 1994-2003||Authors:||YANG, TSOU-TONG
HUANG, FU- YUAN
|Keywords:||Central nervous system viral infection;enterovirus, pulmonary edema;risk factors;viral encephalitis;viral meningitis||Issue Date:||2005||Start page/Pages:||-||Source:||JOURNAL OF MICROBIOLOGY, IMMUNOLOGY AND INFECTION v.38 n.6 pp.417-424||Abstract:||
This study investigated the clinical manifestations and outcomes of central nervous system (CNS) infection by enteroviruses. Cases with CNS involvement among all enterovirus-culture-positive cases from January 1995 to June 2003 were retrospectively reviewed. Among 1028 enterovirus- culture-positive cases, there were 333 cases involving the CNS. Of these, the ratio of male to female subjects was 1.78 , and the mean (± standard deviation) age was 6.83 ± 5.9 years; 21 were premature neonates, and 10 failed to thrive. Disease entities included 282 cases of aseptic meningitis ( 84.7%), 44 cases of encephalitis (13.2%), and 7 cases of encephalomyelitis/polio-like syndrome (2.1%). Of these cases , 97.9% (326/ 333) had fever with peak body temperature at 38 .9ºC, 85% had headache and vomiting, 70% had meningeal signs, 64% had neck stiffness, 16 .6% (55/333) had change of consciousness, 5.4% (18/333) had seizures and 5 .2% (17/333) had myoclonic jerks. Mannitol was administered in 77.2% of patients (257/333), along with intravenous immunoglobulin in 6.6% (22/333) . Twelve cases received ventilator support. One patient died of hand-foot- and-mouth disease, encephalitis plus cardiopulmonary failure, and 2 premature neonates died of hepatic failure, disseminated intravascular coagulation, sepsis-like syndrome and myocarditis. Eighteen had neurologic sequelae, including 7 with limb weakness, 5 with epilepsy, 2 with sixth cranial nerve palsy, 3 with cerebral palsy, 4 with psychomotor retardation , 2 with spasticity, and 1 with hearing loss. Factors associated with unfavorable outcomes (death or sequelae) included younger age (p=0.0003), higher peak white blood cell count (WBC) [p= 0.0009] and skin rash (p=0. 005). Younger age and higher peak WBC were poor prognostic factors of severe enterovirus CNS infection. Death was related to neonatal enterovirus infection and enterovirus 71 infection in young children.
|Appears in Collections:||醫學系|
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