Article Text

25-YEAR EVALUATION OF PAEDIATRIC PATIENTS WITH ENCEPHALITIS IN THE PAEDIATRIC INTENSIVE CARE UNIT
  1. S Rodl1,
  2. I Marschitz2,
  3. M Brunner-Kainz3,
  4. E Sorantin4,
  5. G Zobel1
  1. 1PICU, Department of Paediatrics, University Hospital Graz, Graz, Austria
  2. 2Department of Paediatrics, University Hospital Graz, Graz, Austria
  3. 3Neurological Unit, Department of Paediatrics, University Hospital Graz, Graz, Austria
  4. 4Paediatric Radiology Unit, Department of Radiology, University Hospital Graz, Graz, Austria

Abstract

Introduction Encephalitis is a rare disease that occurs in children. The herpes simplex virus is one of the most dangerous infections leading to encephalitis. At the beginning, the symptoms of encephalitis may not be specific, but seizures or somnolence will lead to presentation in hospital.

Patients and Methods All patients with encephalitis and admission to our 12-bed paediatric intensive care unit (PICU) from 1985 to 2007, prospective study, documentation of prehospital illness, Glasgow coma scale (GCS), physiological scores at admission, chemistry of cerebrospinal fluid, computed tomography, magnetic resonance imaging and EEG.

Results We elected 40 patients in this study, mean age 7.1 ± 5.7 years. In 19 patients we found an infection with herpes simplex viruses, whereas in 17 patients we were not able to identify a specific virus. 14 patients presented a GCS less than 8. By means of magnetic resonance imaging, encephalitis was diagnosed in 17 of 32 patients. The EEG showed pathological findings in all patients, but only six patients showed specific signs of encephalitis. Nine of our patients with herpes simplex infection recovered completely, six of them had neurological defects and four of them died. In the patient group without herpes infection, 15 recovered completely, five of them had neurological defects and one patient died.

Discussion Patients with herpes simplex virus encephalitis showed a significantly worse outcome compared with patients without herpes simplex infection. Convulsions were found in 65% of patients with neurological deficits or death, but only 35% of patients experienced a complete remission.

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