Dados do Trabalho

Título

EPIDEMIOLOGICAL PROFILE OF ENCEPHALITIS CASES IN A PUBLIC CHILDREN'S HOSPITAL IN SAO PAULO

Introdução

Encephalitis is an inflammation of the brain associated with clinical evidence of neurologic dysfunction. The main cause of encephalitis is viral. Although the gold standard test for diagnosis is a brain biopsy, it is rarely performed. Thus, indirect evidence of inflammation, and ancillary noninvasive tests, such as an altered cerebrospinal fluid (CSF), are essential to the diagnosis of encephalitis. More than 50% of cases of encephalitis will remain without determination of the etiologic agent, which will often impact on treatment and prognosis.

Objetivo

To describe the cases of encephalitis affecting children and adolescents in a pediatric public hospital in São Paulo, Brazil from 2020 to 2024.

Método

We analyzed the medical records of all patients with a CSF analysis from January 2020 to May 2024 in our hospital. We identified 85 patients and selected those who met the major criteria and at least two minor criteria for encephalitis by the 2013 International Encephalitis Consortium (n=29). We collected demographic data, clinical manifestations, and etiologic investigation data of the selected cases.

Resultados

29 patients were classified as having encephalitis. 48% were females (n=15) and median age was 3 (range 0-14). 86.2% (n=25) of the children were previously healthy. Four patients had comorbidities (immunosuppression n=2, asthma n=1, congenital heart disease n=1). 55.2% (n=16) of patients required ICU support and 31% (n=9) were intubated. Of the minor diagnosis criteria, 89.7% (n=26) of patients had fever, 44.8% (n=13) had a seizure, 55.2% (n=16) had focal neurological symptoms; 82.8% (n=24) had an increase in the CSF leukocyte count, 3.4% (n=1) had changes in computed tomography, and 17.2% (n=5) had changes in the electroencephalogram. CS PCR identified the etiological agent in 20.6% of cases (n=6), being human herpesvirus 1-2 (n=2), human herpesvirus 6 (n=1), Neisseria meningitidis (n=1), Haemohilus influenzae associated with Streptococcus pneumoniae (n=1) and Bocavirus (n=1). Serology was positive for herpes 1-2 IgM in 19.7% (n=5) of patients and for cytomegalovirus IgM in 6.8% (n=2).

Conclusão

Although PCR is an important diagnostic tool in cases of encephalitis, etiology was difficult to obtain in most cases. While the main cause of encephalitis is viral, some bacteria can penetrate the blood-brain barrier and also cause neurological symptoms. Serological tests can be helpful to identify the etiological agent, in order to establish the best possible treatment.

Referências

1. TUNKEL, Allan R.; GLASER, Carol A.; BLOCH, Karen C.; SEJVAR, James J.; MARRA, Christina M.; ROOS, Karen L.; HARTMAN, Barry J.; KAPLAN, Sheldon L.; SCHELD, W. Michael; WHITLEY, Richard J.. The Management of Encephalitis: clinical practice guidelines by the infectious diseases society of america. Clinical Infectious Diseases, [S.L.], v. 47, n. 3, p. 303-327, 1 ago. 2008. Oxford University Press (OUP). http://dx.doi.org/10.1086/589747.
2. VENKATESAN, A.; TUNKEL, A. R.; BLOCH, K. C.; LAURING, A. S.; SEJVAR, J.; BITNUN, A.; STAHL, J-P.; MAILLES, A.; DREBOT, M.; RUPPRECHT, C. E.. Case Definitions, Diagnostic Algorithms, and Priorities in Encephalitis: consensus statement of the international encephalitis consortium. Clinical Infectious Diseases, [S.L.], v. 57, n. 8, p. 1114-1128, 15 jul. 2013. Oxford University Press (OUP). http://dx.doi.org/10.1093/cid/cit458.
3. COSTA, Bruna Klein da; SATO, Douglas Kazutoshi. Viral encephalitis: a practical review on diagnostic approach and treatment. Jornal de Pediatria, [S.L.], v. 96, p. 12-19, mar. 2020. Elsevier BV. http://dx.doi.org/10.1016/j.jped.2019.07.006.
4. MESSACAR, Kevin; FISCHER, Marc; DOMINGUEZ, Samuel R.; TYLER, Kenneth L.; ABZUG, Mark J.. Encephalitis in US Children. Infectious Disease Clinics Of North America, [S.L.], v. 32, n. 1, p. 145-162, mar. 2018. Elsevier BV. http://dx.doi.org/10.1016/j.idc.2017.10.007.

Palavras Chave

Encephalitis; Children; epidemiological