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2020

ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

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CENTRAL NERVOUS SYSTEM COMPLICATIONS OF VARICELLA-ZOSTER VIRUS IN CHILDHOOD: A 12-YEARS’ EXPERIENCE OF A PEDIATRIC HOSPITAL

Filipa Marujo1, José Pedro Vieira2, Catarina Gouveia1, Maria João Brito1

1- Infectious Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Central de Lisboa, Portugal
2- Pediatric Neurology Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Central de Lisboa, Portugal

- reunião internacional na ESPID 2019

Background: The varicella zoster virus (VZV) is a neurotropic herpesvirus. About 14%-20% of all pediatric varicella hospitalizations are due to neurologic complications.
Methods: Descriptive study of children admitted with neurological complications by VZV in a tertiary pediatric hospital, between 1st January 2006 and 31th December 2018. Epidemiological, clinical, therapeutic and evolution data were analyzed.
Results: 40 children (10.7%) of 375 varicella hospitalizations, had neurologic complications (median age 36 months; 65% male). Of these 80% were previously healthy,12/40 (30%) received previous oral acyclovir and one child was vaccinated. The time between rash onset and neurologic symptoms ranged from 1 to 4 days (median 4 days). Clinical syndromes included seizures (n=15), acute cerebellar ataxia (n=14), transient changes in neurological examination (n=2), encephalitis (n=3), acute disseminated encephalomyelitis (ADEM) (n=2), stroke (n=2), Guillain-Barre syndrome (n=1) and acute cerebellar edema (n=1).There was a trend for severe complications in older children (45vs36 months; p=0,086) and in children who received previous oral acyclovir (5/9). Median days between onset of rash and neurological symptoms were higher in patients with severe disease (8vs3days; p=0.026). All patients with severe disease underwent treatment with intravenous acyclovir. 7/9 of children with severe illness had either a motor deficit (4) or disturbed consciousness (3). Residual neurologic sequelae (hemiparesis) at one year occurred in one patient with hematologic disease undergoing bone marrow transplantation and ischemic stroke.
Conclusions: Nervous system complications are rare in childhood and can follow primary VZV infection even after vaccination or antiviral prophylactic therapy. Although severe illness can occur, the majority recover without neurologic sequelae.

Palavras Chave: complications, neurologic, varicella zoster virus