1 - Paediatrics Infectious Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
2 - Paediatrics Neurology Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
3 - Neurorradiology Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
4 - Infectious Diseases Department, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
- Apresentação oral em reunião internacional: 41st Annual Meeting of the European Society for Paediatric Infectious Diseases
Introduction: Enterovirus A71 (EV-71) is a common cause of hand-foot-mouth disease but has emerged as a neurotropic agent. Our aim was to characterize clinical features and evolution of children with EV-71 neurologic disease admitted to a paediatric tertiary center.
Methods: Retrospective observational study of paediatric patients (<18 years) with neurologic disease and detection of EV-71 from any biologic specimen in a tertiary-level hospital in Portugal, over a 5-year period (2018-2022).
Results: Five children were identified, with a median age of 26 months (min 16 days, max 4 years old), 3 males and 4 became ill during September-October. The diagnosis were rhombencephalitis (2/5), rhombencephalomyelitis (n=1) and aseptic meningitis (n=1). Other diagnosis was viral sepsis with positive CSF EV71 PCR. Neurological symptoms identified were drowsiness (4/5), ataxia (2/5), non epileptic myoclonic jerks (1/5), hypotonia (1/5), diplopia (1/5) and dysautonomia (1/5). Other non-neurological symptoms were fever (4/5), vomiting (4/5), exanthema (2/5) and herpangina (2/5). CSF showed pleocytosis in 4/5 patients, 2/4 polymorphonuclear. MRI (n=3) showed increased T2-weighted signal in the dorsal part of the brainstem, 2/3 involving the cerebellum and 1/3 including cervical and dorsal myelitis. PCR detected enterovirus in nasopharyngeal (5/5), stool (5/5), CSF (2/5) and blood (1/1). Three patients were treated: intravenous immunoglobulin (incipient bulbar symptoms-diplopia) (1/3), methylprednisolone (severe lethargy) (1/3) and both (flaccid paresis with autonomic dysregulation) (1/3). One patient required PICU admission. Median length of stay was 7 days [4;15]. At one month follow-up, no neurologic sequelae were found.
Conclusions: EV-71 can cause serious neurologic disease. Early recognition and timely intervention are the key to reducing morbidity and mortality in moderate to severe neurologic disease. Randomized controlled trials are crucial to define best therapeutic management of these patients.
Palavras Chave: ataxia, enterovirus, EV-A71, rhombenchephalitis.