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Enteroviral and herpes simplex virus central nervous system infections in infants < 90 days old: a Paediatric Investigators’ Collaborative Network on Infections in Canada (PICNIC) study

BACKGROUND: The relative contribution of viruses to central nervous system (CNS) infections in young infants is not clear. For viral CNS infections, there are limited data on features that suggest HSV etiology or on predictors of unfavorable outcome. METHODS: In this cross-sectional retrospective st...

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Autores principales: Petel, Dara, Barton, Michelle, Renaud, Christian, Ouchenir, Lynda, Brophy, Jason, Bowes, Jennifer, Khan, Sarah, Bitnun, Ari, McDonald, Jane, Boisvert, Andrée-Anne, Ting, Joseph, Roberts, Ashley, Robinson, Joan L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249448/
https://www.ncbi.nlm.nih.gov/pubmed/32456669
http://dx.doi.org/10.1186/s12887-020-02151-4
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author Petel, Dara
Barton, Michelle
Renaud, Christian
Ouchenir, Lynda
Brophy, Jason
Bowes, Jennifer
Khan, Sarah
Bitnun, Ari
McDonald, Jane
Boisvert, Andrée-Anne
Ting, Joseph
Roberts, Ashley
Robinson, Joan L.
author_facet Petel, Dara
Barton, Michelle
Renaud, Christian
Ouchenir, Lynda
Brophy, Jason
Bowes, Jennifer
Khan, Sarah
Bitnun, Ari
McDonald, Jane
Boisvert, Andrée-Anne
Ting, Joseph
Roberts, Ashley
Robinson, Joan L.
author_sort Petel, Dara
collection PubMed
description BACKGROUND: The relative contribution of viruses to central nervous system (CNS) infections in young infants is not clear. For viral CNS infections, there are limited data on features that suggest HSV etiology or on predictors of unfavorable outcome. METHODS: In this cross-sectional retrospective study, seven centers from the Pediatric Investigators Collaborative Network on Infections in Canada identified infants < 90 days of age with CNS infection proven to be due to enterovirus (EV) or herpes simplex virus (HSV) January 1, 2013 through December 31, 2014. RESULTS: Of 174 CNS infections with a proven etiology, EV accounted for 103 (59%) and HSV for 7 (4%). All HSV cases and 41 (40%) EV cases presented before 21 days of age. Four HSV cases (57%) and 5 EV cases (5%) had seizures. Three (43%) HSV and 23 (23%) EV cases lacked cerebrospinal fluid (CSF) pleocytosis. HSV cases were more likely to require ICU admission (p = 0.010), present with seizures (p = 0.031) and have extra-CNS disease (p < 0.001). Unfavorable outcome occurred in 12 cases (11% of all EV and HSV infections) but was more likely following HSV than EV infection (4 (57%) versus 8 (8%); p = 0.002). CONCLUSIONS: Viruses accounted for approximately two-thirds of proven CNS infections in the first 90 days of life. Empiric therapy for HSV should be considered in suspected CNS infections in the first 21 days even in the absence of CSF pleocytosis unless CSF parameters are suggestive of bacterial meningitis. Neurodevelopmental follow-up should be considered in infants whose course of illness is complicated by seizures.
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spelling pubmed-72494482020-06-04 Enteroviral and herpes simplex virus central nervous system infections in infants < 90 days old: a Paediatric Investigators’ Collaborative Network on Infections in Canada (PICNIC) study Petel, Dara Barton, Michelle Renaud, Christian Ouchenir, Lynda Brophy, Jason Bowes, Jennifer Khan, Sarah Bitnun, Ari McDonald, Jane Boisvert, Andrée-Anne Ting, Joseph Roberts, Ashley Robinson, Joan L. BMC Pediatr Research Article BACKGROUND: The relative contribution of viruses to central nervous system (CNS) infections in young infants is not clear. For viral CNS infections, there are limited data on features that suggest HSV etiology or on predictors of unfavorable outcome. METHODS: In this cross-sectional retrospective study, seven centers from the Pediatric Investigators Collaborative Network on Infections in Canada identified infants < 90 days of age with CNS infection proven to be due to enterovirus (EV) or herpes simplex virus (HSV) January 1, 2013 through December 31, 2014. RESULTS: Of 174 CNS infections with a proven etiology, EV accounted for 103 (59%) and HSV for 7 (4%). All HSV cases and 41 (40%) EV cases presented before 21 days of age. Four HSV cases (57%) and 5 EV cases (5%) had seizures. Three (43%) HSV and 23 (23%) EV cases lacked cerebrospinal fluid (CSF) pleocytosis. HSV cases were more likely to require ICU admission (p = 0.010), present with seizures (p = 0.031) and have extra-CNS disease (p < 0.001). Unfavorable outcome occurred in 12 cases (11% of all EV and HSV infections) but was more likely following HSV than EV infection (4 (57%) versus 8 (8%); p = 0.002). CONCLUSIONS: Viruses accounted for approximately two-thirds of proven CNS infections in the first 90 days of life. Empiric therapy for HSV should be considered in suspected CNS infections in the first 21 days even in the absence of CSF pleocytosis unless CSF parameters are suggestive of bacterial meningitis. Neurodevelopmental follow-up should be considered in infants whose course of illness is complicated by seizures. BioMed Central 2020-05-26 /pmc/articles/PMC7249448/ /pubmed/32456669 http://dx.doi.org/10.1186/s12887-020-02151-4 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Petel, Dara
Barton, Michelle
Renaud, Christian
Ouchenir, Lynda
Brophy, Jason
Bowes, Jennifer
Khan, Sarah
Bitnun, Ari
McDonald, Jane
Boisvert, Andrée-Anne
Ting, Joseph
Roberts, Ashley
Robinson, Joan L.
Enteroviral and herpes simplex virus central nervous system infections in infants < 90 days old: a Paediatric Investigators’ Collaborative Network on Infections in Canada (PICNIC) study
title Enteroviral and herpes simplex virus central nervous system infections in infants < 90 days old: a Paediatric Investigators’ Collaborative Network on Infections in Canada (PICNIC) study
title_full Enteroviral and herpes simplex virus central nervous system infections in infants < 90 days old: a Paediatric Investigators’ Collaborative Network on Infections in Canada (PICNIC) study
title_fullStr Enteroviral and herpes simplex virus central nervous system infections in infants < 90 days old: a Paediatric Investigators’ Collaborative Network on Infections in Canada (PICNIC) study
title_full_unstemmed Enteroviral and herpes simplex virus central nervous system infections in infants < 90 days old: a Paediatric Investigators’ Collaborative Network on Infections in Canada (PICNIC) study
title_short Enteroviral and herpes simplex virus central nervous system infections in infants < 90 days old: a Paediatric Investigators’ Collaborative Network on Infections in Canada (PICNIC) study
title_sort enteroviral and herpes simplex virus central nervous system infections in infants < 90 days old: a paediatric investigators’ collaborative network on infections in canada (picnic) study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249448/
https://www.ncbi.nlm.nih.gov/pubmed/32456669
http://dx.doi.org/10.1186/s12887-020-02151-4
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