Cerebrospinal Fluid Neopterin in Children With Enterovirus-Related Brainstem Encephalitis.
Brain Stem
/ pathology
Child, Preschool
Encephalitis, Viral
/ cerebrospinal fluid
Encephalomyelitis
/ cerebrospinal fluid
Enterovirus A, Human
/ pathogenicity
Enterovirus Infections
/ cerebrospinal fluid
Female
Humans
Infant
Magnetic Resonance Imaging
Male
Neopterin
/ cerebrospinal fluid
Prospective Studies
Biomarkers
Brainstem encephalitis
EV-A71
Enterovirus
Neopterin
Journal
Pediatric neurology
ISSN: 1873-5150
Titre abrégé: Pediatr Neurol
Pays: United States
ID NLM: 8508183
Informations de publication
Date de publication:
07 2019
07 2019
Historique:
received:
15
09
2018
revised:
29
01
2019
accepted:
31
01
2019
pubmed:
3
4
2019
medline:
2
5
2020
entrez:
3
4
2019
Statut:
ppublish
Résumé
Enterovirus-A71 causes outbreaks of brainstem encephalitis, ranging from self-limited disease to acute flaccid paralysis. The aim of this study was to assess the role of cerebrospinal fluid (CSF) neopterin as a biomarker of disease severity in children with enterovirus-related brainstem encephalitis. A descriptive, prospective cohort study was conducted from April 2016 to March 2017 in a tertiary hospital. Pediatric patients with a diagnosis of brainstem encephalitis with or without myelitis due to enterovirus infection were enrolled. The final study group comprised a convenience sample including all patients with sufficient CSF volume for neopterin determination. The major variables considered in estimating the severity were the diagnosis of encephalomyelitis, the presence of lesions and extensive lesions on brain and spinal magnetic resonance imaging (MRI), hospital stay length greater than seven days, and sequelae at day 30. Of 60 patients, CSF neopterin could be measured in 36. Median age was 26 months (interquartile range: 19 to 32). Thirty-three were diagnosed with brainstem encephalitis and three with encephalomyelitis. Enterovirus-A71 was the only identified genotype (25 of 25). CSF neopterin levels were elevated (>61 nmol/L) in 33 of 36 (92%), with a median of 347 nmol/L (interquartile range: 204 to 525). CSF neopterin was useful to distinguish patients with lesions on MRI (area under the receiver operating characteristic curve = 0.76; P = 0.02) and extensive lesions (area under the receiver operating characteristic curve = 0.76; P = 0.04). This study suggests an association between CSF neopterin levels and the presence of inflammatory lesions on MRI.
Sections du résumé
BACKGROUND
Enterovirus-A71 causes outbreaks of brainstem encephalitis, ranging from self-limited disease to acute flaccid paralysis. The aim of this study was to assess the role of cerebrospinal fluid (CSF) neopterin as a biomarker of disease severity in children with enterovirus-related brainstem encephalitis.
METHODS
A descriptive, prospective cohort study was conducted from April 2016 to March 2017 in a tertiary hospital. Pediatric patients with a diagnosis of brainstem encephalitis with or without myelitis due to enterovirus infection were enrolled. The final study group comprised a convenience sample including all patients with sufficient CSF volume for neopterin determination. The major variables considered in estimating the severity were the diagnosis of encephalomyelitis, the presence of lesions and extensive lesions on brain and spinal magnetic resonance imaging (MRI), hospital stay length greater than seven days, and sequelae at day 30.
RESULTS
Of 60 patients, CSF neopterin could be measured in 36. Median age was 26 months (interquartile range: 19 to 32). Thirty-three were diagnosed with brainstem encephalitis and three with encephalomyelitis. Enterovirus-A71 was the only identified genotype (25 of 25). CSF neopterin levels were elevated (>61 nmol/L) in 33 of 36 (92%), with a median of 347 nmol/L (interquartile range: 204 to 525). CSF neopterin was useful to distinguish patients with lesions on MRI (area under the receiver operating characteristic curve = 0.76; P = 0.02) and extensive lesions (area under the receiver operating characteristic curve = 0.76; P = 0.04).
CONCLUSIONS
This study suggests an association between CSF neopterin levels and the presence of inflammatory lesions on MRI.
Identifiants
pubmed: 30935719
pii: S0887-8994(18)30986-X
doi: 10.1016/j.pediatrneurol.2019.01.024
pii:
doi:
Substances chimiques
Neopterin
670-65-5
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
70-73Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.