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American Academy of Pediatrics
Article

Infectious and Autoimmune Causes of Encephalitis in Children

Timothy A. Erickson, Eyal Muscal, Flor M. Munoz, Timothy Lotze, Rodrigo Hasbun, Eric Brown and Kristy O. Murray
Pediatrics June 2020, 145 (6) e20192543; DOI: https://doi.org/10.1542/peds.2019-2543
Timothy A. Erickson
aSection of Pediatric Tropical Medicine, National School of Tropical Medicine,
bDepartment of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Houston, Texas;
fWilliam T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, Texas
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Eyal Muscal
gSection of Rheumatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas;
fWilliam T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, Texas
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Flor M. Munoz
cSection of Infectious Diseases,
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Timothy Lotze
dSection of Neurology, Department of Pediatrics, and
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Rodrigo Hasbun
eSection of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, Texas; and
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Eric Brown
bDepartment of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Houston, Texas;
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Kristy O. Murray
aSection of Pediatric Tropical Medicine, National School of Tropical Medicine,
fWilliam T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, Texas
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Abstract

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BACKGROUND AND OBJECTIVES: Encephalitis can result in neurologic morbidity and mortality in children. Newly recognized infectious and noninfectious causes of encephalitis have become increasingly important over the past decade.

METHODS: We retrospectively reviewed medical records from pediatric patients in Houston diagnosed with encephalitis in both an urban and rural catchment area between 2010 and 2017. We conducted an investigation to understand the etiology, clinical characteristics, and diagnostic testing practices in this population.

RESULTS: We evaluated 231 patients who met the case definition of encephalitis, among which 42% had no recognized etiology. Among those with an identified etiology, the most common were infectious (73; 31%), including viral (n = 51; 22%), with the most frequent being West Nile virus (WNV; n = 12), and bacterial (n = 19; 8%), with the most frequent being Bartonella henselae (n = 7). Among cases of autoimmune encephalitis (n = 60; 26%), the most frequent cause was anti–N-methyl-D-aspartate receptor (NMDAR) encephalitis (n = 31). Autoimmune causes were seen more commonly in female (P < .01) patients. Testing for herpes simplex virus and enterovirus was nearly universal; testing for anti-NMDAR encephalitis, WNV, and Bartonella was less common.

CONCLUSIONS: WNV was the most common infectious cause of encephalitis in our pediatric population despite lower testing frequency for WNV than herpes simplex virus or enterovirus. Increasing testing for anti-NMDAR encephalitis resulted in frequent identification of cases. Increased awareness and testing for WNV and Bartonella would likely result in more identified causes of pediatric encephalitis. Earlier etiologic diagnosis of encephalitides may lead to improve clinical outcomes.

  • Accepted March 19, 2020.
  • Copyright © 2020 by the American Academy of Pediatrics

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Pediatrics
Vol. 145, Issue 6
1 Jun 2020
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Infectious and Autoimmune Causes of Encephalitis in Children
Timothy A. Erickson, Eyal Muscal, Flor M. Munoz, Timothy Lotze, Rodrigo Hasbun, Eric Brown, Kristy O. Murray
Pediatrics Jun 2020, 145 (6) e20192543; DOI: 10.1542/peds.2019-2543

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Infectious and Autoimmune Causes of Encephalitis in Children
Timothy A. Erickson, Eyal Muscal, Flor M. Munoz, Timothy Lotze, Rodrigo Hasbun, Eric Brown, Kristy O. Murray
Pediatrics Jun 2020, 145 (6) e20192543; DOI: 10.1542/peds.2019-2543
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