Key result
Among 7,735 children with suspected encephalitis, 4.27% were positive for enterovirus, which was associated with significant elevation of 28 cerebrospinal fluid cytokines compared to controls.
Why the study?
Enteroviruses are common causes of viral encephalitis in children, but the epidemiological and pathological characteristics of enterovirus encephalitis needed to be better understood.
Observational (n=7,735)
The study identifies age, sex, and seasonal patterns for enterovirus encephalitis in children and highlights significant dysregulation of multiple CSF cytokines.
Should not yet change encephalitis management; hypothesis-generating for cytokine-targeted approaches in enteroviral cases.
Enteroviruses (EVs) are common causes of viral encephalitis in children. To better understand the epidemiological and pathological characteristics of EV encephalitis, we enrolled suspected encephalitis patients younger than 15 years old in Hangzhou, China, from October 2016 to September 2019 for cerebrospinal fluid (CSF) collection and analyses. A total of 7735 CSF samples were collected, among which 330 (4.27%) were positive for the EV genome. The positivity rate was significantly higher in boys than girls ( χ 2 = 5.68, p = 0.02). The monthly case numbers peaked from June to August (80.30%). Among the different age groups, the 0–2 months age group showed the highest number of cases (28.48% of all cases). The 6–7 years (10.82%) and 9–10 years (9.29%) age groups showed the highest EV‐positivity rates among suspected encephalitis cases. Sixty‐two EV‐positive and 53 control CSF samples were collected for Bio‐Plex Pro human cytokine assays that simultaneously tested 48 cytokines. Principle component analyses showed significant separation between EV‐positive and control samples, but insignificant separation between children and newborns. The levels of 28 cytokines and chemokines were significantly elevated in the EV‐positive group including many proinflammatory and a few anti‐inflammatory cytokines, as well as chemokines belonging to the CC and CXC subfamilies. Only one cytokine, stem cell growth factor‐β, showed a decrease in the EV‐positive group. Thus, this study revealed age, sex, and seasonal preferences for EV encephalitis incidences in children and identified many cytokines dysregulated during EV encephalitis.
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Xu et al. (2021) conducted an observational in Enterovirus encephalitis (n=7,735). Enterovirus infection vs. Control (EV-negative) was evaluated on Enterovirus genome positivity in cerebrospinal fluid. Among 7,735 children with suspected encephalitis, 4.27% were positive for enterovirus, which was associated with significant elevation of 28 cerebrospinal fluid cytokines compared to controls.
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