Childhood encephalitis in the Greater Mekong region (the SouthEast Asia Encephalitis Project): A multicentre prospective study
Background: Encephalitis is a worldwide public health issue, with a substantially high burden among children in southeast Asia. We aimed to determine the causes of encephalitis in children admitted to hospitals across the Greater Mekong region by implementing a comprehensive state-of-the-art diagnostic procedure harmonised across all centres, and identifying clinical characteristics related to patients' conditions. Methods: In this multicentre, observational, prospective study of childhood encephalitis, four referral hospitals in Cambodia, Vietnam, Laos, and Myanmar recruited children (aged 28 days to 16 years) who presented with altered mental status lasting more than 24 h and two of the following minor criteria: fever (within the 72 h before or after presentation), one or more generalised or partial seizures (excluding febrile seizures), a new-onset focal neurological deficit, cerebrospinal fluid (CSF) white blood cell count of 5 per mL or higher, or brain imaging (CT or MRI) suggestive of lesions of encephalitis. Comprehensive diagnostic procedures were harmonised across all centres, with first-line testing was done on samples taken at inclusion and results delivered within 24 h of inclusion for main treatable causes of disease and second-line testing was done thereafter for mostly non-treatable causes. An independent expert medical panel reviewed the charts and attribution of causes of all the included children. Using multivariate analyses, we assessed risk factors associated with unfavourable outcomes (ie, severe neurological sequelae and death) at discharge using data from baseline and day 2 after inclusion. This study is registered with ClinicalTrials.gov, NCT04089436, and is now complete. Findings: Between July 28, 2014, and Dec 31, 2017, 664 children with encephalitis were enrolled. Median age was 4·3 years (1·8–8·8), 295 (44%) children were female, and 369 (56%) were male. A confirmed or probable cause of encephalitis was identified in 425 (64%) patients: 216 (33%) of 664 cases were due to Japanese encephalitis virus, 27 (4%) were due to dengue virus, 26 (4%) were due to influenza virus, 24 (4%) were due to herpes simplex virus 1, 18 (3%) were due to Mycobacterium tuberculosis, 17 (3%) were due to Streptococcus pneumoniae, 17 (3%) were due to enterovirus A71, 74 (9%) were due to other pathogens, and six (1%) were due to autoimmune encephalitis. Diagnosis was made within 24 h of admission to hospital for 83 (13%) of 664 children. 119 (18%) children had treatable conditions and 276 (42%) had conditions that could have been preventable by vaccination. At time of discharge, 153 (23%) of 664 children had severe neurological sequelae and 83 (13%) had died. In multivariate analyses, risk factors for unfavourable outcome were diagnosis of M tuberculosis infection upon admission (odds ratio 3·23 [95% CI 1·04–10·03]), coma on day 2 (2·90 [1·78–4·72]), supplementary oxygen requirement (1·89 [1·25–2·86]), and more than 1 week duration between symptom onset and admission to hospital (3·03 [1·68–5·48]). At 1 year after inclusion, of 432 children who were discharged alive from hospital with follow-up data, 24 (5%) had died, 129 (30%) had neurological sequelae, and 279 (65%) had completely recovered.
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S50 - Santé humaine encéphalite enfant hôpital enquête diagnostic analyse multivariée agent infectieux agent pathogène survie évolution collecte de données http://aims.fao.org/aos/agrovoc/c_10594 http://aims.fao.org/aos/agrovoc/c_1547 http://aims.fao.org/aos/agrovoc/c_24183 http://aims.fao.org/aos/agrovoc/c_7537 http://aims.fao.org/aos/agrovoc/c_2238 http://aims.fao.org/aos/agrovoc/c_28921 http://aims.fao.org/aos/agrovoc/c_92340 http://aims.fao.org/aos/agrovoc/c_5630 http://aims.fao.org/aos/agrovoc/c_7538 http://aims.fao.org/aos/agrovoc/c_2745 http://aims.fao.org/aos/agrovoc/c_2128 http://aims.fao.org/aos/agrovoc/c_29734 http://aims.fao.org/aos/agrovoc/c_7260 http://aims.fao.org/aos/agrovoc/c_4073 http://aims.fao.org/aos/agrovoc/c_8227 http://aims.fao.org/aos/agrovoc/c_12076 http://aims.fao.org/aos/agrovoc/c_1155 S50 - Santé humaine encéphalite enfant hôpital enquête diagnostic analyse multivariée agent infectieux agent pathogène survie évolution collecte de données http://aims.fao.org/aos/agrovoc/c_10594 http://aims.fao.org/aos/agrovoc/c_1547 http://aims.fao.org/aos/agrovoc/c_24183 http://aims.fao.org/aos/agrovoc/c_7537 http://aims.fao.org/aos/agrovoc/c_2238 http://aims.fao.org/aos/agrovoc/c_28921 http://aims.fao.org/aos/agrovoc/c_92340 http://aims.fao.org/aos/agrovoc/c_5630 http://aims.fao.org/aos/agrovoc/c_7538 http://aims.fao.org/aos/agrovoc/c_2745 http://aims.fao.org/aos/agrovoc/c_2128 http://aims.fao.org/aos/agrovoc/c_29734 http://aims.fao.org/aos/agrovoc/c_7260 http://aims.fao.org/aos/agrovoc/c_4073 http://aims.fao.org/aos/agrovoc/c_8227 http://aims.fao.org/aos/agrovoc/c_12076 http://aims.fao.org/aos/agrovoc/c_1155 |
spellingShingle |
S50 - Santé humaine encéphalite enfant hôpital enquête diagnostic analyse multivariée agent infectieux agent pathogène survie évolution collecte de données http://aims.fao.org/aos/agrovoc/c_10594 http://aims.fao.org/aos/agrovoc/c_1547 http://aims.fao.org/aos/agrovoc/c_24183 http://aims.fao.org/aos/agrovoc/c_7537 http://aims.fao.org/aos/agrovoc/c_2238 http://aims.fao.org/aos/agrovoc/c_28921 http://aims.fao.org/aos/agrovoc/c_92340 http://aims.fao.org/aos/agrovoc/c_5630 http://aims.fao.org/aos/agrovoc/c_7538 http://aims.fao.org/aos/agrovoc/c_2745 http://aims.fao.org/aos/agrovoc/c_2128 http://aims.fao.org/aos/agrovoc/c_29734 http://aims.fao.org/aos/agrovoc/c_7260 http://aims.fao.org/aos/agrovoc/c_4073 http://aims.fao.org/aos/agrovoc/c_8227 http://aims.fao.org/aos/agrovoc/c_12076 http://aims.fao.org/aos/agrovoc/c_1155 S50 - Santé humaine encéphalite enfant hôpital enquête diagnostic analyse multivariée agent infectieux agent pathogène survie évolution collecte de données http://aims.fao.org/aos/agrovoc/c_10594 http://aims.fao.org/aos/agrovoc/c_1547 http://aims.fao.org/aos/agrovoc/c_24183 http://aims.fao.org/aos/agrovoc/c_7537 http://aims.fao.org/aos/agrovoc/c_2238 http://aims.fao.org/aos/agrovoc/c_28921 http://aims.fao.org/aos/agrovoc/c_92340 http://aims.fao.org/aos/agrovoc/c_5630 http://aims.fao.org/aos/agrovoc/c_7538 http://aims.fao.org/aos/agrovoc/c_2745 http://aims.fao.org/aos/agrovoc/c_2128 http://aims.fao.org/aos/agrovoc/c_29734 http://aims.fao.org/aos/agrovoc/c_7260 http://aims.fao.org/aos/agrovoc/c_4073 http://aims.fao.org/aos/agrovoc/c_8227 http://aims.fao.org/aos/agrovoc/c_12076 http://aims.fao.org/aos/agrovoc/c_1155 Pommier, Jean-David Gorman, Christopher Crabol, Yoann Bleakley, Kevin Sothy, Heng Santy, Ky Tran, Huong Thi Thu Nguyen, Lam Van Bunnakea, Em Hlaing, Chaw Su Aye Mya Min, Aye Cappelle, Julien Herrant, Magali Piola, Patrice Rosset, Bruno Chevalier, Véronique Tarantola, Arnaud Channa, Mey SEAe Consortium, et al., Childhood encephalitis in the Greater Mekong region (the SouthEast Asia Encephalitis Project): A multicentre prospective study |
description |
Background: Encephalitis is a worldwide public health issue, with a substantially high burden among children in southeast Asia. We aimed to determine the causes of encephalitis in children admitted to hospitals across the Greater Mekong region by implementing a comprehensive state-of-the-art diagnostic procedure harmonised across all centres, and identifying clinical characteristics related to patients' conditions. Methods: In this multicentre, observational, prospective study of childhood encephalitis, four referral hospitals in Cambodia, Vietnam, Laos, and Myanmar recruited children (aged 28 days to 16 years) who presented with altered mental status lasting more than 24 h and two of the following minor criteria: fever (within the 72 h before or after presentation), one or more generalised or partial seizures (excluding febrile seizures), a new-onset focal neurological deficit, cerebrospinal fluid (CSF) white blood cell count of 5 per mL or higher, or brain imaging (CT or MRI) suggestive of lesions of encephalitis. Comprehensive diagnostic procedures were harmonised across all centres, with first-line testing was done on samples taken at inclusion and results delivered within 24 h of inclusion for main treatable causes of disease and second-line testing was done thereafter for mostly non-treatable causes. An independent expert medical panel reviewed the charts and attribution of causes of all the included children. Using multivariate analyses, we assessed risk factors associated with unfavourable outcomes (ie, severe neurological sequelae and death) at discharge using data from baseline and day 2 after inclusion. This study is registered with ClinicalTrials.gov, NCT04089436, and is now complete. Findings: Between July 28, 2014, and Dec 31, 2017, 664 children with encephalitis were enrolled. Median age was 4·3 years (1·8–8·8), 295 (44%) children were female, and 369 (56%) were male. A confirmed or probable cause of encephalitis was identified in 425 (64%) patients: 216 (33%) of 664 cases were due to Japanese encephalitis virus, 27 (4%) were due to dengue virus, 26 (4%) were due to influenza virus, 24 (4%) were due to herpes simplex virus 1, 18 (3%) were due to Mycobacterium tuberculosis, 17 (3%) were due to Streptococcus pneumoniae, 17 (3%) were due to enterovirus A71, 74 (9%) were due to other pathogens, and six (1%) were due to autoimmune encephalitis. Diagnosis was made within 24 h of admission to hospital for 83 (13%) of 664 children. 119 (18%) children had treatable conditions and 276 (42%) had conditions that could have been preventable by vaccination. At time of discharge, 153 (23%) of 664 children had severe neurological sequelae and 83 (13%) had died. In multivariate analyses, risk factors for unfavourable outcome were diagnosis of M tuberculosis infection upon admission (odds ratio 3·23 [95% CI 1·04–10·03]), coma on day 2 (2·90 [1·78–4·72]), supplementary oxygen requirement (1·89 [1·25–2·86]), and more than 1 week duration between symptom onset and admission to hospital (3·03 [1·68–5·48]). At 1 year after inclusion, of 432 children who were discharged alive from hospital with follow-up data, 24 (5%) had died, 129 (30%) had neurological sequelae, and 279 (65%) had completely recovered. |
format |
article |
topic_facet |
S50 - Santé humaine encéphalite enfant hôpital enquête diagnostic analyse multivariée agent infectieux agent pathogène survie évolution collecte de données http://aims.fao.org/aos/agrovoc/c_10594 http://aims.fao.org/aos/agrovoc/c_1547 http://aims.fao.org/aos/agrovoc/c_24183 http://aims.fao.org/aos/agrovoc/c_7537 http://aims.fao.org/aos/agrovoc/c_2238 http://aims.fao.org/aos/agrovoc/c_28921 http://aims.fao.org/aos/agrovoc/c_92340 http://aims.fao.org/aos/agrovoc/c_5630 http://aims.fao.org/aos/agrovoc/c_7538 http://aims.fao.org/aos/agrovoc/c_2745 http://aims.fao.org/aos/agrovoc/c_2128 http://aims.fao.org/aos/agrovoc/c_29734 http://aims.fao.org/aos/agrovoc/c_7260 http://aims.fao.org/aos/agrovoc/c_4073 http://aims.fao.org/aos/agrovoc/c_8227 http://aims.fao.org/aos/agrovoc/c_12076 http://aims.fao.org/aos/agrovoc/c_1155 |
author |
Pommier, Jean-David Gorman, Christopher Crabol, Yoann Bleakley, Kevin Sothy, Heng Santy, Ky Tran, Huong Thi Thu Nguyen, Lam Van Bunnakea, Em Hlaing, Chaw Su Aye Mya Min, Aye Cappelle, Julien Herrant, Magali Piola, Patrice Rosset, Bruno Chevalier, Véronique Tarantola, Arnaud Channa, Mey SEAe Consortium, et al., |
author_facet |
Pommier, Jean-David Gorman, Christopher Crabol, Yoann Bleakley, Kevin Sothy, Heng Santy, Ky Tran, Huong Thi Thu Nguyen, Lam Van Bunnakea, Em Hlaing, Chaw Su Aye Mya Min, Aye Cappelle, Julien Herrant, Magali Piola, Patrice Rosset, Bruno Chevalier, Véronique Tarantola, Arnaud Channa, Mey SEAe Consortium, et al., |
author_sort |
Pommier, Jean-David |
title |
Childhood encephalitis in the Greater Mekong region (the SouthEast Asia Encephalitis Project): A multicentre prospective study |
title_short |
Childhood encephalitis in the Greater Mekong region (the SouthEast Asia Encephalitis Project): A multicentre prospective study |
title_full |
Childhood encephalitis in the Greater Mekong region (the SouthEast Asia Encephalitis Project): A multicentre prospective study |
title_fullStr |
Childhood encephalitis in the Greater Mekong region (the SouthEast Asia Encephalitis Project): A multicentre prospective study |
title_full_unstemmed |
Childhood encephalitis in the Greater Mekong region (the SouthEast Asia Encephalitis Project): A multicentre prospective study |
title_sort |
childhood encephalitis in the greater mekong region (the southeast asia encephalitis project): a multicentre prospective study |
url |
http://agritrop.cirad.fr/601216/ http://agritrop.cirad.fr/601216/1/Pommier%20et%20al%20%20SEAe%20LGH%202022.pdf |
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dig-cirad-fr-6012162024-01-29T19:06:11Z http://agritrop.cirad.fr/601216/ http://agritrop.cirad.fr/601216/ Childhood encephalitis in the Greater Mekong region (the SouthEast Asia Encephalitis Project): A multicentre prospective study. Pommier Jean-David, Gorman Christopher, Crabol Yoann, Bleakley Kevin, Sothy Heng, Santy Ky, Tran Huong Thi Thu, Nguyen Lam Van, Bunnakea Em, Hlaing Chaw Su, Aye Mya Min Aye, Cappelle Julien, Herrant Magali, Piola Patrice, Rosset Bruno, Chevalier Véronique, Tarantola Arnaud, Channa Mey, SEAe Consortium, et al.. 2022. Lancet. Global Health, 10 (7) : e989-e1002.https://doi.org/10.1016/S2214-109X(22)00174-7 <https://doi.org/10.1016/S2214-109X(22)00174-7> Childhood encephalitis in the Greater Mekong region (the SouthEast Asia Encephalitis Project): A multicentre prospective study Pommier, Jean-David Gorman, Christopher Crabol, Yoann Bleakley, Kevin Sothy, Heng Santy, Ky Tran, Huong Thi Thu Nguyen, Lam Van Bunnakea, Em Hlaing, Chaw Su Aye Mya Min, Aye Cappelle, Julien Herrant, Magali Piola, Patrice Rosset, Bruno Chevalier, Véronique Tarantola, Arnaud Channa, Mey SEAe Consortium, et al., eng 2022 Lancet. Global Health S50 - Santé humaine encéphalite enfant hôpital enquête diagnostic analyse multivariée agent infectieux agent pathogène survie évolution collecte de données http://aims.fao.org/aos/agrovoc/c_10594 http://aims.fao.org/aos/agrovoc/c_1547 http://aims.fao.org/aos/agrovoc/c_24183 http://aims.fao.org/aos/agrovoc/c_7537 http://aims.fao.org/aos/agrovoc/c_2238 http://aims.fao.org/aos/agrovoc/c_28921 http://aims.fao.org/aos/agrovoc/c_92340 http://aims.fao.org/aos/agrovoc/c_5630 http://aims.fao.org/aos/agrovoc/c_7538 http://aims.fao.org/aos/agrovoc/c_2745 http://aims.fao.org/aos/agrovoc/c_2128 Mékong Asie du Sud-Est Cambodge Viet Nam République démocratique populaire lao Myanmar http://aims.fao.org/aos/agrovoc/c_29734 http://aims.fao.org/aos/agrovoc/c_7260 http://aims.fao.org/aos/agrovoc/c_4073 http://aims.fao.org/aos/agrovoc/c_8227 http://aims.fao.org/aos/agrovoc/c_12076 http://aims.fao.org/aos/agrovoc/c_1155 Background: Encephalitis is a worldwide public health issue, with a substantially high burden among children in southeast Asia. We aimed to determine the causes of encephalitis in children admitted to hospitals across the Greater Mekong region by implementing a comprehensive state-of-the-art diagnostic procedure harmonised across all centres, and identifying clinical characteristics related to patients' conditions. Methods: In this multicentre, observational, prospective study of childhood encephalitis, four referral hospitals in Cambodia, Vietnam, Laos, and Myanmar recruited children (aged 28 days to 16 years) who presented with altered mental status lasting more than 24 h and two of the following minor criteria: fever (within the 72 h before or after presentation), one or more generalised or partial seizures (excluding febrile seizures), a new-onset focal neurological deficit, cerebrospinal fluid (CSF) white blood cell count of 5 per mL or higher, or brain imaging (CT or MRI) suggestive of lesions of encephalitis. Comprehensive diagnostic procedures were harmonised across all centres, with first-line testing was done on samples taken at inclusion and results delivered within 24 h of inclusion for main treatable causes of disease and second-line testing was done thereafter for mostly non-treatable causes. An independent expert medical panel reviewed the charts and attribution of causes of all the included children. Using multivariate analyses, we assessed risk factors associated with unfavourable outcomes (ie, severe neurological sequelae and death) at discharge using data from baseline and day 2 after inclusion. This study is registered with ClinicalTrials.gov, NCT04089436, and is now complete. Findings: Between July 28, 2014, and Dec 31, 2017, 664 children with encephalitis were enrolled. Median age was 4·3 years (1·8–8·8), 295 (44%) children were female, and 369 (56%) were male. A confirmed or probable cause of encephalitis was identified in 425 (64%) patients: 216 (33%) of 664 cases were due to Japanese encephalitis virus, 27 (4%) were due to dengue virus, 26 (4%) were due to influenza virus, 24 (4%) were due to herpes simplex virus 1, 18 (3%) were due to Mycobacterium tuberculosis, 17 (3%) were due to Streptococcus pneumoniae, 17 (3%) were due to enterovirus A71, 74 (9%) were due to other pathogens, and six (1%) were due to autoimmune encephalitis. Diagnosis was made within 24 h of admission to hospital for 83 (13%) of 664 children. 119 (18%) children had treatable conditions and 276 (42%) had conditions that could have been preventable by vaccination. At time of discharge, 153 (23%) of 664 children had severe neurological sequelae and 83 (13%) had died. In multivariate analyses, risk factors for unfavourable outcome were diagnosis of M tuberculosis infection upon admission (odds ratio 3·23 [95% CI 1·04–10·03]), coma on day 2 (2·90 [1·78–4·72]), supplementary oxygen requirement (1·89 [1·25–2·86]), and more than 1 week duration between symptom onset and admission to hospital (3·03 [1·68–5·48]). At 1 year after inclusion, of 432 children who were discharged alive from hospital with follow-up data, 24 (5%) had died, 129 (30%) had neurological sequelae, and 279 (65%) had completely recovered. article info:eu-repo/semantics/article Journal Article info:eu-repo/semantics/publishedVersion http://agritrop.cirad.fr/601216/1/Pommier%20et%20al%20%20SEAe%20LGH%202022.pdf text cc_by_nc_nd info:eu-repo/semantics/openAccess https://creativecommons.org/licenses/by-nc-nd/4.0/ https://doi.org/10.1016/S2214-109X(22)00174-7 10.1016/S2214-109X(22)00174-7 info:eu-repo/semantics/altIdentifier/doi/10.1016/S2214-109X(22)00174-7 info:eu-repo/semantics/altIdentifier/purl/https://doi.org/10.1016/S2214-109X(22)00174-7 |