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Neurological disease seen in SG children with enterovirus infections

Stephen Padilla
09 May 2017
The guideline aims to help doctors improve the lives of young people living with the debilitating condition.

A wide spectrum of neurological manifestations, including some unusual neurological disease presentations, has been identified in Singaporean children with enterovirus infections, according to a recent study. This results in a relatively low incidence of long-term neurological sequelae.

“In this study, we found that 75.0 percent of patients with documented enterovirus infections presented with some form of neurological manifestation,” researchers said. “This result is reflective of a population of patients who are diagnosed with enterovirus infection and require hospital admission.”

A total of 48 patients (age range, 6 days to 17.8 years) were diagnosed with enterovirus infection during the study period. There were 36 (75.0 percent) who developed some form of neurological manifestations, of whom 23 (63.9 percent) presented with aseptic meningitis, six (16.7 percent) presented with encephalitis and eight (22.2 percent) developed seizures during the acute illness. [Singapore Med J 2017;58:189-195]

Other neurological manifestations included acute cerebellitis (n=1), transverse myelitis (n=1) and autonomic dysfunction (n=1). Patients aged >1 year had a significantly higher incidence of neurological manifestations than younger patients (p=0.043). No mortalities or clinical presentations with polio-like syndrome were recorded.

Interestingly, long-term neurological sequelae remained low at 16.7 percent of patients with neurological manifestations.

“Nonetheless, some of these neurological morbidities were severe and, therefore, careful evaluation of children with neurological involvement is necessary,” researchers said.

Among those with no neurological manifestation, a significantly greater proportion presented with hand, foot and mouth disease (HFMD) and poor feeding. A higher proportion of patients with HFMD was seen among those who did not develop neurological manifestations vs those who developed such (33.3 vs 2.8 percent; p=0.011). No difference was observed in the prevalence of other non-neurological presentations among patients with and without neurological manifestations.

In this study, clinical data were collected retrospectively from patients admitted to National University Hospital, Singapore, from August 2007 to October 2011 and diagnosed with enterovirus infection, based on the enterovirus polymerase chain reaction test, or cultures form throat and rectal swabs or cerebrospinal fluid samples. Researchers then reviewed the occurrence of neurological manifestations and assessed clinical outcomes.

The major limitation of the study was the small number of patients in this cohort. “A larger number of patients may be necessary to verify significant results in future cohort studies,” researchers said.

“Further work needs to be done so that we can have a better understanding of the wide spectrum of disease presentations and clinical morbidities associated with enterovirus infections in the paediatric population,” they added.

One of the more common childhood infections, enterovirus infections are associated with significant neurological morbidity, including aseptic meningitis, encephalitis, polio-like syndrome and myoclonic jerks, said researchers. [J Korean Med Sci 2013;28:120-7; J Microbiol Immunol Infect 2004;37:82-7]

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