Nguyen Hoang Thien Huong, Nguyen Duc Toan, Tran Ba Thien, Truong Huu Khanh, Nguyen Minh Tuan, Tran Thanh Truc, Nguyen An Nghia, Le Quoc Thinh, Nguyen Thi Kim Thoa, Le Nguyen Thanh Nhan, Ngo Ngoc Quang Minh, Hugo C Turner, C Louise Thwaites, Nguyen Thanh Hung, Le Van Tan, Sarosh R Irani, Du Tuan Quy
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引用次数: 0
Abstract
Background: The recognition of autoimmune causes of encephalitis has led to epidemiological shifts in the worldwide characteristics of encephalitis. N-methyl-D-aspartate receptor (NMDAR) antibody encephalitis leads to well-established complex neuropsychiatric manifestations. In low- and middle-income countries, including Vietnam, its relative incidence, especially in children, is unknown and most neurologists currently consider infectious encephalitis prior to autoimmune etiologies.
Methods: The study was prospectively conducted at Children's Hospital 1 in Ho Chi Minh City between March 2020 and December 2022. Any child admitted to the Department of Infectious Diseases and Neurology fulfilling the case definition of encephalitis was eligible to participate. Cerebrospinal fluid samples were collected alongside meta-clinical data for analysis.
Results: We recruited 164 children with a clinical diagnosis of encephalitis. Etiologies were determined as NMDAR antibody encephalitis in 23 of 164 cases (14.0%), Japanese encephalitis virus in 14 of 164 (8.5%), and herpes simplex virus in 4 of 164 (2.4%). Clinical categorizations suggested idiopathic viral encephalitis in another 71 (43.3%), and autoimmune encephalitis of unknown origin in the remaining 52. Factors including demographics, specific clinical features, cerebrospinal fluid and electroencephalogram findings, and length of hospital stay were significantly different between NMDAR antibody encephalitis and Japanese encephalitis.
Conclusions: At a tertiary children's hospital in Vietnam, the prevalence of NMDAR antibody encephalitis exceeds that of Japanese encephalitis, the most common infectious encephalitis cause in Southeast Asia. NMDAR antibody encephalitis is associated with long hospital stay and poor outcomes. These findings should change pediatric diagnostics, to earlier consider autoimmune treatments in this clinical setting.
背景：对脑炎自身免疫性病因的认识导致了世界范围内脑炎特征的流行病学转变。n -甲基- d -天冬氨酸受体（NMDAR）抗体脑炎导致公认的复杂神经精神表现。在包括越南在内的低收入和中等收入国家，其相对发病率，特别是在儿童中，尚不清楚，大多数神经学家目前认为感染性脑炎先于自身免疫性病因。方法：该研究于2020年3月至2022年12月在胡志明市第一儿童医院进行前瞻性研究。任何进入传染病和神经病学科符合脑炎病例定义的儿童都有资格参加。收集脑脊液样本和meta临床数据进行分析。结果：我们招募了164名临床诊断为脑炎的儿童。164例中有23例（14.0%）为NMDAR抗体脑炎，14例（8.5%）为日本脑炎病毒，4例（2.4%）为单纯疱疹病毒。临床分类提示特发性病毒性脑炎71例（43.3%），其余52例为不明原因的自身免疫性脑炎。NMDAR抗体脑炎与日本脑炎的人口学特征、特殊临床特征、脑脊液和脑电图检查结果、住院时间等因素存在显著差异。结论：在越南的一家三级儿童医院，NMDAR抗体脑炎的患病率超过了东南亚最常见的感染性脑炎——日本脑炎。NMDAR抗体脑炎与住院时间长和预后差有关。这些发现应该改变儿科诊断，在这种临床环境中更早地考虑自身免疫治疗。
期刊介绍：
Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.
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