Çocuklarda ansefalit: 27 vakanın sunumu

Amaç: Son 9 yıl içinde takip ettiğimiz ansefalitli olgularımızın etiyolojik ajanlar, klinik tablo ve prognoz yönünden incelenmesi amaçlanmıştır. Yöntemler: 2000-2008 yılları arasında ansefalit tanısı ile yatırılıp tedavi edilen hastaların kayıtları retrospektif olarak incelendi. Bulgular: Araştırma döneminde 27 hasta ansefalit tanısı aldı. Hastaların ortanca yaşı 90 ay (5 ay-15 yıl) ve erkek/kız oranı 2/1 idi. Başvuru sırasındaki en sık yakınmalar ateş (%85), bilinç değişiklikleri (%77), konvülsiyon (%59), baş ağrısı (%59) ve kusma (%52) olarak tespit edildi. On yedi (%63) hastada etken saptandı, saptanan etkenler; kabakulak virüsü (4 hasta), kızamıkçık virüsü (4 hasta), Epstein Barr virüs (3 hasta), herpes simpleks virüs tip 1 (2 hasta), sitomegalovirüs (1 hasta), kızamık virüsü (1 hasta), varisella zoster virüs (1 hasta) ve enterovirüs (1 hasta) idi. On hastada ise etken saptanamadı. Beş hastada sekel gelişti. Bir hasta ise kaybedildi. Sonuç: Ansefalitlerde etken dağılımı geniştir. Epidemiyolojik özelliklere ve aşılama programlarına göre görülen etkenler zaman içinde değişiklik gösterebilir. Vakaların önemli bir kısmında etken saptanamamaktadır. Ülkemizde de ansefalitlerde etken tanımlama ve uygun tedavi olasılığı arttıkça ve the patients aşıları ile aşılı çocukların sayısı arttıkça morbidite ve mortalite azalacaktır.

Encephalitis in children: Presentation of 27 cases

Objective: To determine the etiology, clinical presentation and prognosis of the patients with encephalitis in the last nine years. Methods: Data from patients with encephalitis treated between 2000 and 2008 were examined retrospectively. Results: Twenty seven patients were diagnosed as encephalitis. The median age of the patients was 90 months (5 months-15 years) and male/female ratio was 2/1. The most common symptoms on admission were fever (85%), alterations in consciousness (77%), convulsion (59%), headache (59%), and vomiting (52%). In 17 (63%) patients, the etiological agents were determined, which were mumps virus (4 patients), rubella virus (4 patients), Epstein-Barr virus (3 patients), herpes simplex virus type 1 (2 patients), cytomegalovirus (1 patient), measles virus (1 patient), varicella-zoster virus (1 patient) and enterovirus (1 patient). In 10 patients, the etiological agents could not be found. In five patients, permanent sequelae developed. One patient died. Conclusion: The spectrum of the etiological agents of encephalitis is vast. These agents can change with time according to epidemiological features and vaccination programs. The agents could not be detected in the majority of the cases. In our country, the morbidity and the mortality will decrease as the possibilities for detection of etiological agents and administration of appropriate treatment and the proportion of the patients vaccinated with measles-mumps-rubella and chickenpox vaccines increases.

Kaynakça

1. Clarke M, Newton RW, Klapper PE, Sutcliffe H, Laing I, Wallace G. Childhood encephalopathy: viruses, immune response, and outcome. Dev Med Child Neurol 2006; 48 : 294-300.

2. Koskiniemi M, Rautonen J, Lehtokoski-Lehtiniemi E, Vaheri A. Epidemiology of encephalitis in children: a 20-year survey. Ann Neurol 1991; 29: 492-7.

3. Rautonen J, Koskiniemi M, Vaheri A. Prognostic factors in childhood acute encephalitis. Pediatr Infect Dis J 1991; 10: 441-6.

4. Koskiniemi M, Korppi M, Mustonen K, et al. Epidemiology of encephalitis in children. A prospective multicentre study. Eur J Pediatr 1997; 156: 541-5.

5. Kolski H, Ford-Jones EL, Richardson S, et al. Etiology of acute childhood encephalitis at the hospital for sick children, Toronto, 1994-1995. Clin Infect Dis 1998; 26: 398-409.

6. Lahat E, Barr J, Barkai G, Paret G, Brand N, Barzilai A. Long term neurological outcome of herpes encephalitis. Arch Dis Child 1999; 80: 69-71.

7. Cizman M, Jazbec J. Etiology of acute encephalitis in childhood in Slovenia. Pediatr Infect Dis J 1993; 12: 903-8.

8. Klein SK, Hom DL, Anderson MR, Latrizza AT, Toltzis P. Predictive factors of short-term neurologic outcome in children with encephalitis. Pediatr Neurol 1994; 11: 308-12.

9. Xu Y, Zhaori G, Vene S, et al. Viral etiology of acute childhood encephalitis in Beijing diagnosed by analysis of single samples. Pediatr Infect Dis J 1996; 15: 1018-24.

10. Ilias A, Galanakis E, Raissaki M, Kalmanti M. Childhood encephalitis in Crete, Greece. J Child Neurol 2006; 21: 910-2.

11. Glaser CA, Gilliam S, Schnurr D, et al. In search of encephalitis etiologies: diagnostic challenges in the California Encephalitis Project, 1998-2000. Clin Infect Dis 2003; 36: 731-42.

12. Aygun AD, Kabakus N, Celik I, et al. Long-term neurological outcome of acute encephalitis. J Trop Pediatr 2001; 47: 243-7.

13. Lewis P, Glaser CA. Encephalitis. Pediatr Rev 2005; 26: 353-63.

14. Khetsuriani N, Holman RC, Anderson LJ. Burden of encephalitis-associated hospitalizations in the United States, 1988-1997. Clin Infect Dis 2002; 35: 175-82.

15. Fowler A, Stödberg T, Eriksson M, Wickström R. Childhood encephalitis in Sweden: Etiology, clinical presentation and outcome. Eur J Pediatr Neurol 2008; 12: 484-90.

16. Uysal G, Köse G, Kızılateş S, Yılmaz N, Güven A. Akut ansefalitli olgularda etiyolojik ve klinik değerlendirme. T Klin Pediatri 1999; 8: 199-204.

17. Chokephaibulkit K, Kankirawatana P, Apintanapong S, et al. Viral etiologies of encephalitis in Thai children. Pediatr Infect Dis J 2001; 20: 216-8.

18. Casrouge A, Zhang SY, Eidenschenk C, et al. Herpes simplex virus encephalitis in human UNC-93B deficiency. Science 2006; 314: 308-12.

19. Aurelius E, Johansson B, Skoldenberg B, Staland A, Forsgren M. Rapid diagnosis of herpes simplex encephalitis by nested polymerase chain reaction assay of cerebrospinal fluid. Lancet 1991; 337: 189-92.

20. Huang CC, Liu CC, Chang YC, Chen CY, Wang ST, Yeh TF. Neurologic complications in children with enterovirus 71 infection. N Engl J Med 1999; 341: 936-42.

21. Willoughby RE, Long SS. Encephalitis, meningoencephalitis, acute disseminated encephalomyelitis, and acute necrotizing encephalopathy. In: Long SS, Pickering LK, Prober CG (eds). Principles and Practice of Pediatric Infectious Diseases. 3th edition. Philadelphia: Churchill Livingstone Elsevier; 2008. p. 310-8.

22. Stanberry LR. Herpes simplex virus. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF (eds). Nelson Textbook of Pediatrics. 18th edition. Philadelphia: Saunders Elsevier; 2007. p. 1360-6.

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