title: Classification of acute encephalopathy in respiratory syncytial virus infection.
abstract: Infection with respiratory syncytial virus (RSV) is known to be associated with central nervous system symptoms such as convulsions. We investigated cytokines, nitrogen oxide (NO)(                            x                         ), and the viral genome in cerebrospinal fluid (CSF) obtained from children with RSV infection-related convulsions or central nervous symptoms and compared the data with type of encephalopathy. Of nine patients enrolled (six boys and three girls; aged 10 days-3 years), one metabolic error, five excitotoxicity, one cytokine storm, and two hypoxia cases were found. The patients presented with unilateral convulsions, generalized convulsions, and convulsions following cardiopulmonary arrest, apnea, and nuchal rigidity. In all patients, a rapid check for RSV of nasal fluid was positive. The RSV genome (subgroup A) was detected in the CSF of five of the nine patients; two patients with hypoxic encephalopathy were negative for the RSV genome. The CSF interleukin (IL)-6 levels were high only in patients with the excitotoxicity and cytokine storm type of encephalopathy. NO(                            x                         ) levels were high in all the subject cases. In the excitotoxicity type, NO(                            x                         ) levels were significantly higher than those in the control and other groups. NO(                            x                         ) level may become an important parameter for the diagnosis and classification of acute encephalopathy in RSV. Strategies to treat each type of encephalopathy, targeting cytokines and free radicals, should be established.
authors.affiliation: Department of Pediatrics, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. shinichiro-m@hotmail.co.jp
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Morichi
authors.forename: Hisashi
authors.initials: H
authors.lastname: Kawashima
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ioi
authors.forename: Gaku
authors.initials: G
authors.lastname: Yamanaka
authors.forename: Yasuyo
authors.initials: Y
authors.lastname: Kashiwagi
authors.forename: Akinori
authors.initials: A
authors.lastname: Hoshika
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Nakayama
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Watanabe
mesh_terms: D000208:Acute Disease; D002494:Central Nervous System Infections / Q000134:cerebrospinal fluid / Q000145:classification* / Q000821:virology; D002675:Child, Preschool; D003244:Consciousness Disorders / Q000134:cerebrospinal fluid / Q000821:virology; D016207:Cytokines / Q000134:cerebrospinal fluid; D005260:Female; D016679:Genome, Viral; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000134:cerebrospinal fluid / Q000821:virology; D007223:Infant; D007231:Infant, Newborn; D015850:Interleukin-6 / Q000134:cerebrospinal fluid; D008297:Male; D009589:Nitrogen Oxides / Q000134:cerebrospinal fluid; D012367:RNA, Viral / Q000134:cerebrospinal fluid; D018357:Respiratory Syncytial Virus Infections / Q000134:cerebrospinal fluid / Q000145:classification* / Q000821:virology; D012136:Respiratory Syncytial Viruses / Q000235:genetics / Q000302:isolation & purification; D012640:Seizures / Q000134:cerebrospinal fluid / Q000821:virology
chemical_list: D016207:Cytokines; D015850:Interleukin-6; D009589:Nitrogen Oxides; D012367:RNA, Viral