title: Outcome of Encephalitis in Pediatric Intensive Care Unit.
abstract: OBJECTIVE
  To review pathogens, morbidity and mortality in pediatric intensive care unit (PICU) patients with viral and infectious encephalitis.
  
  
  METHODS
  Retrospective chart review of all patients with encephalitis admitted to the PICU between 2002 and 2014 was done.
  
  
  RESULTS
  Encephalitis (n = 46) accounted for 2.7 % of PICU admissions, but 11.8 % PICU mortality over a 12-y period. A microorganism (primarily virus) was identified in 59 % of encephalitis patients in the PICU. Enteroviruses and herpes viruses were isolated from the cerebrospinal fluid (CSF). Respiratory viruses [such as respiratory syncytial virus (RSV) and influenza viruses] and enteric viruses (such as rotavirus and norovirus) were obtained in the nasopharyngeal aspirate and stool respectively, but undetectable from the CSF. More than one-fourth patients with encephalitis died in the PICU. Boys accounted for 85 % of nonsurvivors and 52 % survivors (p = 0.038). Mechanical ventilation, inotrope, intravenous immunoglobulin (IVIG) and corticosteroid usage were significantly higher among non-survivors (p 0.001-0.044). Binomial logistic regression showed that patients who received corticosteroid had a lower chance of survival than those who did not after adjusting for gender, IVIG and mechanical ventilation (adjusted odd ratio = 0.071, 95 % CI 0.006-0.881; p 0.039). Eighteen (55 %) of the survivors had moderate-to-severe neurodevelopmental impairments.
  
  
  CONCLUSIONS
  Encephalitis is associated with significant mortality despite intensive care. Over 25 % case died and 55 % of survivors had moderate-to-severe neurodevelopmental impairments. There appeared to be no emerging outbreaks of encephalitis during the 15-y study period.
authors.affiliation: Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, 6/F, Clinical Sciences Building, Shatin, Hong Kong. ehon@hotmail.com.
authors.forename: Kam-Lun Ellis
authors.initials: KL
authors.lastname: Hon
authors.affiliation: Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, 6/F, Clinical Sciences Building, Shatin, Hong Kong.
authors.forename: Yin Ching K
authors.initials: YC
authors.lastname: Tsang
authors.affiliation: Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, 6/F, Clinical Sciences Building, Shatin, Hong Kong.
authors.forename: Lawrence C N
authors.initials: LC
authors.lastname: Chan
authors.affiliation: Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, Hong Kong.
authors.forename: Hing Wing
authors.initials: HW
authors.lastname: Tsang
authors.affiliation: Department of Chemical Pathology, Alice Ho Miu Ling Nethersole Hospital, New Territories, Hong Kong, Hong Kong.
authors.forename: Kit Ying Kitty
authors.initials: KY
authors.lastname: Wong
authors.affiliation: Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, Hong Kong.
authors.forename: Yuet Hong Gordon
authors.initials: YH
authors.lastname: Wu
authors.affiliation: Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: Paul K S
authors.initials: PK
authors.lastname: Chan
authors.affiliation: Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, 6/F, Clinical Sciences Building, Shatin, Hong Kong.
authors.forename: Kam Lau
authors.initials: KL
authors.lastname: Cheung
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: Eric Y K
authors.initials: EY
authors.lastname: Ng
authors.affiliation: Division of Critical Care Medicine, Nicklaus Childrens Hospital, Miami, FL, USA.
authors.forename: Balagangadhar R
authors.initials: BR
authors.lastname: Totapally
mesh_terms: D002648:Child; D004660:Encephalitis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D011379:Prognosis; D012136:Respiratory Syncytial Viruses; D012189:Retrospective Studies
keywords: Encephalitis; Enteric virus; Enterovirus; Herpes virus; Morbidity; Mortality; PICU; Respiratory virus