oxadiazoles and Encephalitis--Viral

A distinctive pattern of enterovirus 71 (EV71) infection, characterized by fever, exanthem, acute pulmonary edema (PE), brainstem encephalitis, and flaccid paresis, affects infants and young children. Most die rapidly owing to respiratory failure and fulminant PE.. The authors report short- and long-term outcome of six survivors of the acute illness.. In the context of acute PE and widespread weakness, recognition of the underlying neurologic disorder was facilitated by the distinctive pattern of MRI signal abnormalities in posterior pons and medulla. EV71-specific PCR of clinical samples helped confirm the diagnosis. Acute PE was managed with mechanical ventilation, afterload reduction, and inotrope support, and resolved completely over days. One patient with minimal neurologic recovery died 9 weeks after disease onset. The other patients have residual neurologic dysfunction, varying from subtle monoparesis to severe bulbar dysfunction, central and peripheral respiratory failure, and flaccid quadriparesis. Faster neurologic recovery was associated with less long-term deficit. Long-term outcome was similar in patients treated with and without pleconaril or IV immunoglobulin. Three long-term survivors treated with IV corticosteroids had less severe long-term neurologic disability than two not treated with steroids.. Acute pulmonary edema and encephalomyelitis occurs with EV71 infection in infants. Long-term neurologic outcome varied from minor, focal weakness to profound, global motor dysfunction with respiratory failure.

Topics: Acute Disease; Antiviral Agents; Child, Preschool; Combined Modality Therapy; Disease Outbreaks; Encephalitis, Viral; Enterovirus; Enterovirus Infections; Female; Follow-Up Studies; Humans; Immunoglobulins, Intravenous; Infant; Magnetic Resonance Imaging; Male; New South Wales; Oxadiazoles; Oxazoles; Pulmonary Edema; Survival Analysis; Survivors

During the Australian summer of 2000/2001, there was an outbreak of enterovirus 71 infection in Sydney. Between December 2000 and May 2001, approximately 200 children presented to Sydney Children's Hospital with hand-foot-and-mouth disease and 18 experienced neurologic complications. Four presented with acute invasive central nervous system disease and severe pulmonary edema. We describe the cardiorespiratory disturbances and intensive care management of these four consecutive children successfully treated for neurogenic pulmonary edema attributed to proven enterovirus 71 infection. All four survived the acute stage of the illness. However, all four have been left with significant debilitating morbidity. Epidemic enterovirus 71 brainstem encephalitis presenting as neurogenic pulmonary edema can be successfully managed in the pediatric intensive care unit but has great potential to yield a large number of handicapped toddlers and become "the poliomyelitis of the 21st century."

Topics: Antiviral Agents; Child, Preschool; Echocardiography; Encephalitis, Viral; Enterovirus; Enterovirus Infections; Female; Follow-Up Studies; Humans; Infant; Intensive Care Units, Pediatric; Magnetic Resonance Imaging; Male; Oxadiazoles; Oxazoles; Pulmonary Edema; Respiration, Artificial; Time Factors