Diagnostic markers of acute encephalitis syndrome and COVID-associated multisystem inflammatory syndrome in children from Southern India.

Autor: Damodar T; Department of Neurovirology, National Institute of Mental Health & Neurosciences, Bangalore, India., Dunai C; Department of Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.; National Institute for Health and Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK., Prabhu N; Department of Neurovirology, National Institute of Mental Health & Neurosciences, Bangalore, India., Jose M; Department of Neurovirology, National Institute of Mental Health & Neurosciences, Bangalore, India., Akhila L; Department of Neurovirology, National Institute of Mental Health & Neurosciences, Bangalore, India., Kinhal UV; Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bangalore, India., Anusha Raj K; Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bangalore, India., Marate S; Department of Neurovirology, National Institute of Mental Health & Neurosciences, Bangalore, India., Lalitha AV; Department of Pediatric Critical Care, St John's Medical College and Hospital, Bangalore, India., Dsouza FS; Department of Pediatrics, St John's Medical College and Hospital, Bangalore, India., Sajjan SV; Department of Pediatrics, Bangalore Medical College and Research Institute, Bangalore, India., Gowda VK; Department of Pediatrics, Indira Gandhi Institute of Child Health, Bangalore, India., Basavaraja GV; Department of Pediatrics, Indira Gandhi Institute of Child Health, Bangalore, India., Singh B; Tropical & Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK.; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.; Department of Infectious Diseases, Christian Medical College, Vellore, India., Prathyusha PV; Department of Biostatistics, National Institute of Mental Health & Neurosciences, Bangalore, India., Tharmaratnam K; Department of Health Data Science, Institute of Population Health, University of Liverpool, UK., Ravi V; Department of Neurovirology, National Institute of Mental Health & Neurosciences, Bangalore, India., Kolamunnage-Dona R; Department of Health Data Science, Institute of Population Health, University of Liverpool, UK., Solomon T; National Institute for Health and Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.; The Pandemic Institute, Liverpool, UK.; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK., Turtle L; Department of Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.; National Institute for Health and Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK., Yadav R; Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India., Michael BD; Department of Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.; National Institute for Health and Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.; The Pandemic Institute, Liverpool, UK.; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK., Mani RS; Department of Neurovirology, National Institute of Mental Health & Neurosciences, Bangalore, India.
Jazyk: angličtina
Zdroj: Journal of medical virology [J Med Virol] 2024 May; Vol. 96 (5), pp. e29666.
DOI: 10.1002/jmv.29666
Abstrakt: Acute encephalitis syndrome (AES) in children poses a significant public health challenge in India. This study aims to explore the utility of host inflammatory mediators and neurofilament (NfL) levels in distinguishing etiologies, assessing disease severity, and predicting outcomes in AES. We assessed 12 mediators in serum (n = 58) and 11 in cerebrospinal fluid (CSF) (n = 42) from 62 children with AES due to scrub typhus, viral etiologies, and COVID-associated multisystem inflammatory syndrome (MIS-C) in Southern India. Additionally, NfL levels in serum (n = 20) and CSF (n = 18) were examined. Clinical data, including Glasgow coma scale (GCS) and Liverpool outcome scores, were recorded. Examining serum and CSF markers in the three AES etiology groups revealed notable distinctions, with scrub typhus differing significantly from viral and MIS-C causes. Viral causes had elevated serum CCL11 and CCL2 compared with scrub typhus, while MIS-C cases showed higher HGF levels than scrub typhus. However, CSF analysis showed a distinct pattern with the scrub typhus group exhibiting elevated levels of IL-1RA, IL-1β, and TNF compared with MIS-C, and lower CCL2 levels compared with the viral group. Modeling the characteristic features, we identified that age ≥3 years with serum CCL11 < 180 pg/mL effectively distinguished scrub typhus from other AES causes. Elevated serum CCL11, HGF, and IL-6:IL-10 ratio were associated with poor outcomes (p = 0.038, 0.005, 0.02). Positive CSF and serum NfL correlation, and negative GCS and serum NfL correlation were observed. Median NfL levels were higher in children with abnormal admission GCS and poor outcomes. Measuring immune mediators and brain injury markers in AES provides valuable diagnostic insights, with the potential to facilitate rapid diagnosis and prognosis. The correlation between CSF and serum NfL, along with distinctive serum cytokine profiles across various etiologies, indicates the adequacy of blood samples alone for assessment and monitoring. The association of elevated levels of CCL11, HGF, and an increased IL-6:IL-10 ratio with adverse outcomes suggests promising avenues for therapeutic exploration, warranting further investigation.
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Databáze: MEDLINE
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