Zhongguo quanke yixue (Jun 2023)
Clinical Characteristics and Risk Factors for Unfavourble Prognosis of Mycoplasma Pneumoniae Encephalitis in Children
Abstract
Background The incidence of Mycoplasma pneumoniae encephalitis (MPIE) in children has increased in recent years, but it is under-recognized by clinicians due to its heterogenous clinical presentations and limited diagnostic tools. Objective To analyze the clinical characteristics of children with MPIE and to explore the independent risk factors for unfavourble prognosis, so as to provide a theoretical basis for reducing the incidence of neurological sequelae and mortality of MPIE in children. Methods The clinical data of 101 children with MPIE who were hospitalized in Department of Neurology, Children's Hospital of Hebei Province from January 2020 to June 2022 were retrospectively analyzed. The Glasgow Outcome Scale (GOS) was used to assess the children's condition at discharge, by which they were divided into favourble prognosis group and unfavourble prognosis group. Clinical characteristics including demographics (age, gender, etc.) , clinical symptoms and signs, as well as auxiliary examination results〔laboratory tests related to Mycoplasma pneumoniae (MP) , cerebrospinal fluid (CSF) , electroencephalogram (EEG) and imaging, and immunological indicators〕and treatment were analyzed, and then compared between the two groups. Multivariate Logistic regression analysis was used to explore the independent risk factors for unfavourble prognosis of MPIE. Results The prevalence of favourble and unfavourble prognosis was 72.3% (73/101) and 27.7% (28/101) , respectively. Most of the children were of school age, and MPIE in them was mainly manifested by occurring sporadically throughout the year but with a relatively high incidence in winter and spring, acute onset, with fever as the most common symptom, lalopathy and dyskinesia and other focal lesions as the common neurological manifestations. Epilepsy was found in some cases, which may even develop into refractory status epilepticus. The prevalence of MP in CSF detected by PCR was 26.7% (27/101) . The EEG mainly showed slowing of background alpha rhythm. Brain MRI mainly showed long T1 and T2 signals in the involved region, and the abnormal rates of both were 68.3% (69/101) and 44.6% (45/101) , respectively. By tests for cellular immunity and humoral immunity, or the blood or CSF test in some children, anti-NMDAR, myelin oligodendrocyte glycoprotein and other immune encephalitis and demyelinating related antibodies could be detected. There were significant differences between favourble and unfavourble prognosis groups in the prevalence of psychobehavioral abnormality, disturbance of consciousness, epileptic seizures, status epilepticus, focal neurological dysfunction, EEG abnormalities, brain MRI abnormalities, hormone therapy and intravenous immunoglobulin therapy, as well as average level of white blood cell count in CSF (P<0.05) . Multivariate Logistic regression analysis showed that focal neurological dysfunction〔OR=6.292, 95%CI (1.188, 33.327) , P=0.035〕, status epilepticus〔OR=18.031, 95%CI (1.231, 264.082) , P=0.031〕, abnormal EEG〔OR=7.379, 95%CI (1.077, 50.548) , P=0.042〕, abnormal brain MRI〔OR=5.757, 95%CI (1.105, 30.003) , P=0.038〕, and requiring hormone therapy〔OR=12.441, 95%CI (1.082, 143.114) , P=0.043〕were independent risk factors for unfavourble prognosis in children with MPIE. Conclusion Focal neurological dysfunction, status epilepticus, abnormal EEG and brain MRI changes and the need for glucocorticoid therapy may be independent risk factors for unfavourble prognosis in children with MPIE, and clinicians should pay high attention to these factors to early identify them, so that the incidence of neurological sequelae and mortality of MPIE could be reduced.
Keywords
