Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Feb 11;14(1):106-111.
doi: 10.3390/idr14010014.

Challenges in the Diagnosis of Viral Encephalitis in Children: The Case of Two Siblings

Eleni Vergadi  1 , Maria Zacharioudaki  1 , Maria Raissaki  2 , Emmanouil Galanakis  1
Affiliations
Case Reports

Challenges in the Diagnosis of Viral Encephalitis in Children: The Case of Two Siblings

Eleni Vergadi et al. Infect Dis Rep. .

Abstract

Encephalitis in children may lead to adverse outcomes and long-term neurodevelopmental sequelae. The prompt identification of the causative agent is important to guide proper management in cases with encephalitis; however, the etiology often remains undetermined. The use of polymerase chain reaction (PCR) analysis in the cerebrospinal fluid (CSF) has increased the diagnostic yield in encephalitis cases; however, it may be occasionally misleading. In this article, we describe the case of a male immunocompetent child with encephalitis in which human herpesvirus-7 (HHV-7) was detected in CSF by PCR. As the detection of HHV-7 DNA in the CSF alone is insufficient to prove an etiologic association of severe encephalitis in immunocompetent children, alternative diagnoses were pursued. Enterovirus (E-11) was detected by PCR analysis of the nasopharyngeal and rectal swabs of the male patient. The final diagnosis was facilitated by the findings in his sibling, which presented concurrently with enteroviral encephalitis. Failure to detect enterovirus in the CSF by PCR does not exclude enteroviral encephalitis; screening of other samples, from other body sites, may be necessary to identify the virus, and physicians should take into consideration all evidence, including history, clinical presentation, and sick contacts' clinical status.

Keywords: HHV-7; children; encephalitis; enterovirus; neonates; seizures.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
MRI of the brain, FLAIR sequence (TR/TE/FA: 7000/135/150). (A–C): Axial images at presentation show hyperintense posterior part of the pons (arrow in (A)), swollen and hyperintense anteromedial (black arrow) and posteromedial (arrowheads) parts of the thalami in B, as well as a left-sided cortical hyperintensity (arrow in (C)). (D–F): Images at six-month follow-up, same sequence, respective planes, show complete resolution of findings.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Jain S., Patel B., Bhatt G.C. Enteroviral encephalitis in children: Clinical features, pathophysiology, and treatment advances. Pathog. Glob. Health. 2014;108:216–222. doi: 10.1179/2047773214Y.0000000145. - DOI - PMC - PubMed
    1. Messacar K., Fischer M., Dominguez S.R., Tyler K.L., Abzug M.J. Encephalitis in US Children. Infect. Dis. Clin. N. Am. 2018;32:145–162. doi: 10.1016/j.idc.2017.10.007. - DOI - PMC - PubMed
    1. Sadarangani M., Willis L., Kadambari S., Gormley S., Young Z., Beckley R., Gantlett K., Orf K., Blakey S., Martin N.G., et al. Childhood meningitis in the conjugate vaccine era: A prospective cohort study. Arch. Dis. Child. 2014;100:292–294. doi: 10.1136/archdischild-2014-306813. - DOI - PubMed
    1. Ekambaram M., Nabower A., Rajbhandari P., Eisenberg J., Goodrich N., Ampofo K., Gollehon N.S., Martin K.C., Lyden E., Snowden J. Evaluation of Discordant Results Between FilmArray Meningitis/Encephalitis Panel and Conventional Testing in Pediatric Patients: A Multisite Retrospective Cohort Study. J. Pediatric. Infect. Dis. Soc. 2022;10:piab126. doi: 10.1093/jpids/piab126. - DOI - PubMed
    1. Schwartz K.L., Richardson S.E., Ward K.N., Donaldson C., MacGregor D., Banwell B., Mahant S., Bitnun A. Delayed Primary HHV-7 Infection and Neurologic Disease. Pediatrics. 2014;133:e1541–e1547. doi: 10.1542/peds.2013-3344. - DOI - PubMed

Publication types