Severe Encephalitis in Infant with COVID-19: A Case Report

Aspazija Sofijanova; Sonja  Bojadzieva; Filip Duma; Elizabeta Superlishka; Avdi Murtezani; Olivera Jordanova

doi:10.3889/oamjms.2020.5485

Authors

Aspazija Sofijanova Department of Intensive Care Unit, University Children’s Hospital, Ss Cyril and Methodius University, Skopje, Republic of Macedonia
Sonja Bojadzieva Department of Gastroenterology, University Children’s Hospital, Ss Cyril and Methodius University, Skopje, Republic of Macedonia
Filip Duma Department of Neurology, University Children’s Hospital, Ss Cyril and Methodius University, Skopje, Republic of Macedonia
Elizabeta Superlishka Department of Intensive Care Unit, University Children’s Hospital, Ss Cyril and Methodius University, Skopje, Republic of Macedonia
Avdi Murtezani Department of Gastroenterology, University Children’s Hospital, Ss Cyril and Methodius University, Skopje, Republic of Macedonia
Olivera Jordanova Department of Clinical Laboratory, University Children’s Hospital, Ss Cyril and Methodius University, Skopje, Republic of Macedonia

DOI:

https://doi.org/10.3889/oamjms.2020.5485

Keywords:

Encephalitis, Coronaviruses (CoVs), Infant

Abstract

BACKGROUND: Encephalitis is a serious condition that contains neurological dysfunction cause by inflammation of the brain tissue. Etiological factors for the occurrence of this condition include infectious and non-infectious causes.

CASE REPORT: We are presented 9-month-old infant referred to our clinic in convulsive status, fever, and disturbed consciousness. From anamnestic information, the infant has been febrile for 2 days with profuse vomiting initiating just before admission at the clinic. At the moment of admission in the clinic, the infant looked intoxicated with generalized tonic-clonic seizures, with shortness of breath and fever with a weakened reaction to painful stimuli. It was admitted in the Isolation Unit by the protocol of the clinic. Laboratory investigations were done. Due to the persistence of convulsive status, a computed tomography scan of the brain was performed with the finding of enlargement of the lateral ventricles, with intraventricular masses and pronounced internal hydrocephalus. The results of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) from the infant were positive as well as the grandmother. The infant was intubated immediately and put on mechanical ventilation SIPPV.

CONCLUSION: Our case report could suggest that SARS-CoV-2 infection may cause severe clinical symptoms, neurological manifestations, and encephalitis in infants.

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References

Hancock B. Re: Public Health and Wellbeing Amendment (No Jab, No Play) Bill; 2015.

Kennedy PG. Viral encephalitis: Causes, differential diagnosis, and management. J Neurol Neurosurg Psychiatry. 2004;75(Suppl 1):i10-5. PMid:14978145

Roos KL. Meningitis, encephalitis, brain abscess, and empyema. In: Harrison’s Principles of Internal Medicine. New York: McGraw Hill Education; 2008. p. 2621-41.

Fisher DL, Defres S, Solomon T. Measles-induced encephalitis. QJM. 2015;108(3):177-82. https://doi.org/10.1093/qjmed/hcu113 PMid:24865261

Larner AJ. Neuropsychological Neurology: The Neurocognitive Impairments of Neurological Disorders. Cambridge: Cambridge University Press; 2013. https://doi.org/10.1017/cbo9781139176095

Armangue T, Petit-Pedrol M, Dalmau J. Autoimmune encephalitis in children. J Child Neurol. 2012;27(11):1460-9. https://doi.org/10.1177/0883073812448838 PMid:22935553

Venkatesan A, Tunkel AR, Bloch KC, Lauring AS, Sejvar J, Bitnun A, et al. Case definitions, diagnostic algorithms, and priorities in encephalitis: Consensus statement of the international encephalitis consortium. Clin Infect Dis. 2013;57(8):1114-28. https://doi.org/10.3410/f.718040335.793486207 PMid:23861361

Kneen R, Michael BD, Menson E, Mehta B, Easton A, Hemingway C, et al. Management of suspected viral encephalitis in children association of British neurologists and British paediatric allergy, immunology and infection group national guidelines. J Infect. 2012;64(5):449-77. https://doi.org/10.1016/j.jinf.2011.11.013 PMid:22120594

Ito Y, Kimura H, Yabuta Y, Ando Y, Murakami T, Shiomi M, et al. Exacerbation of herpes simplex encephalitis after successful treatment with acyclovir. Clin Infect Dis. 2000;30(1):185-7. https://doi.org/10.1086/313618 PMid:10619751

Lewis P, Glaser CA. Encephalitis. Pediatr Rev. 2005;26(10):347.

Zekeridou A, Karantoni E, Viaccoz A, Ducray F, Gitiaux C, Villega F, et al. Treatment and outcome of children and adolescents with N-methyl-D-aspartate receptor encephalitis. PMid:25987208

Weiss SR, Leibowitz JL. Coronavirus pathogenesis. Adv Virus Res. 2011;81:85164. PMid:22094080

Masters PS, Perlman S. Coronaviridae. In: Knipe DM, Howley PM, editors. Fields Virology. 6th ed. Philidephia, PA: Lippincott Williams and Wilkins; 2013. p. 825-58.

Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470-3. https://doi.org/10.1016/s0140-6736(20)30185-9 PMid:31986257

Andersen KG, Rambaut A, Lipkin WI, Holmes EC, Garry RF. The proximal origin of SARS-CoV-2. Nat Med. 2020;26:450-2. https://doi.org/10.1038/s41591-020-0820-9 PMid:32284615

Li F. Receptor recognition mechanisms of coronaviruses: A decade of structural studies. J Virol. 2015;89:1954-64. PMid:25428871

Hoffmann M, Kleine-Weber H, Pöhlmann S. A multibasic cleavage site in the spike protein of SARS-CoV-2 is essential for infection of human lung cells. Mol Cell. 2020;78:779-84.e5. https://doi.org/10.1016/j.molcel.2020.04.022 PMid:32362314

Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J, et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Transl Res. 2020;220:1-13. https://doi.org/10.1016/j.trsl.2020.04.007 PMid:32299776

Zubair AS, McAlpine LS, Gardin T, Farhadian S, Kuruvilla DE, Spudich S. Neuropathogenesis and neurologic manifestations of the coronaviruses in the age of coronavirus disease 2019: A review. JAMA Neurol. 2020;77(8):1018-27. https://doi.org/10.1001/jamaneurol.2020.2065 PMid:32469387

Ye M, Ren Y, Lv T. Encephalitis as a clinical manifestation of COVID-19. Brain Behav Immun. 2020;88:945-6. PMid:32283294

Wang HY, Li XL, Yan ZR, Sun XP, Han J, Zhang BW. Potential neurological symptoms of COVID-19. Ther Adv Neurol Disord. 2020;13:1756286420917830. https://doi.org/10.1177/1756286420917830 PMid:32284735

Cruz AT, Zeichner SL. COVID-19 in children: Initial characterization of the pediatric disease. Pediatrics. 2020;145(6):e20200834. https://doi.org/10.1542/peds.2020-0834 PMid:32179659

Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020;58(4):712-3.

Zimmermann P, Curtis N. Coronavirus infections in children including COVID-19: An overview of the epidemiology, clinical features, diagnosis, treatment and prevention options in children. Pediatr Infect Dis J. 2020;39(5):355-68. https://doi.org/10.1097/inf.0000000000002660 PMid:32310621

Thompson C, Kneen R, Riordan A, Kelly D, Pollard AJ. Encephalitis in children. Arch Dis Child. 2012;97(2):150-61. https://doi.org/10.1136/archdischild-2011-300100 PMid:21715390

Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation and Treatment Coronavirus (COVID-19). Treasure Island, FL: StatPearls Publishing; 2020.

Singhal T. A review of coronavirus disease-2019 (COVID-19). Indian J Pediatr. 2020;87(4):281-6. PMid:32166607

Xia W, Shao J, Guo Y, Peng X, Li Z, Hu D. Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults. Pediatr Pulmonol. 2020;55(5):1169-74. https://doi.org/10.1002/ppul.24718 PMid:32134205

Gu J, Han B, Wang J. COVID-19: Gastrointestinal manifestations and potential fecal oral transmission. Gastroenterology. 2020;158(6):1518-9. https://doi.org/10.1053/j.gastro.2020.02.054 PMid:32142785

Mao L, Wang M, Chen S, He Q, Chang J, Hong C, et al. Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: A retrospective case series study. JAMA Neurol. 2020;77(6):683-69. https://doi.org/10.1101/2020.02.22.20026500 PMid:32275288