Acute encephalitis and encephalopathy associated with human parvovirus B19 infection in children

Table 1 Basic characteristics of children with B19 encephalitis and encephalopathy

Case No.	Ref.	Age	Gender	Diagnosis	Underlying disorders	Immunodeficiency
1	[16]	8 yr	M	Encephalitis		-
2	[17]	9 mo	M	Encephalitis		-
3	[19,20]	5 yr	F	Encephalitis		-
4	[23,24]	2 mo	F	Encephalitis		-
5	[23,24]	2 yr	M	Encephalitis	Acute lymphocytic leukemia	+
6	[23,24]	2 yr	F	Encephalitis		-
7	[23,24]	6 yr	F	Encephalitis	Cockayne syndrome	+
8	[23,24]	9 yr	M	Encephalitis		-
9	[23,24]	13 yr	F	Encephalitis	Crigler-Najar syndrome	-
10	[23,34]	13 yr	M	Encephalitis		-
11	[23,34]	15 yr	F	Encephalitis		-
12	[23,24]	1 d	F	Encephalitis	Necrotizing enterocolitis Patent ductus arteriosus Respiratory distress syndrome	+
13	[23,24]	1 d	F	Encephalitis	Ventricular septal defect Atrial septal defect Patent ductus arteriosus Turner syndrome Obstructive jaundice	+
14	[25]	8 yr	F	Encephalitis	Sickle cell disease Nephrotic syndrome	+
15	[25]	8 yr	M	Encephalitis	Sickle cell disease Nephrotic syndrome	+
16	[25]	12 yr	F	Encephalitis	Sickle cell disease Aplastic crisis	+
17	[25]	14 yr	M	Encephalitis	Sickle cell disease Aplastic crisis	+
18	[27]	10 yr	F	Encephalitis		-
19	[28]	9 yr	M	Encephalitis	Nephropathic cystinosis Renal transplant	+
20	[30]	4 yr	F	Encephalitis		-
21	[31]	5 yr	F	Encephalitis and cerebellitis		-
22	[18]	8 yr	F	Encephalopathy		-
23	[19]	5 yr	F	Encephalopathy		-
24	[21]	5 yr	M	Encephalopathy		-
25	[22]	4 yr	M	Encephalopathy	Prader-Willi syndrome	-
26	[26]	13 yr	F	Encephalopathy	Sβ + thalassemia	+
27	[9]	8 yr	F	Chorea encephalopathy		-
28	[10]	1 yr	M	Chorea encephalopathy		-
29	[11]	1 yr	M	Chorea encephalopathy		-
30	[11]	1 yr	F	Chorea encephalopathy		-
31	[29]	9 yr	F	MERS	Hereditary spherocytosis	-
32	[12]	11 yr	M	MERS	Hereditary spherocytosis	-
33	[12]	10 yr	M	MERS	Hereditary spherocytosis	-
34	[13]	9 yr	F	PRES	Acute glomerulonephritis	-

MERS: Clinically mild encephalitis/encephalopathy with reversible splenial lesion; PRES: Posterior reversible encephalopathy syndrome; F: Female; M: Male.

Table 2 Clinical manifestations of children with B19 encephalitis and encephalopathy

Case	B19 related symptoms			Neurological manifestations			Complications	Sequelae or death
No.	Fever	Rash	Arthralgia	Unconsciousness	Seizure	Focal neurologic signs
1	+	+	+	+	-	+Neurogenic bladder		Left weakness and clonus
2	+	-	-	+	+	-		Psychomotor retardation
3	+	+	-	+	+	-	Status epilepticus	Epilepsy Mental retardation
4	+	-	-	+	+	-		-
5	+	-	-	+	-	-		Cognitive deficit
6	+	-	-	+	-	+Ataxia		-
7	-	-	-	+	-	-	Multiple organ failure Acute renal failure	Died
8	-	-	-	+	+	-		Cognitive deficit Epilepsy
9	-	-	-	+	-	-		Not determined
10	-	-	-	+	-	+ Right hemiparesis Ataxia		-
11	-	-	-	+	-	-		Cognitive deficit
12	-	-	-	+	-	-		Died
13	-	-	-	+	-	-		Died
14	-	-	-	+	+	+ Right hemiparesis Transient blindness	Acute renal failure Aplastic crisis Acute chest syndrome	-
15	-	-	-	+	+	+ Cortical blindness	Acute renal failure Aplastic crisis Acute chest syndrome	-
16	+	-	-	+	+	+ Focal seizures	Acute renal failure Acute chest syndrome	-
17	+	-	-	+	+	-		-
18	+	-	-	+	+	-	Status epilepticus	Epilepsy
19	-	-	+	+	+	-		-
20	+	-	-	+	+	+ Cerebellar syndrome		Cerebellar syndrome
21	+	+	-	+	+	-		Cerebellar syndrome
22	-	-	+	+	+	-		-
23	-	+	-	+	+	-		-
24	-	-	-	+	-	-	Pancytopenia Liver dysfunction	-
25	-	-	-	+	-	-		Spastic quadriplegia
26	+	-	-	+	-	-	Aplastic crisis	-
27	-	-	-	+	-	+ Chorea		-
28	-	-	-	+	-	+ Chorea		-
29	-	-	-	+	+	+ Left hemiparesis Athetosis		-
30	-	-	-	+	+	+ Left hemiparesis Choreo-athetosis		Global developmental delay
31	+	+	-	+	-	-	Aplastic crisis Pancytopenia	-
32	+	-	-	+	-	-	Aplastic crisis HLH Pancytopenia	-
33	+	-	-	+	-	-	Aplastic crisis HLH Pancytopenia	-
34	+	+	-	+	+	+ Loss of vision	Transient SLE symptoms Hypertension	-

HLH: Hemophagocytic lymphohistiocytosis; SLE: Systemic lupus erythematosus.

Table 3 Laboratory data and treatment of children with B19 encephalitis and encephalopathy

Case	Anemia	Serum B19 markers			CSF B19 markers			CSF		IVIG
No.		IgM	IgG	DNA	IgM	IgG	DNA	Pleocytosis	Increased protein	and/or steroids
1	-							+	-	-
2	-							-	+	-
3	-	+	+	+			-	+	+	-
4		-	-	-	-	-	+	-		IVIG
5					+	-	-	-	-	-
6	+				-	-	+	-	-	-
7	-				-	-	+			-
8	+	+	-	+	-	-	+			-
9	-						+			-
10	-						+	-		-
11	-						+	+		-
12	+	+	-	+	+	-	+			-
13	+	-	-	-	-	-	+			-
14	+	+	+	+				+		-
15	+	+	+	+				+		-
16	+	+	+	+				+		-
17	+	+	+	+				+		-
18	-	+	-		-	-		+	+	IVIG and steroids
19	+	+		+				+	+	-
20	-	-	-	+	-	-	+	+	-	IVIG and steroids
21	-	+	+	+			+	+	+	Steroids
22	+	+		+			+	-		-
23	-	+	+	+			+	-	+	-
24	+	+	+	+			+	-	+	-
25	-	+	+	+	-	-	+	+	+	-
26	+	+	+	-	-	-		-	-	Steroids
27	+			+			+	-	-	-
28	-	+	+				+	-	-	IVIG and steroids
29	-	+	-							-
30	+	+	-					+	-	-
31	+	-	+	+			+	-	-	Steroids
32	+							-	-	IVIG
33	+							-	-	IVIG
34	+	+	+	+			+	-	-	-

IVIG: Intravenous immunoglobulin; CSF: Cerebrospinal fluid.