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. 2025 Feb 4;20(2):e0318818.
doi: 10.1371/journal.pone.0318818. eCollection 2025.

High mortality rates and long-term complications in children with infectious brainstem encephalitis: A study of sixteen cases

Yuanyuan Zhou  1 , Yi Zhu  1 , Lingfeng Cao  2 , Yingyan Shi  3 , Jun Shen  1   4
Affiliations

High mortality rates and long-term complications in children with infectious brainstem encephalitis: A study of sixteen cases

Yuanyuan Zhou et al. PLoS One. .

Abstract

Objective: Brainstem encephalitis (BE) can cause sudden death in children. Fewer studies have been conducted on the incidence, clinical manifestations, pathogens and post-infectious sequelae of pediatric infectious BE.

Methods: Pediatric patients diagnosed with BE in our Medical Center from 01 January 2015 to 31 July 2024 were retrospectively reviewed. The clinical data of these children were obtained from the hospital's medical database on 15 August 2024. The number of outpatient and inpatient patients at our Medical Center during that period were provided by the hospital data center. Data analysis was conducted using Excel 2019.

Results: A total of twenty-eight cases were diagnosed with BE in our National Children's Medical Center over the past decade. Among them, 57.1% (16/28) cases were diagnosed with infectious BE. The incidence of infectious BE was estimated to be 16 cases per 30 million outpatient visits and 13 cases per 500,000 hospitalized patients. Fever, consciousness disorders and seizures were observed in 75.0% (12/16), 68.8% (11/16) and 62.5% (10/16) of the cases, respectively. Among them, 31.3% (5/16) cases were diagnosed as human enterovirus infections, 12.5% (2/16) cases were confirmed to be influenza B virus infections, while one case each was diagnosed with herpes simplex virus 1 and human herpesvirus 6 infection. The mortality rate during hospitalization was 12.5% (2/16). Among the surviving patients, 50.0% (7/14) of them had follow-up records, 85.7% (6/7) of the survivors suffered from sequelae such as motor disorders.

Conclusion: Fever, consciousness disorders and seizures were the major clinical manifestations in patients with infectious BE visited our Medical Center. These rare cases exhibited a notably high mortality rate and a significant frequency of long-term complications.

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Conflict of interest statement

NO authors have competing interests

Figures

Fig 1
Fig 1. Cranial MRI of a case presenting with infectious brainstem encephalitis.
The cranial MRI was conducted on the fourth day following admission for a seven-year-old boy diagnosed with HHV-6 BE, revealing a lesion site in the brainstem as indicated by the arrow.
See this image and copyright information in PMC

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Grants and funding

This study was supported by The National Key Research and Development Program of China (2022YFC2704901), the Project of Invigorating Health Care through Science, Technology and Education (Nantong Municipal Key Medical Discipline), and Beijing Natural Science Foundation (L242052). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.