The Pediatric infectious disease journal · 2026
Diagnostic Challenges in Pediatric Infectious Encephalitis: Applicability of the International Encephalitis Consortium Criteria and Prognostic Factors in a Multicenter Study.
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García Bailo Celia, Alonso-Cadenas José Antonio, Cantarín Verónica, Bidaurrazaga García Klaudia Irati, Velasco Roberto, Calvo Cillán Alicia, Borrull Senra Ana María, López Fernández Cristina, Olaciregui Echenique Izaskun, Méndez Sánchez Alejandra, Campo Fernández Nathalie, Collazo Vallduriola Iris, González Abad María José, García Blanco Celia, de la Iglesia Rivaya Ana, Escolà Morales Laura, Figueroa Jiménez Sara, Valle T-Figueras Inés, Gómez Borja
Аннотация
BACKGROUND: The International Encephalitis Consortium (IEC) criteria are widely used to diagnose pediatric encephalitis, although their performance has not been evaluated.
OBJECTIVE: To evaluate IEC criteria in children with suspected encephalitis and identify prognostic factors associated with adverse outcomes.
METHODS: Secondary analysis of a retrospective multicenter study including children aged <18 years undergoing cerebrospinal fluid polymerase chain reaction testing for suspected encephalitis in 10 Spanish Pediatric Emergency Departments between 2017 and 2023. Patients were classified according to the IEC criteria. Children fulfilling the major criterion and 1 minor criterion plus pathogen confirmation were classified as subthreshold encephalitis. Multivariable logistic regression was used to identify prognostic factors for adverse outcomes.
RESULTS: Of 446 children, 118 met IEC criteria (60 confirmed, 15 probable, 43 possible encephalitis). Twenty additional cases were classified as subthreshold encephalitis. Rates of adverse outcomes were similar in both groups (31.4% vs. 30.0%). Independent predictors of adverse outcomes were abnormal neuroimaging (adjusted odds ratio [aOR], 3.2; 95% confidence interval [CI], 1.6-6.4; P < 0.001), focal neurologic deficits (aOR, 2.6; 95% CI, 1.3-5.2; P = 0.01), bacterial etiology (aOR, 2.7; 95% CI, 1.05-6.8; P = 0.03), seizures (aOR, 2.1; 95% CI, 1.0-4.5; P = 0.04) and microbiologic confirmation (aOR, 1.9; 95% CI, 1.0-3.6; P = 0.048).
CONCLUSIONS: Children with altered mental status and an encephalitis-associated pathogen but only 1 minor IEC criterion may represent missed encephalitis cases. Microbiologic confirmation, particularly bacterial etiology, and 3 minor IEC criteria were independently associated with worse outcomes, with abnormal neuroimaging being the strongest predictor.
OBJECTIVE: To evaluate IEC criteria in children with suspected encephalitis and identify prognostic factors associated with adverse outcomes.
METHODS: Secondary analysis of a retrospective multicenter study including children aged <18 years undergoing cerebrospinal fluid polymerase chain reaction testing for suspected encephalitis in 10 Spanish Pediatric Emergency Departments between 2017 and 2023. Patients were classified according to the IEC criteria. Children fulfilling the major criterion and 1 minor criterion plus pathogen confirmation were classified as subthreshold encephalitis. Multivariable logistic regression was used to identify prognostic factors for adverse outcomes.
RESULTS: Of 446 children, 118 met IEC criteria (60 confirmed, 15 probable, 43 possible encephalitis). Twenty additional cases were classified as subthreshold encephalitis. Rates of adverse outcomes were similar in both groups (31.4% vs. 30.0%). Independent predictors of adverse outcomes were abnormal neuroimaging (adjusted odds ratio [aOR], 3.2; 95% confidence interval [CI], 1.6-6.4; P < 0.001), focal neurologic deficits (aOR, 2.6; 95% CI, 1.3-5.2; P = 0.01), bacterial etiology (aOR, 2.7; 95% CI, 1.05-6.8; P = 0.03), seizures (aOR, 2.1; 95% CI, 1.0-4.5; P = 0.04) and microbiologic confirmation (aOR, 1.9; 95% CI, 1.0-3.6; P = 0.048).
CONCLUSIONS: Children with altered mental status and an encephalitis-associated pathogen but only 1 minor IEC criterion may represent missed encephalitis cases. Microbiologic confirmation, particularly bacterial etiology, and 3 minor IEC criteria were independently associated with worse outcomes, with abnormal neuroimaging being the strongest predictor.