Viral etiological causes of febrile seizures for respiratory pathogens (EFES Study)

Abstract

Background: Febrile seizure is the most common childhood neurological disorder, is an important health problem with potential short-and long-term complications, also leading to economic burden and increased parental anxiety about fevers and seizures occurring in their children. There are no routine recommendation to detect etiological causes of FS for neurological perspective, further knowledge about the etiological causes of FS in children will support preventive measures and follow-up strategies. The aim of this study is to evaluate the percentage of respiratory viruses in children with FS. Methods: This prospective multicenter study, entitled "Viral etiological causes of febrile seizures for respiratory pathogens (EFES Study)" examined representative populations in eight different cities in Turkey between March 1, 2016 and April 1, 2017. Nasopharyngeal swabs were taken from all children at presentation. A respiratory multiplex array was performed to detect for influenza A and B; respiratory syncytial virus A and B; human parainfluenza virus 1-2-3 and 4; human coronavirus 229E and OC43; human rhinovirus; human enterovirus; human adenovirus; human bocavirus; human metapneumovirus. Results: During the study period, at least one virus was detected in 82.7% (144/174) of children with FS. The most frequently detected virus was adenovirus, followed by influenza A and influenza B. Detection of more than one virus was present in 58.3% of the children with FS, and the most common co-existence was the presence of adenovirus and influenza B. In children younger than 12 months, Coronavirus OC43 was the most common, while influenza A was most frequently observed in children older than 48 months (p < 0.05). Human bocavirus was common in children who experienced complex FS, while respiratory syncytial virus (RSV) A was more common in children who experienced simple FS. Influenza B virus was the most common virus identified in children who were experiencing their first incidence of FS (p < 0.05).Conclusions: This study indicates that respiratory viruses are important in the etiology of FS in children. The results show that antibiotics must be prescribed carefully in children with FS since the majority of cases are related to viral causes. Widespread use of the existing quadrivalent influenza vaccine might be useful for the prevention of FS related to the flu. Further vaccine candidates for potential respiratory pathogens, including RSV, might be helpful for the prevention of FS. ARTICLE HISTORY

Neurologic manifestations in an infant with COVID-19

“…5 Most febrile seizures occur in the setting of viral infections; most commonly adenovirus, followed by influenza, rhinovirus, and RSV with coronavirus OC43 are detected in children younger than 12 months old. 6 Our patient had COVID-19 in addition to rhinovirus confirmed on high throughput sequencing. Interestingly, a study of coronavirus-positive infants in the first 6 months of life noted a 27% coinfection rate with rhinovirus.…”

Broad spectrum antiviral remdesivir inhibits human endemic and zoonotic deltacoronaviruses with a highly divergent RNA dependent RNA polymerase

“…Unlike SARS- and MERS-CoV, which are known to cause more sporadic outbreaks, the other four human CoV are endemic causing annual widespread morbidity in infants and the elderly, potentially requiring hospitalization. ( Carman et al, 2018 ; Falsey et al, 2002 ; Varghese et al, 2018 ). Although rare, endemic human CoV like HCoV-229E and HCoV-OC43 can also cause severe respiratory disease (pneumonia, ARDS, etc.)…”

“…asthma, COPD) and the elderly ( Dijkman et al, 2012 ; Falsey et al, 2002 ). In children, severe respiratory tract CoV infections require hospitalization in about 10% of cases and have been associated with febrile seizure in those less than 1 year old ( Carman et al, 2018 ; Heimdal et al, 2019 ). CoV infection can also be severe in the elderly requiring hospitalization and can even cause acute respiratory distress syndrome (ARDS) ( Falsey et al, 2002 ; Vassilara et al, 2018 ).…”

Neurological manifestations of coronavirus infections – a systematic review

“…18,19 Another prospective multicenter study from Turkey included 192 children with febrile seizures and found that HCoV OC43 is the single most common, yet still rare, cause for febrile seizures in children under 12 months (6% of children under 12 months with febrile seizures were positive for OC43). 20 Finally, five case reports in children described the following neurological complications associated with the detection of coronavirus: acute flaccid paralysis, acute disseminated encephalomyelitis (ADEM), Guillain-Barr e syndrome (GBS) and two cases of fatal encephalitis (both in children with underlying immune deficiency), described in Table S4.…”