Childhood XXXX : viruses, immune response, and outcome.

@entity1 @entity198 @entity75 @entity16 @entity772 @entity1800 @entity3027
This study examined @entity1 with an acute @entity75 illness for evidence of @entity1800 , disordered blood-brain barrier function, intrathecal immunoglobulin synthesis, and interferon (IFN) production, and related their temporal occurrence to outcome. A prospective study of 22 @entity1 (13 males, 9 females; age range 1mo to 13y, median 2y 4mo), recorded clinical details, with serum and cerebrospinal fluid (CSF) analysis near presentation and then on convalescent specimens taken up to day 39 of the @entity16 . Outcome was assessed with standard scales between 18 months and 3 years after presentation. A history consistent with @entity1800 was given in 17 @entity1 but laboratory evidence of @entity1800 was found in only 7 (7/17). In 18 out of 21 @entity1 , an elevated CSF:serum albumin ratio indicative of impairment of the blood-CSF and blood-brain barriers was detected at some stage of the illness. In 14 of the 15 @entity1 with a raised immunoglobulin G index, and in 12 of the 14 @entity1 where the CSF was positive for oligoclonal bands, this was preceded by, or was observed at the same time as, an abnormal albumin ratio. Sixteen @entity1 (16/18) had elevated @entity3027 levels in serum, or CSF, or in both. We conclude that these findings indicate an initial disruption of the blood-brain barrier followed by intrathecal antibody production by activated lymphocytes, clonally restricted to a few antigens. This is the first in vivo study to show this as an important pathogenetic mechanism of @entity198 in @entity1 . Poor outcome was associated with young age, a deteriorating electroencephalogram pattern from grade 1 to grade 2, and the degree of @entity75 , particularly when prolonged, but not with Glasgow @entity772 Scale score. The persistence of @entity3027 was associated with a good prognosis.
