J Korean Med Sci.  2023 Nov;38(46):e358. 10.3346/jkms.2023.38.e358.

Complications of the Central Nervous System in Pediatric Patients With Common Cold Coronavirus Infection During 2014–2019

• Park H
• Kim KR
• Huh HJ
• Yoon Y
• Park E
• Cho J
• Lee J
• Lee J
• Kim JH
• Kim YJ

• KMID: 2548540
• DOI: http://doi.org/10.3346/jkms.2023.38.e358

Abstract

Background
In pediatric patients, the common cold coronavirus (ccCoV) usually causes mild respiratory illness. There are reports of coronavirus causing central nervous system (CNS) infection in experimental animal models. Some immunocompromised patients have also been reported to have fatal CNS infections with ccCoV. The aim of this study was to investigate the clinical characteristics of CNS complications related to ccCoV infection.
Methods
From January 2014 to December 2019, a retrospective analysis was performed of medical records from hospitalized patients under 19 years of age whose ccCoV was detected through polymerase chain reaction in respiratory specimens. The CNS complications were defined as clinically diagnosed seizure, meningitis, encephalopathy, and encephalitis.
Results
A total of 436 samples from 420 patients were detected as ccCoV. Among the 420 patients, 269 patients were immunocompetent and 151 patients were immunocompromised. The most common type of ccCoV was OC43 (52% in immunocompetent, 37% in immunocompromised). CNS complications were observed in 9.4% (41/436). The most common type of CNS complication was the fever-provoked seizure under pre-existing neurologic disease (42% in immunocompetent and 60% in immunocompromised patients). Among patients with CNS complications, two immunocompetent patients required intensive care unit admission due to encephalitis. Three patients without underlying neurological disease started anti-seizure medications for the first time at this admission. There was no death related to ccCoV infection.
Conclusion
ccCoV infection may cause severe clinical manifestations such as CNS complications or neurologic sequelae, even in previously healthy children.

Keyword

Common Cold Coronavirus; Central Nervous System Infection; Pediatrics; Immunocompromised

Figure

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  Fig. 1 Overview of study flow.CNS = central nervous system, ICU = intensive care unit.aTwo deaths result from underlying due to cancer progression and chronic complications with graft-versus host disease after hematopoietic cell transplant, respectively.

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  Fig. 2 Brain magnetic resonance images of patients with encephalitis. (A-C), a 15-year-old previously healthy boy diagnosed with encephalitis and common ccCoV OC43 infection and admitted to the intensive care unit for three weeks. (A) Post-contrast T1-weighted image shows surface enhancement of the medulla (arrowhead) without other parenchymal lesion of the brain initially. (B) Follow-up T2-weighted axial image obtained two weeks later reveals high signal intensity at the bilateral insula, basal ganglia, thalami, and splenium (not shown), while improved leptomeningeal enhancement at the surface of the medulla (C). (D-G), an 8-year-old previously healthy girl diagnosed with encephalitis and common ccCoV OC43 infection and received methylprednisolone pulse treatment. Initial T2-weighted FLAIR axial (D) and coronal (E) images show swelling and high-signal intensity of the left insular, left frontal, and both temporooccipital gyri. Follow-up FLAIR images obtained 15 months later (F, G) show interval improvement of the gyral swelling.ccCoV = cold coronavirus, FLAIR = fluid-attenuated inversion recovery.

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