Top

Published in:

Open Access 01-12-2014 | Research

Acute cerebellitis in varicella: a ten year case series and systematic review of the literature

Authors: Elena Bozzola, Mauro Bozzola, Alberto Eugenio Tozzi, Valeria Calcaterra, Daniela Longo, Andrzej Krzystofiak, Alberto Villani

Published in: Italian Journal of Pediatrics | Issue 1/2014

Abstract

Background

Acute cerebellitis (AC) is the most common neurological complication of varicella. Nevertheless, it has been scarcely studied. The objective of this study were to asses the occurrence of AC among children hospitalized for varicella and to analyze its specific clinical picture and outcome.

Methods

We retrospectively reviewed the medical records of children admitted to the hospital for varicella between 1^st October 2003 and 1^st June 2013 and we compared our results with literature. Children were all unvaccinated for varicella.

Results

In our case series, AC was found out in 48 out of 457 patients (10.5%). The highest frequency of AC was observed in children from 1 to 5 years of age (60.9%). The most characteristic symptom of AC was a broad-based gait disturbance that progressed gradually over the course of a few days (95.8%). Other common symptoms included slurred speech (37.5%), vomiting (31.25%), headache (29.16%), dysmetry (25%) and tremor (22.91%). After a long hospitalization (median of 11 days), all but one children were dismissed without invalidating sequelae.

Conclusions

Data from this study may help to better address the problem of varicella cerebellar complications in hospitalized children and to monitor changes over time caused by an increase in vaccination coverage.

Available only for authorised users

Rack AL, Grote V, Streng A, Belohradsky BH, Heinen F, von Kries R, Liese JG: Neurologic varicella complications before routine immunization in Germany. Pediatr Neurol. 2010, 42 (1): 40-48. 10.1016/j.pediatrneurol.2009.07.012.CrossRefPubMed

Bozzola E, Tozzi AE, Bozzola M, Krzysztofiak A, Valentini D, Grandin A, Villani A: Neurological complications of varicella in childhood: case series and a systematic review of the literature. Vaccine. 2012, 30 (39): 5785-5790. 10.1016/j.vaccine.2012.05.057.CrossRefPubMed

Peterson CL, Mascola L, Chao SM, Lieberman JM, Arcinue EL, Blumberg DA, Kim KS, Kovacs A, Wong VK, Brunell PA: Children hospitalized for varicella: a prevaccine review. J Pediatr. 1996, 129 (4): 529-536. 10.1016/S0022-3476(96)70117-8.CrossRefPubMed

Marchetto S, de Benedictis FM, de Martino M, Versace A, Chiappini E, Bertaine C, Osimani P, Cordiali R, Gabiano C, Galli L: Epidemiology of hospital admissions for chickenpox in children: an Italian multicentre study in the pre-vaccine era. Acta Paediatr. 2007, 96 (10): 1490-1493. 10.1111/j.1651-2227.2007.00465.x.CrossRefPubMed

Salas AA, Nava A: Acute cerebellar ataxia in childhood: initial approach in the emergency department. Emerg Med J. 2010, 27 (12): 956-957. 10.1136/emj.2009.079376.CrossRefPubMed

Chi CY, Wang SM, Lin HC, Liu CC: Complications of varicella infection in children in southern Taiwan. J Microbiol Immunol Infect. 2006, 39 (5): 402-407.PubMed

Ryan MM, Engle EC: Acute ataxia in childhood. J Child Neurol. 2003, 18: e309-e316. 10.1177/08830738030180050901.CrossRef

Bonsignori F, Chiappini E, Frenos S, Peraldo M, Galli L, de Martino M: Hospitalization rates for complicated and uncomplicated chickenpox in a poorly vaccined pediatric population. Infection. 2007, 35 (6): 444-450. 10.1007/s15010-007-6248-z.CrossRefPubMed

Cameron JC, Allan G, Johnston F, Finn A, Heath PT, Booy R: Severe complications of chickenpox in hospitalised children in the UK and Ireland. Arch Dis Child. 2007, 92 (12): 1062-1066. 10.1136/adc.2007.123232.PubMedCentralCrossRefPubMed

10.

Chan JY, Tian L, Kwan Y, Chan W, Leung C: Hospitalizations for varicella in children and adolescents in a referral hospital in Hong Kong, 2004 to 2008: a time series study. BMC Public Health. 2011, 11: 366-10.1186/1471-2458-11-366.PubMedCentralCrossRefPubMed

11.

Elena B, Anna Q, Andrzej K, Elisabetta P, Laura L, Alberto T: Haematological complications in otherwise healthy children hospitalized for varicella. Vaccine. 2011, 29 (8): 1534-1537. 10.1016/j.vaccine.2010.12.095.CrossRefPubMed

12.

Frenos S, Galli L, Chiappini E, de Martino M: An increasing incidence of chickenpox central nervous system complications in children: what’s happening in Tuscany?. J Clin Virol. 2007, 38 (4): 358-361. 10.1016/j.jcv.2006.12.020.CrossRefPubMed

13.

Grimprel E, Levy C, de La Rocque F, Cohen R, Soubeyrand B, Caulin E, Derrough T, Lecuyer A, D’Athis P, Gaudelus J, Pediatricians Working Group: Paediatric varicella hospitalisations in France: a nationwide survey. Clin Microbiol Infect. 2007, 13 (5): 546-549. 10.1111/j.1469-0691.2007.01706.x.CrossRefPubMed

14.

Koturoglu G, Kurugöl Z, Cetin N, Hizarcioglu M, Vardar F, Helvaci M, Capar Z, Ozkinay F, Ozkinay C: Complications of varicella in healthy children in Izmir, Turkey. Pediatr Int. 2005, 47 (3): 296-299. 10.1111/j.1442-200x.2005.02054.x.CrossRefPubMed

15.

Liese JG, Grote V, Rosenfeld E, Fischer R, Belohradsky BH, v Kries R, ESPED Varicella Study Group: The burden of varicella complications before the introduction of routine varicella vaccination in Germany. Pediatr Infect Dis J. 2008, 27 (2): 119-124. 10.1097/INF.0b013e3181586665.CrossRefPubMed

16.

Losurdo G, Bertoluzzo L, Canale F, Timitilli A, Bondi E, Castagnola E, Giacchino R: Varicella and its complications as cause of hospitalization. Infez Med. 2005, 13 (4): 229-234.PubMed

17.

Ozdemir H, Candir MO, Karbuz A, Belet N, Tapisiz A, Ciftçi E, Ince E: Chickenpox complications, incidence and financial burden in previously healthy children and those with an underlying disease in Ankara in the pre-vaccination period. Turk J Pediatr. 2011, 53 (6): 614-625.PubMed

18.

Theodoridou M, Laina I, Hadjichristodoulou C, Syriopoulou V: Varicella-related complications and hospitalisations in a tertiary pediatric medical center before vaccine introduction. Eur J Pediatr. 2006, 165 (4): 273-274. 10.1007/s00431-005-0043-6.CrossRefPubMed

19.

Uduman SA, Sheek-Hussein M, Bakir M, Trad O, Al-Hussani M, Uduman J, Sheikhs F: Pattern of varicella and associated complications in children in Unite Arab Emirates: 5-year descriptive study. East Mediterr Health J. 2009, 15 (4): 800-806.PubMed

20.

van Lier A, van der Maas NA, Rodenburg GD, Sanders EA, de Melker HE: Hospitalization due to varicella in the Netherlands. BMC Infect Dis. 2011, 11: 85-10.1186/1471-2334-11-85.PubMedCentralCrossRefPubMed

21.

Bonhoeffer J, Baer G, Muehleisen B, Aebi C, Nadal D, Schaad UB, Heininger U: Prospective surveillance of hospitalisations associated with varicella-zoster virus infections in children and adolescents. Eur J Pediatr. 2005, 164 (6): 366-370. 10.1007/s00431-005-1637-8.CrossRefPubMed

22.

Balfour HH, Edelman CK, Anderson RS, Reed NV, Slivken RM, Marmor LH, Dix L, Aeppli D, Talarico CL: Controlled trial of acyclovir for chickenpox evaluating time of initiation and duration of therapy and viral resistance. Pediatr Infect Dis J. 2001, 20 (10): 919-926. 10.1097/00006454-200110000-00002.CrossRefPubMed

23.

Uchibori A, Sakuta M, Kusunoki S, Chiba A: Autoantibodies in postinfectious acute cerebellar ataxia. Neurology. 2005, 65: 1114-1116. 10.1212/01.wnl.0000178802.38268.1e.CrossRefPubMed

24.

Adams C, Diadori P, Schoenroth L, Fritzler M: Autoantibodies in childhood post varicella acute cerebellar ataxia. Can J Neurol Sci. 2000, 27: 316-320.CrossRefPubMed

25.

Fritzler MJ, Zhang M, Stinton LM, Rattner JB: Spectrum of centrosome autoantibodies in childhood varicella and post-varicella acute cerebellar ataxia. BMC Pediatr. 2003, 3: 11-10.1186/1471-2431-3-11.PubMedCentralCrossRefPubMed

26.

Gieron-Korthals MA, Westberry KR, Emmanuel PJ: A cute childhood ataxia: 10-year experience. J Child Neurol. 1994, 9: 381-10.1177/088307389400900408.CrossRefPubMed

27.

De Bruecker Y, Claus F, Demaerel P, Ballaux F, Sciot R, Lagot L, Buyse G, Willms G: MRI findings in acute cerebellitis. Eur Radiol. 2004, 14: 1478-CrossRefPubMed

28.

Camacho-Badilla K, Méndez I, Soriano-Fallas A, Ulloa-Gutiérrez R, Avila-Aguero ML: Postvaricella cerebellar ataxia in children in Costa Rica. An Pediatr (Barc). 2008, 68 (1): 49-53. 10.1157/13114471.CrossRef

29.

Heininger U, Seward JF: Varicella. Lancet. 2006, 368: 1365-1376. 10.1016/S0140-6736(06)69561-5.CrossRefPubMed

Title: Acute cerebellitis in varicella: a ten year case series and systematic review of the literature
Authors: Elena Bozzola
Mauro Bozzola
Alberto Eugenio Tozzi
Valeria Calcaterra
Daniela Longo
Andrzej Krzystofiak
Alberto Villani
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Italian Journal of Pediatrics / Issue 1/2014
Electronic ISSN: 1824-7288
DOI: https://doi.org/10.1186/1824-7288-40-57

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Acute cerebellitis in varicella: a ten year case series and systematic review of the literature

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2014

Prevalence of malnutrition among pre-school children in, South-east Nigeria

Predictive diagnostic value for the clinical features accompanying intellectual disability in children with pathogenic copy number variations: a multivariate analysis

Clinical heterogeneity of abnormal glucose homeostasis associated with the HNF4A R311H mutation

Psychotherapy versus usual care in pediatric migraine and tension-type headache: a single-blind controlled pilot study

SETIL: Italian multicentric epidemiological case–control study on risk factors for childhood leukaemia, non hodgkin lymphoma and neuroblastoma: study population and prevalence of risk factors in Italy

Efficacy of Grintuss® pediatric syrup in treating cough in children: a randomized, multicenter, double blind, placebo-controlled clinical trial