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Diagnostic challenges in pediatric infectious encephalitis: applicability of the international encephalitis consortium criteria and prognostic factors in a multicenter study
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Date
2026-10-19
Authors
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
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Publisher
Wolters Kluwer
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Abstract
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.
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Keywords
Pediatric Infectious encephalitis , International Encephalitis Consortium (IEC) , Suspected encephalitis
Citation
García Bailo, C., Alonso-Cadenas, J.A., Cantarín, V., Bidaurrazaga García, K.I., Velasco, R., Calvo Cillán, A., Borrull Senra, A.M., López Fernández, C., Olaciregui Echenique, I., Méndez Sánchez, A., Campo Fernández, N., Collazo Vallduriola, I., González Abad, M.J., García Blanco, C., De La Iglesia Rivaya, A., Escolà Morales, L., Figueroa Jiménez, S., Valle T-Figueras, I. and Gómez, B. (2026) 'Diagnostic challenges in pediatric infectious encephalitis: applicability of the international encephalitis consortium criteria and prognostic factors in a multicenter study', The Pediatric Infectious Disease Journal https://doi.org/10.1097/INF.0000000000005444
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