Microbiologic Findings in Acute Facial Palsy in Children

Microbiologic Findings in Acute Facial Palsy in Children

OBJECTIVEMicrobiologic causes of facial palsy in children were investigated. STUDY DESIGNProspective clinical study. SETTINGTertiary referral center. PATIENTSForty-six children aged 0 to 16 years with peripheral facial palsy. INTERVENTIONSPaired serum samples and cerebrospinal fluid were tested to f...

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Published in:Otology & neurotology Vol. 34; no. 7; pp. e82 - e87
Main Authors: Kanerva, Mervi, Nissinen, Janne, Moilanen, Kirsi, Mäki, Minna, Lahdenne, Pekka, Pitkäranta, Anne
Format: Journal Article
Language:English
Published: United States Copyright by Otology & Neurotology, Inc. Image copyright Wolters Kluwer Health/Anatomical Chart Company 01-09-2013
Subjects:
Acute Disease
Adolescent
Animals
Antibodies, Bacterial - analysis
Antibodies, Bacterial - cerebrospinal fluid
Antibodies, Viral - analysis
Antibodies, Viral - cerebrospinal fluid
Bacterial Infections - complications
Bacterial Infections - microbiology
Bell Palsy - microbiology
Bell Palsy - virology
Borrelia - immunology
Child
Child, Preschool
Female
Humans
Infant
Leukocyte Count
Lyme Neuroborreliosis - classification
Lyme Neuroborreliosis - microbiology
Male
Prospective Studies
Ticks
Virus Diseases - complications
Virus Diseases - virology
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Summary:OBJECTIVEMicrobiologic causes of facial palsy in children were investigated. STUDY DESIGNProspective clinical study. SETTINGTertiary referral center. PATIENTSForty-six children aged 0 to 16 years with peripheral facial palsy. INTERVENTIONSPaired serum samples and cerebrospinal fluid were tested to find indications of microbes associated with facial palsy. The microbes tested were herpes simplex virus 1 and 2, varicella-zoster virus, human herpesvirus-6, Mycoplasma pneumoniae, Borrelia burgdorferi, influenza A and B virus, picorna, cytomegalovirus, parainfluenza virus, respiratory syncytial virus, coxsackie B5 virus, adenovirus, and enterovirus, Chlamydia psittaci, and Toxoplasma gondii. Besides the routine tests in clinical practice, serum and cerebrospinal fluid samples were tested with a highly sensitive microarray assay for DNA of herpes simplex virus 1 and 2; human herpes virus 6A, 6B, and 7; Epstein-Barr virus, cytomegalovirus, and varicella zoster virus. RESULTSIncidence for facial palsy was 8.6/100,000/children/year. Cause was highly plausible in 67% and probable in an additional 11% of cases. Borrelia burgdorferi caused facial palsy in 14 patients (30%), varicella zoster virus in 5 (11%) (one with concomitant adenovirus), influenza A in 3 (6%), herpes simplex virus 1 in 2 (4%) (one with concomitant enterovirus), otitis media in 2 (4%), and human herpesvirus 6 in 2 (4%). Mycoplasma pneumoniae, neurofibromatosis, and neonatal age facial palsy affected 1 child (2%) each. CONCLUSIONMicrobiologic etiology association of pediatric facial palsy could frequently be confirmed. Borreliosis was the single most common cause; hence, cerebrospinal fluid sampling is recommended for all pediatric cases in endemic areas. Varicella zoster virus accounted for 11% of the cases, being the second most common factor.
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ISSN:1531-7129
1537-4505
DOI:10.1097/MAO.0b013e318289844c