{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T04:25:00Z","timestamp":1782361500859,"version":"3.54.5"},"reference-count":30,"publisher":"Centers for Disease Control and Prevention (CDC)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Emerg. Infect. Dis."],"published-print":{"date-parts":[[2026,2]]},"DOI":"10.3201\/eid3202.250549","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T01:43:55Z","timestamp":1770687835000},"page":"169-179","source":"Crossref","is-referenced-by-count":1,"title":["Life-Threatening SARS-CoV-2\u2013Associated Encephalopathy and Multiorgan Failure in Children, Asia and Oceania, 2022\u20132024"],"prefix":"10.3201","volume":"32","author":[{"given":"Mariko","family":"Kasai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Sakuma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motomasa","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Nishiyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nanako","family":"Kawata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jainn-Jim","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuang-Lin","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Velda","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shekeeb S.","family":"Mohammad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell C.","family":"Dale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terrence","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Muramatsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osamu","family":"Mitani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiyuki","family":"Kobayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kouhei","family":"Ishida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichi","family":"Abe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ichiro","family":"Kuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-ichi","family":"Takanashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1822","reference":[{"key":"key-10.3201\/eid3202.250549-202602201412-R1","doi-asserted-by":"publisher","first-page":"1085082","DOI":"10.3389\/fnins.2023.1085082","article-title":"Severe pediatric acute encephalopathy syndromes related to SARS-CoV-2.","volume":"17","author":"Sakuma","year":"2023","journal-title":"Front Neurosci"},{"key":"key-10.3201\/eid3202.250549-202602201412-R2","doi-asserted-by":"publisher","first-page":"122867","DOI":"10.1016\/j.jns.2024.122867","article-title":"Clinical characteristics of SARS-CoV-2-associated encephalopathy in children: Nationwide epidemiological study.","volume":"457","author":"Kasai","year":"2024","journal-title":"J Neurol Sci"},{"key":"key-10.3201\/eid3202.250549-202602201412-R3","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1111\/dmcn.16067","article-title":"International consensus definitions for infection-triggered encephalopathy syndromes.","volume":"67","author":"Sakuma","year":"2025","journal-title":"Dev Med Child Neurol"},{"key":"key-10.3201\/eid3202.250549-202602201412-R4","doi-asserted-by":"publisher","first-page":"985","DOI":"10.1136\/adc.67.8.985","article-title":"Haemorrhagic shock encephalopathy syndrome in the British Isles.","volume":"67","author":"Bacon","year":"1992","journal-title":"Arch Dis Child"},{"key":"key-10.3201\/eid3202.250549-202602201412-R5","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1093\/jpids\/piaa063","article-title":"Acute fulminant cerebral edema: a newly recognized phenotype in children with suspected encephalitis.","volume":"10","author":"Krishnan","year":"2021","journal-title":"J Pediatric Infect Dis Soc"},{"key":"key-10.3201\/eid3202.250549-202602201412-R6","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/j.pediatrneurol.2020.10.005","article-title":"Fatal cerebral edema in a child with COVID-19.","volume":"114","author":"Kim","year":"2021","journal-title":"Pediatr Neurol"},{"key":"key-10.3201\/eid3202.250549-202602201412-R7","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1001\/jamaneurol.2021.0504","article-title":"Neurologic involvement in children and adolescents hospitalized in the United States for COVID-19 or multisystem inflammatory syndrome.","volume":"78","author":"LaRovere","year":"2021","journal-title":"JAMA Neurol"},{"key":"key-10.3201\/eid3202.250549-202602201412-R8","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1093\/jpids\/piac116","article-title":"Fatal fulminant cerebral edema in six children with SARS-CoV-2 Omicron BA.2 infection in Taiwan.","volume":"12","author":"Lin","year":"2023","journal-title":"J Pediatric Infect Dis Soc"},{"key":"key-10.3201\/eid3202.250549-202602201412-R9","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1016\/j.braindev.2020.08.001","article-title":"Guidelines for the diagnosis and treatment of acute encephalopathy in childhood.","volume":"43","author":"Mizuguchi","year":"2021","journal-title":"Brain Dev"},{"key":"key-10.3201\/eid3202.250549-202602201412-R10","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1542\/peds.96.4.765","article-title":"Recommended guidelines for uniform reporting of pediatric advanced life support: the pediatric Utstein style. A statement for healthcare professionals from a task force of the American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council.","volume":"96","author":"Zaritsky","year":"1995","journal-title":"Pediatrics"},{"key":"key-10.3201\/eid3202.250549-202602201412-R11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"key-10.3201\/eid3202.250549-202602201412-R12","doi-asserted-by":"publisher","first-page":"1014071","DOI":"10.3389\/fnins.2023.1014071","article-title":"Complement-dependent cytotoxicity of human autoantibodies against myelin oligodendrocyte glycoprotein.","volume":"17","author":"Kohyama","year":"2023","journal-title":"Front Neurosci"},{"key":"key-10.3201\/eid3202.250549-202602201412-R13","doi-asserted-by":"crossref","unstructured":"Toma K, Aoki K, Kurosawa H, Nishiyama M, Maruyama A. Two cases of COVID-19-related hemorrhagic shock and encephalopathy syndrome with different outcomes. Brain Dev Case Reports. 2024;2:100024. 10.1016\/j.bdcasr.2024.100024","DOI":"10.1016\/j.bdcasr.2024.100024"},{"key":"key-10.3201\/eid3202.250549-202602201412-R14","doi-asserted-by":"crossref","unstructured":"Ninan S, Thompson P, Gershon T, Ford N, Mills W, Jewells V,  Fatal pediatric COVID-19 case with seizures and fulminant cerebral edema. Child Neurol Open. 2021;8:2329048X211022532. 10.1177\/2329048X211022532","DOI":"10.1177\/2329048X211022532"},{"key":"key-10.3201\/eid3202.250549-202602201412-R15","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1007\/s12098-022-04404-9","article-title":"Fulminant encephalitis caused by SARS-CoV-2 in a two-month-old infant.","volume":"90","author":"Abdelbari","year":"2023","journal-title":"Indian J Pediatr"},{"key":"key-10.3201\/eid3202.250549-202602201412-R16","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1007\/s12098-023-04510-2","article-title":"Acute fulminant cerebral edema presenting as refractory status epilepticus in a SARS-CoV-2 PCR-positive child without pulmonary involvement.","volume":"90","author":"Botre","year":"2023","journal-title":"Indian J Pediatr"},{"key":"key-10.3201\/eid3202.250549-202602201412-R17","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1001\/jamaneurol.2022.3881","article-title":"Changes in distribution of severe neurologic involvement in US pediatric inpatients with COVID-19 or multisystem inflammatory syndrome in children in 2021 vs 2020.","volume":"80","author":"LaRovere","year":"2023","journal-title":"JAMA Neurol"},{"key":"key-10.3201\/eid3202.250549-202602201412-R18","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.pediatrneurol.2024.04.004","article-title":"Severe neurological manifestation associated with coronavirus disease 2019 in children during the Omicron variant-predominant period.","volume":"156","author":"Kim","year":"2024","journal-title":"Pediatr Neurol"},{"key":"key-10.3201\/eid3202.250549-202602201412-R19","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/j.braindev.2023.08.008","article-title":"The first case of hemorrhagic shock and encephalopathy syndrome with fulminant hypercytokinemia associated with pediatric COVID-19.","volume":"46","author":"Kurane","year":"2024","journal-title":"Brain Dev"},{"key":"key-10.3201\/eid3202.250549-202602201412-R20","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/S0140-6736(83)90057-0","article-title":"Haemorrhagic shock and encephalopathy: a new syndrome with a high mortality in young children.","volume":"2","author":"Levin","year":"1983","journal-title":"Lancet"},{"key":"key-10.3201\/eid3202.250549-202602201412-R21","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/1471-2431-8-43","article-title":"Hemorrhagic shock and encephalopathy syndrome\u2014the markers for an early HSES diagnosis.","volume":"8","author":"Rinka","year":"2008","journal-title":"BMC Pediatr"},{"key":"key-10.3201\/eid3202.250549-202602201412-R22","doi-asserted-by":"publisher","first-page":"120321","DOI":"10.1016\/j.jns.2022.120321","article-title":"Effect of higher body temperature and acute brain edema on mortality in hemorrhagic shock and encephalopathy syndrome.","volume":"439","author":"Kuki","year":"2022","journal-title":"J Neurol Sci"},{"key":"key-10.3201\/eid3202.250549-202602201412-R23","doi-asserted-by":"publisher","first-page":"155324","DOI":"10.1016\/j.cyto.2020.155324","article-title":"Elevated cytokine, chemokine, and growth and differentiation factor-15 levels in hemorrhagic shock and encephalopathy syndrome: A retrospective observational study.","volume":"137","author":"Yamaguchi","year":"2021","journal-title":"Cytokine"},{"key":"key-10.3201\/eid3202.250549-202602201412-R24","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1038\/nri3070","article-title":"Monocyte recruitment during infection and inflammation.","volume":"11","author":"Shi","year":"2011","journal-title":"Nat Rev Immunol"},{"key":"key-10.3201\/eid3202.250549-202602201412-R25","doi-asserted-by":"publisher","first-page":"e16","DOI":"10.1182\/blood-2010-12-326355","article-title":"Gene expression profiling reveals the defining features of the classical, intermediate, and nonclassical human monocyte subsets.","volume":"118","author":"Wong","year":"2011","journal-title":"Blood"},{"key":"key-10.3201\/eid3202.250549-202602201412-R26","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1016\/j.it.2021.06.001","article-title":"The \u2018cytokine storm\u2019: molecular mechanisms and therapeutic prospects.","volume":"42","author":"Karki","year":"2021","journal-title":"Trends Immunol"},{"key":"key-10.3201\/eid3202.250549-202602201412-R27","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1038\/s41577-020-0331-4","article-title":"Pathological inflammation in patients with COVID-19: a key role for monocytes and macrophages.","volume":"20","author":"Merad","year":"2020","journal-title":"Nat Rev Immunol"},{"key":"key-10.3201\/eid3202.250549-202602201412-R28","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1164\/ajrccm.182.3.436","article-title":"Severe acute respiratory syndrome and venous thromboembolism in multiple organs.","volume":"182","author":"Xiang-Hua","year":"2010","journal-title":"Am J Respir Crit Care Med"},{"key":"key-10.3201\/eid3202.250549-202602201412-R29","doi-asserted-by":"publisher","first-page":"1146","DOI":"10.1038\/s41590-020-0779-1","article-title":"The dynamic changes in cytokine responses in COVID-19: a snapshot of the current state of knowledge.","volume":"21","author":"Buszko","year":"2020","journal-title":"Nat Immunol"},{"key":"key-10.3201\/eid3202.250549-202602201412-R30","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1001\/jama.2025.11534","article-title":"Influenza-associated acute necrotizing encephalopathy in US children.","volume":"334","author":"Silverman","year":"2025","journal-title":"JAMA"}],"container-title":["Emerging Infectious Diseases"],"original-title":[],"deposited":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T19:19:27Z","timestamp":1771615167000},"score":1,"resource":{"primary":{"URL":"https:\/\/wwwnc.cdc.gov\/eid\/article\/32\/2\/25-0549_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":30,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"URL":"https:\/\/doi.org\/10.3201\/eid3202.250549","relation":{},"ISSN":["1080-6040","1080-6059"],"issn-type":[{"value":"1080-6040","type":"print"},{"value":"1080-6059","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]}}}