Complex Febrile Seizures Followed by Complete Recovery in an Infant with High-Titer 2009 Pandemic Influenza A (H1N1) Virus Infection

Abstract

We describe a 2009 H1N1 virus infection with a high viral load in a previously healthy infant who presented with complex febrile seizures and improved on oseltamivir without neurologic sequelae. Febrile seizures may be a complication in young children experiencing infection with high viral loads of 2009 H1N1 influenza virus. CASE REPORTIn March of 2010, a previously healthy 8-month-old male presented to the emergency room (ER) with 2 days of upper respiratory symptoms, including cough, congestion, fever to 102.5°F, and seizure activity. Three seizures occurred prior to presentation to the ER, each episode lasting up to 2 h. These events were accompanied by perioral cyanosis and emesis. The family history was significant for complex febrile seizures in the patient's mother and sister, who had no history of epilepsy. Upon arrival in the ER, the patient continued to have seizurelike activity described as "glassy-looking eyes" and limpness with concurrent myoclonal jerking of the head. His vital signs at presentation were as follows: rectal temperature, 103.3°F; heart rate, 132 beats per minute; respiratory rate, 40 breaths per minute. His level of consciousness was 9 on the Glasgow coma scale. His venous blood gas pH was 6.9, with a partial O 2 pressure (pO 2 ) of 77 mm Hg. Due to decreased breath sounds bilaterally, increased work of breathing, and diminished neurologic status, the patient was placed on mechanical ventilation and admitted to the intensive care unit (ICU). The results of noncontrasted computed tomography (CT) of the head, electroencephalogram (EEG), complete blood count (CBC), and a basic metabolic panel, including aspartate transaminase (AST) and alanine aminotransferase (ALT), were within normal limits, with the exception of a blood glucose level of 185 mg/dl. Urine, cerebrospinal fluid (CSF), blood, and respiratory specimens were collected for detection of potential pathogens. A nasopharyngeal swab (NPS) specimen revealed a positive PCR result for influenza A virus, which was further subtyped as 2009 H1N1. CSF studies were remarkable for pleocytosis, with 46 total cells in the chamber and a lymphocyte predominance and CSF glucose of 126 mg/dl; no red cells were observed. CSF protein was within normal limits at 30 mg/dl. A chest X-ray revealed a vague opacity suggestive of atelectasis, contusion, or infiltrate in the central left lung.The patient was started simultaneously on 24 mg oseltamivir every 12 h for the positive NPS and 500 mg ceftriaxone every 12 h for the chest X-ray findings. Temperatures up to 104°F rectally were recorded overnight in the absence of overt seizure activity. The following morning, the venous blood gas values normalized, and the patient was extubated and weaned from O 2 supplementation. Ceftriaxone therapy was changed to an oral cephalosporin. Bacterial cultures of urine, blood, and CSF were all negative. The patient was treated with 24 mg oseltamivir every 12 h for 5 days, and family members received oseltamivir for influenza prophylaxis. On day 3 of admission, the pat...

Neurological complications of pandemic influenza A H1N1 2009 infection: European case series and review

“…ECH has 140 paediatric beds, admits 20,000 children annually and serves a population of seven million (1.5 million children). Hospital data (case notes) of all children hospitalised with the 2009 H1N1 virus infection identified from microbiological records between 1 April 2009 to 31 March 2010 were reviewed. A child with acute neurological complications associated with the 2009 H1N1 virus infection was defined as having laboratory-confirmed infection with seizures, encephalopathy, encephalitis or any focal neurological syndrome (e.g.…”

Profile of the Alere i Influenza A & B assay: a pioneering molecular point-of-care test

“…Antigen EIA Rapid, poor sensitivity, some are CLIAwaived <30 min Diagnosis (detection) [12] Antigen IFA Good sensitivity and specificity, subjective interpretation 1 to 4 h Diagnosis (detection) [11] Tube and shell vial culture Good standard, time consuming 1 to 7 days Diagnosis (detection, differentiation, typing and characterization) and research [13] Serology Retrospective, cross-reaction 2 to 8 h Epidemiology and research [14] NAAT, monoplex High sensitivity and specificity, potential quantification 1 to 8 h Diagnosis (detection, differentiation, and limited typing) and research [25,27] NAAT, multiplex High sensitivity and specificity, covering other pathogens, FilmArray RP EZ is CLIAwaived 1 to 8 hr Diagnosis (detection, differentiation, and limited typing) and research [16,45] NAAT, POCT Rapid, good sensitivity and specificity, some are CLIA-waived (see Table 2) 15-30 min Diagnosis (detection and limited differentiation) and research [27,29,31] Expert Rev Mol Diagn. Author manuscript; available in PMC 2019 May 01.…”

“…The accuracy of an influenza diagnostic test is determined by the sensitivity and specificity of the test and the influenza prevalence in the community. Currently available assays include: rapid influenza antigen detection tests, direct immunofluorescent assays and nucleic acid amplification tests (NAATs) [7,8,[10][11][12]. Rapid antigen tests can produce results in just 15~30 minutes and are simple to perform; however, false negative results are a major concern with these tests.…”

“…After the onset of flu, the virus can be detected in nasopharyngeal swabs (NPS), NP aspirate or wash and nasal swabs (NS), but the sensitivity and specificity might vary by the type of laboratory facility and technique available, the type of specimen tested and the time between onset of illness and specimen collection. There are numerous commercial assays available, including direct antigen detection [11,12], viral culture [13], serology [14], and molecular assays [8][9][10]15] (Table 1).…”

Febrile Seizures With Pandemic (H1N1) 2009 Virus Infection

“…The first patient in Japan was identified during May 2009. A few reports on FSs associated with 2009 pandemic influenza have been published [12][13][14]. However, the clinical features of FSs associated with 2009 pandemic influenza have not yet been reported.…”