Neurologic Complications of Influenza

Shah, Snehal; Keil, Anthony D.; Gara, Kieren; Nagarajan, Lakshmi

doi:10.1177/0883073813499610

Cited by 18 publications

(12 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our study, laboratory data did not show any significant alteration either when the whole study group was observed, or when the cohort was divided into the two different age groups, as reported in available literature [2,[5][6][7][8]19,24].…”

Section: Discussionsupporting

confidence: 69%

Characteristics and Outcome of Influenza-Associated Encephalopathy/Encephalitis Among Children In A Tertiary Pediatric Hospital In Italy, 2017-2019

Mastrolia

Rubino

Resti

et al. 2019

Preprint

View full text Add to dashboard Cite

BACKGROUND: Influenza is the most frequent cause of acute upper respiratory tract infections during winter season. Although rare, neurological manifestations are known to occur during influenza infection and approximatively three-quarters of cases are in children. In this study, we aimed to characterize the burden and clinical spectrum of influenza-associated encephalopathy and encephalitis in children admitted at a tertiary pediatric hospital in Italy over two influenza seasons (2017-2019).METHODS: We retrospectively analyzed clinical, laboratory, instrumental data and outcome of patients discharged with ICD9-CM 487.0 code RESULTS: Fifteen children (13.1% of those discharged with a diagnosis of influenza infection in the study period), had influenza-associated central nervous system (CNS) manifestations. Eight patients (53.3%) were diagnosed as influenza encephalitis, 7 (46.7%) as influenza encephalopathy. Median age was 27 months. In children under 2 years of age (40% of all cases) altered consciousness was the most frequent neurological manifestation while respiratory symptoms were present at admission in all cases. Younger children also required intensive care support more frequently. Five subjects (33.3%) presented comorbidity. None of the patients had received seasonal influenza vaccination. The median time from onset of respiratory signs to onset of neurological manifestations was 24 hours. Cerebrospinal fluid (CSF) analysis was normal in most patients and polymerase chain reaction for influenza virus RNA on CSF, when performed, was negative in all samples. Neuroradiological investigations, performed in 5 children, reported cortical and subcortical white matter signal alterations. Oseltamivir was administered only in 2 cases. Fourteen patients recovered without sequelae, and only a 2-year-old girl had minimal impairment in fine motor skills at discharge. CONCLUSIONS: All children presenting acute neurological features during influenza season should be evaluated for influenza-associated CNS complications even if the respiratory involvement is mild. Absence of underlying diseases or other risk factors are not protective factors against CNS influenza-associated complications. The lack of CSF pleocytosis does not exclude CNS involvement. Children under 2 years of age are at higher risk of requiring intensive care support.

show abstract

Section: Discussionsupporting

confidence: 69%

Characteristics and Outcome of Influenza-Associated Encephalopathy/Encephalitis Among Children In A Tertiary Pediatric Hospital In Italy, 2017-2019

Mastrolia

Rubino

Resti

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 69%

Characteristics And Outcome Of Influenza-Associated Encephalopathy/Encephalitis Among Children In A Tertiary Pediatric Hospital In Italy, 2017-2019

Mastrolia

Rubino

Resti

et al. 2019

Preprint

View full text Add to dashboard Cite

BACKGROUND: Influenza is the most frequent cause of acute upper respiratory tract infections during winter season. Although rare, neurological manifestations are known to occur during influenza infection and approximatively three-quarters of cases are in children. In this study, we aimed to characterize the burden and clinical spectrum of influenza-associated encephalopathy and encephalitis in children admitted at a tertiary pediatric hospital in Italy over two influenza seasons (2017-2019). METHODS: We retrospectively analyzed clinical, laboratory, instrumental data and outcome of patients discharged with ICD9-CM 487.0 code RESULTS: Fifteen children (13.1% of those discharged with a diagnosis of influenza infection in the study period), had influenza-associated central nervous system (CNS) manifestations. Eight patients (53.3%) were diagnosed as influenza encephalitis, 7 (46.7%) as influenza encephalopathy. Median age was 27 months. In children under 2 years of age (40% of all cases) altered consciousness was the most frequent neurological manifestation while respiratory symptoms were present at admission in all cases. Younger children also required intensive care support more frequently. Five subjects (33.3%) presented comorbidity. None of the patients had received seasonal influenza vaccination. The median time from onset of respiratory signs to onset of neurological manifestations was 24 hours. Cerebrospinal fluid (CSF) analysis was normal in most patients and polymerase chain reaction for influenza virus RNA on CSF, when performed, was negative in all samples. Neuroradiological investigations, performed in 5 children, reported cortical and subcortical white matter signal alterations. Oseltamivir was administered only in 2 cases. Fourteen patients recovered without sequelae, and only a 2-year-old girl had minimal impairment in fine motor skills at discharge. CONCLUSIONS: All children presenting acute neurological features during influenza season should be evaluated for influenza-associated CNS complications even if the respiratory involvement is mild. Absence of underlying diseases or other risk factors are not protective factors against CNS influenza-associated complications. The lack of CSF pleocytosis does not exclude CNS involvement. Children under 2 years of age are at higher risk of requiring intensive care support.

show abstract

“…This clinicoradiological syndrome is termed ‘mild encephalitis/encephalopathy with reversible splenial lesion’ (figure 2). 10 Another pattern associated with influenza and other infections manifests as bilateral necrosis of the thalami and other regions, including the brainstem, cerebellum and cerebral white matter 8. This syndrome is termed ‘acute necrotising encephalopathy’ and has a more severe clinical course and worse prognosis.…”

Section: Neurological Conditions That Mimic Infectious Encephalitismentioning

confidence: 99%

Infectious encephalitis: mimics and chameleons

Toledano

Davies

2019

Pract Neurol

View full text Add to dashboard Cite

Click here to listen to the Podcast ‘Query encephalitis’ is a common neurological consultation in hospitalised patients. Identifying the syndrome is only part of the puzzle. Although historically encephalitis has been almost synonymous with infection, we increasingly recognise parainfectious or postinfectious as well as other immune-mediated causes. We must also distinguish encephalitis from other causes of encephalopathy, including systemic infection, metabolic derangements, toxins, inherited metabolic disorders, hypoxia, trauma and vasculopathies. Here, we review the most important differential diagnoses (mimics) of patients presenting with an encephalitic syndrome and highlight some unusual presentations (chameleons) of infectious encephalitis.

show abstract

Neurologic Complications of Influenza

Cited by 18 publications

References 10 publications

Characteristics and Outcome of Influenza-Associated Encephalopathy/Encephalitis Among Children In A Tertiary Pediatric Hospital In Italy, 2017-2019

Characteristics and Outcome of Influenza-Associated Encephalopathy/Encephalitis Among Children In A Tertiary Pediatric Hospital In Italy, 2017-2019

Characteristics And Outcome Of Influenza-Associated Encephalopathy/Encephalitis Among Children In A Tertiary Pediatric Hospital In Italy, 2017-2019

Infectious encephalitis: mimics and chameleons

Contact Info

Product

Resources

About