Neurological Manifestations of Influenza A (H1N1): Clinical Features, Intensive Care Needs, and Outcome

Abstract

Objectives To describe neurological manifestations in children with Influenza A (H1N1). Methods This retrospective study was conducted in the Pediatric intensive care unit (PICU) and Pediatric Neurology unit of a tertiary care teaching hospital in North India involving children with PCR confirmed Influenza A (H1N1) with neurological manifestations during 2019 outbreak. Results Six children (5 females, 1 male) were enrolled. All presented with neurological symptoms (seizures and altered sensorium) accompanied with fever and respiratory symptoms with duration of illness of 2-7 d. The admission Glasgow Coma Scale ranged from 4 to 12. Only 2 cases showed cerebrospinal fluid pleocytosis. Neuroimaging was suggestive of diffuse cerebral edema, acute necrotizing encephalopathy of childhood, and acute disseminated encephalomyelitis. All were treated with Oseltamivir. Four cases had clinical features of raised intracranial pressure (ICP) and were managed in PICU, 3 of them needed mechanical ventilation, 3 needed vasoactive drugs, 3 received 3% saline infusion, 1 underwent invasive ICP monitoring, and 3 (cases 4, 5 and 6) received intravenous methylprednisolone (30 mg/kg) for 5 d. Total duration of hospital stay was 10-30 d. Case 2 expired due to refractory raised ICP. Among survivors, 3 children had residual neurological deficits and the remaining 2 had achieved premorbid condition. Conclusions Influenza A (H1N1) can present with isolated or predominant neurological manifestations which can contribute to poor outcome. The authors suggest to rule out H1N1 in any child who presents with unexplained neurological manifestations during seasonal outbreaks of H1N1.

Clinical characteristics of neurological manifestations in influenza-A (H1N1) among children in a tertiary care hospital, South India, during 2019

“…Neurological symptoms developed within 5 days in 87% of patents which is comparable to a study by Amin et al where 65% developed symptoms within 5 days [9]. Similar to other studies in the literature, most common neurological manifestations of influenza-A was altered sensorium and seizures [4,[7][8][9]. The neurological manifestation of influenza is due to the direct invasion of the virus to the central nervous system, associated metabolic encephalopathy associated with infection, and immune dysregulation due to the viral infection [10].…”

“…There are very few reports about the neurological complications of influenza-A H1N1 virus in literature and the prevalence of these complications has not been evaluated yet. Reports from India pertaining to the neurological manifestations of H1N1 are limited to two case reports and a recent case series [2][3][4]. The present analysis is our experience from a tertiary care referral institute in South India admitting influenza-A cases with special reference to the neurological manifestation from July through August 2019.…”

Mudanças Na Sala De Emergência Na Era Covid-19

“…Segundo Takia et al (2020), a incidência de complicações neurológicas em crianças foi estimada em torno de 1,2 por 100.000 ao ano. Múltiplos estudos envolvendo pacientes pediátricos com manifestações neurológicas do H 1 N 1 mostraram uma taxa de mortalidade entre 4 a 30%.…”

Sistema De Informações Geográficas E Bioepidemiológicas Para Monitoramento Da Contaminação Por Covid-19 (Sarscov-2) Na Região Metropolitana Do Recife, Pernambuco - Br

“…Apesar de ser geralmente autolimitada, o envolvimento de múltiplos órgãos pode ocorrer, gerando complicações graves e morbimortalidade significativa. A letalidade está diretamente relacionada à idade, às comorbidades e ao estado vacinal (TAKIA et al, 2020).…”

“…Embora o fechamento total das escolas implementado em anos anteriores tenha tido efeitos positivos na transmissão da Influenza, seu papel na redução da transmissão da COVID-19 depende da suscetibilidade das crianças à infecção e de sua infecciosidade quando contaminadas. Apesar desses dois fatores ainda permanecerem sem resposta, diversos estudos incentivaram consideravelmente o fechamento de escolas em conjunto com outras medidas de distanciamento social, sugerindo que cada medida contribua em parte para o controle da pandemia (COWLING; LIPSITCH, 2020).Os pacientes pediátricos que desenvolveram complicações da gripe geralmente possuíam fatores de risco para uma evolução mais grave, como a presença de doenças respiratórias, neurológicas ou neuromusculares crônicas, além de imunossupressão, cardiopatias congênitas ou nascimento de parto prematuro(FERNÁNDEZ et al, 2019;SCOTTA, 2013).SegundoTakia et al (2020), a incidência de complicações neurológicas em crianças foi estimada em torno de 1,2 por 100.000 ao ano. Múltiplos estudos envolvendo pacientes pediátricos com manifestações neurológicas do H 1 N 1 mostraram uma taxa de mortalidade entre 4 a 30%.…”