To describe and estimate the mortality rate of severe influenza-associated encephalopathy/encephalitis among children admitted to PICUs.DESIGN: Multicenter retrospective study. SETTING: Twelve French PICUs. PATIENTS:All children admitted for influenza-associated encephalopathy/ encephalitis between 2010 and 2018 with no severe preexisting chronic neurologic disorders and no coinfection potentially responsible for the disease. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS:We collected the clinical presentation; laboratory, electroencephalographic, and MRI findings; and treatments used in the PICU. The primary outcome was mortality. The secondary outcomes included sequelae at discharge and last follow-up. We included 41 patients with a median (interquartile range) age of 4.7 years (2.5-8.2 yr). The main reasons for admission were altered consciousness (59%) and status epilepticus (34%); 48% of patients had meningitis, and one third had acute necrotizing encephalopathy on MRI. Mechanical ventilation was required in 73% of patients and hemodynamic support in 24%. The use of specific treatments was variable; steroids were given to 49% of patients. Seven patients (17%) died in the PICU. Median (interquartile range) PICU stay length was 7 days (2-13 d), and total hospital length of stay was 23 days (7-33 d). On hospital discharge, 49% (n = 20) had neurologic sequelae, with 27% (n = 11) having severe disabilities defined by modified Rankin Score greater than or equal to 4. CONCLUSIONS:Children requiring PICU admission for influenza-associated encephalopathy/encephalitis have high mortality and morbidity rates. The management remains highly variable due to the lack of guidelines.
Introduction: Various neurologic manifestations have already been described in children during or after severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infections,. The central nervous system disorders reported in children are mainly encephalopathies during Multisystem inflammatory syndrome (MIS-C). We present here an acute meningo-encephalitis with cerebral vasculitis associated to a COVID-19 infection in a thirteen-year-old girl with a 1-year clinical, EEG and MRI follow-up. Case-report: A thirteen-year-old girl presented acute symptoms of consciousness impairment, frontal headache, hyperthermia and aphasia, with moderate lymphopenia (900/mm3),elevated C-reactive protein (CRP) (17mg/l), cerebrospinal fluid (CSF) pleiocytosis (15 cells/mm3), slow background with frontal focalization on electroencephalogram (EEG), an left frontal ischemic lesion, leptomeningeal enhancement and bilateral limbic FLAIR hyperintensity on cerebral magnetic resonance imaging (MRI). Reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV2 was positive in nasopharyngeal swab and COVID serology was positive for IgM and Ig, whereas extensive auto-immune antibody investigation was negative except for a positive low titre of anti-MOG in CSF and blood. The diagnosis of probable encephalitis associated to cerebral vasculitis after COVID infection was suggested and steroids pulse were started. She recovered within a few days. Six months laters, she had moderate clinical sequels including persistent intermittent headaches, an isolated spatial deficit and focal spikes on the EEG without argument for epilepsia. Conclusion: a teenager without previous medical history presented an acute encephalitis with leptomeningitis and vasculitis after a recent COVID-19 infection. Steroids pulse therapy allowed clinical improvement. Cerebral MRI and EEG helped diagnosis, follow-up of the encephalitis and evolution after treatment
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