Characteristics and Outcomes of Influenza-Associated Encephalopathy Cases Among Children and Adults in Japan, 2010–2015

Okuno, Hideo; Yahata, Yuichiro; Tanaka‐Taya, Keiko; Arai, Satoru; Satoh, Hiroshi; Morino, Saeko; Shimada, Tomoe; Sunagawa, Tomimasa; Uyeki, Timothy M.; Oishi, Kazunori

doi:10.1093/cid/cix1126

Cited by 57 publications

(55 citation statements)

References 31 publications

(30 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the literature, the reported frequency of neurological complications in hospitalized children with influenza infection ranges from 1.7 to 15% in different studies [6]. In our retrospective analysis, we observed 114 cases of influenza infection requiring hospitalization during two influenza seasons and, among these patients, 15 children experienced neurological symptoms resulting in a proportion of 13.1%, as already reported [2,[6][7][8]10,15].…”

Section: Discussionsupporting

confidence: 73%

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: 73%

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

“…Myocarditis and pericarditis have also been rarely described in clinical cases, but demonstrated in autopsy studies [83,84]. Central nervous system complications associated with influenza include encephalitis, acute disseminated encephalomyelitis, transverse myelitis, aseptic meningitis, and Guillain-Barre syndrome [85][86][87] (Table 2).…”

Section: Other Less Common Severe Complications Of Influenzamentioning

confidence: 99%

Influenza virus-related critical illness: pathophysiology and epidemiology

2019

View full text Add to dashboard Cite

Influenza virus affects the respiratory tract by direct viral infection or by damage from the immune system response. In humans, the respiratory epithelium is the only site where the hemagglutinin (HA) molecule is effectively cleaved, generating infectious virus particles. Virus transmission occurs through a susceptible individual’s contact with aerosols or respiratory fomites from an infected individual. The inability of the lung to perform its primary function of gas exchange can result from multiple mechanisms, including obstruction of the airways, loss of alveolar structure, loss of lung epithelial integrity from direct epithelial cell killing, and degradation of the critical extracellular matrix. Approximately 30–40% of hospitalized patients with laboratory-confirmed influenza are diagnosed with acute pneumonia. These patients who develop pneumonia are more likely to be < 5 years old, > 65 years old, Caucasian, and nursing home residents; have chronic lung or heart disease and history of smoking, and are immunocompromised. Influenza can primarily cause severe pneumonia, but it can also present in conjunction with or be followed by a secondary bacterial infection, most commonly by Staphylococcus aureus and Streptococcus pneumoniae . Influenza is associated with a high predisposition to bacterial sepsis and ARDS. Viral infections presenting concurrently with bacterial pneumonia are now known to occur with a frequency of 30–50% in both adult and pediatric populations. The H3N2 subtype has been associated with unprecedented high levels of intensive care unit (ICU) admission. Influenza A is the predominant viral etiology of acute respiratory distress syndrome (ARDS) in adults. Risk factors independently associated with ARDS are age between 36 and 55 years old, pregnancy, and obesity, while protective factors are female sex, influenza vaccination, and infections with Influenza A (H3N2) or Influenza B viruses. In the ICU, particularly during the winter season, influenza should be suspected not only in patients with typical symptoms and epidemiology, but also in patients with severe pneumonia, ARDS, sepsis with or without bacterial co-infection, as well as in patients with encephalitis, myocarditis, and rhabdomyolysis.

show abstract

“…Influenza-associated encephalopathy is more common in children, usually in the setting of an influenza A infection 2. There are limited articles in the literature studying influenza B-related meningoencephalitis in adults.…”

Section: Discussionmentioning

confidence: 99%

“…Diagnosis may be difficult given that influenza viral RNA has rarely been detected in the CSF by PCR 2. Influenza B virus were detected through nasopharyngeal swab viral PCR or serum haemagglutination inhibition test.…”

Section: Discussionmentioning

confidence: 99%

Influenza B-related meningoencephalitis in adults

Chen¹,

Vallat

Norton

2018

BMJ Case Reports

View full text Add to dashboard Cite

We present a case involving an 85-year-old man with acute confusion and new onset seizure following a 1-week history of respiratory prodrome. This case report describes a case of influenza B-related meningoencephalitis supported by evidence of an influenza B infection and temporal relation of the neurological event and respiratory illness in the absence of other identifiable cause. Diagnosis is guided by cerebrospinal fluid profile and nasopharyngeal PCR. Treatment is largely supportive and the effect of vaccination on prevention of this neurological complication remains unclear.

show abstract

Characteristics and Outcomes of Influenza-Associated Encephalopathy Cases Among Children and Adults in Japan, 2010–2015

Abstract: We analyzed national surveillance data on influenza-associated encephalopathy (IAE) cases reported in Japan from 2010 through 2015. We found differences in the clinical features of IAE between adults and children. Fatal outcomes were higher in patients aged ≥40 years.

Cited by 57 publications

References 31 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

Influenza virus-related critical illness: pathophysiology and epidemiology

Influenza B-related meningoencephalitis in adults

Contact Info

Product

Resources

About