Influenza A(H1N1)–Associated Ischemic Stroke in a 9-Month-Old Child

Honorat, R.; Tison, C; Sévely, A; Cheuret, Emmanuel; Chaix, Yves; Claudet, I.

doi:10.1097/pec.0b013e31824dcaa4

Cited by 17 publications

(8 citation statements)

References 7 publications

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“…There have been a few case reports of these atypical and rare complications of pandemic influenza, consistent with our findings. 22 – 24 However, to date, no study has reported so many rare complications of pandemic influenza in a single national cohort of children. There have been a few reports of TM following influenza vaccination (especially the pandemic H1N1 vaccine) 25 ; however, in our study, one unvaccinated child developed TM as a complication of pandemic influenza.…”

Section: Discussionmentioning

confidence: 99%

Clinical epidemiology and predictors of outcome in children hospitalised with influenza A(H1N1)pdm09 in 2009: a prospective national study

Khandaker

Zurynski

Ridley

et al. 2014

Influenza Resp Viruses

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BackgroundThere are few large-scale, prospective studies of influenza A(H1N1)pdm09 in children that identify predictors of adverse outcomes.ObjectivesWe aimed to examine clinical epidemiology and predictors for adverse outcomes in children hospitalised with influenza A(H1N1)pdm09 in Australia.MethodsActive hospital surveillance in six tertiary paediatric referral centres (June–September, 2009). All children aged <15 years admitted with laboratory-confirmed influenza A(H1N1)pdm09 were studied.ResultsOf 601 children admitted with laboratory-confirmed influenza, 506 (84·2%) had influenza A(H1N1)pdm09. Half (51·0%) of children with influenza A(H1N1)pdm09 were previously healthy. Hospital stay was longer in children with pre-existing condition (mean 6·9 versus 4·9 days; P = 0·02) as was paediatric intensive care unit (PICU) stay (7·0 versus 2·3 days; P = 0·005). Rapid diagnosis decreased both antibiotic use and length of hospital and PICU stay. Fifty (9·9%) children were admitted to a PICU, 30 (5·9%) required mechanical ventilation and 5 (0·9%) died. Laboratory-proven bacterial co-infection and chronic lung disease were significant independent predictors of PICU admission (OR 6·89, 95% CI 3·15–15·06 and OR 3·58, 95% CI 1·41–9·07, respectively) and requirement for ventilation (OR 5·61, 95% CI 2·2–14·28 and OR 5·18, 95% CI 1·8–14·86, respectively). Chronic neurological disease was a predictor of admission to PICU (OR 2·30, 95% CI 1·14–4·61).ConclusionsDuring the 2009 pandemic, influenza was a major cause of hospitalisation in tertiary paediatric hospitals. Co-infection and underlying chronic disease increased risk of PICU admission and/or ventilation. Half the children admitted were previously healthy, supporting a role for universal influenza vaccination in children.

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Section: Discussionmentioning

confidence: 99%

Clinical epidemiology and predictors of outcome in children hospitalised with influenza A(H1N1)pdm09 in 2009: a prospective national study

Khandaker

Zurynski

Ridley

et al. 2014

Influenza Resp Viruses

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“…A total of 115 articles were initially retrieved, but eleven of them were eliminated according to our exclusion criteria. Finally, considering our inclusion criteria, only 104 articles (1636 patients) were included and divided into two groups, according to the origin of neurological complications: influenza vaccine‐related (287 patients) or viral infection‐related (1349 patients) (Tables S1 and S2) . The main characteristics of patients are summarized in Table .…”

Section: Resultsmentioning

confidence: 99%

“…121 With respect to pathogenesis, while influenza viruses do not seem to show a direct tropism to the nervous system, virus detection within both retina and the olfactory bulb has been described in animal models. 121,122 Influenza virus has been also detected by isolation or nested RT-PCR in human cerebrospinal fluid 59,74,123,124 on brain tissue in neuropil, ependyma, Purkinje cells, and other neurons. 125 Although in most influenza cases, no virus has been detected in CSF, the reported information stresses the relevance of searching for the virus in the central nervous system in different infection stages, particularly when neurological symptoms are present.…”

Section: Discussionmentioning

confidence: 99%

Neurological events related to influenza A (H1N1) pdm09

Cárdenas

Soto-Hernández

Díaz-Alba

et al. 2014

Influenza Resp Viruses

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ObjectivesTo review neurological complications after the influenza A (H1N1) pdm09, highlighting the clinical differences between patients with post-vaccine or viral infection.DesignA search on Medline, Ovid, EMBASE, and PubMed databases using the keywords “neurological complications of Influenza AH1N1” or “post-vaccine Influenza AH1N1.”SettingOnly papers written in English, Spanish, German, French, Portuguese, and Italian published from March 2009 to December 2012 were included.SampleWe included 104 articles presenting a total of 1636 patient cases. In addition, two cases of influenza vaccine-related neurological events from our neurological care center, arising during the period of study, were also included.Main outcome measuresDemographic data and clinical diagnosis of neurological complications and outcomes: death, neurological sequelae or recovery after influenza A (H1N1) pdm09 vaccine or infection.ResultsThe retrieved cases were divided into two groups: the post-vaccination group, with 287 patients, and the viral infection group, with 1349 patients. Most patients in the first group were adults. The main neurological complications were Guillain-Barre syndrome (GBS) or polyneuropathy (125), and seizures (23). All patients survived. Pediatric patients were predominant in the viral infection group. In this group, 60 patients (4.7%) died and 52 (30.1%) developed permanent sequelae. A wide spectrum of neurological complications was observed.ConclusionsFatal cases and severe, permanent, neurological sequelae were observed in the infection group only. Clinical outcome was more favorable in the post-vaccination group. In this context, the relevance of an accurate neurological evaluation is demonstrated for all suspicious cases, as well as the need of an appropriate long-term clinical and imaging follow-up of infection and post-vaccination events related to influenza A (H1N1) pdm09, to clearly estimate the magnitude of neurological complications leading to permanent disability.

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“…To our knowledge, 2 reported cases of pediatric AIS caused by influenza virus infection have been reported in the literature. A 4-year-old male with influenza A was diagnosed with a subacute infarct of the left middle cerebral artery, and a 9-month-old female diagnosed with influenza HIN1 was diagnosed with a left posterior middle cerebral artery stroke (5,6).…”

Section: Discussionmentioning

confidence: 99%

Cerebrovascular Accident in a Pediatric Patient Presenting With Influenza

Javedani

Zukowski

2019

The Journal of Emergency Medicine

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Background: Acute ischemic stroke (AIS) in pediatric populations accounts for more than half of pediatric strokes and is associated with significant morbidity and mortality. Pediatric AIS can present with nonspecific symptoms or symptoms that mimic alternate pathology. Case Report: A 4-month-old female presented to the emergency department for fever, decreased oral intake, and ''limp'' appearance after antibiotic administration. She was febrile, tachypneic, and hypoxic. Her skin was mottled with 3-s capillary refill, her anterior fontanelle was tense, and she had mute Babinski reflex bilaterally but was moving all extremities. The patient was hyponatremic, thrombocytopenic, and tested positive for influenza A. A computed tomography scan of the brain revealed an acute infarction involving the right frontal, parietal, temporal, and occipital lobes in addition to hyperdensities concerning for thrombosed cortical veins. The patient was transferred for specialty evaluation and was discharged 2 weeks later on levetiracetam. Why Should an Emergency Physician be Aware of This?: Pediatric AIS can present with nonspecific symptoms that mimic alternate pathology. A high level of suspicion is needed so as not to miss the diagnosis of pediatric AIS in the emergency department. A thorough neurologic assessment is warranted, and subtle abnormalities should be investigated further. Ó

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Influenza A(H1N1)–Associated Ischemic Stroke in a 9-Month-Old Child

Abstract: Acute viral infection, notably influenza, is associated with increased susceptibility to stroke, and vaccination against influenza may reduce the risk of stroke.

Cited by 17 publications

References 7 publications

Clinical epidemiology and predictors of outcome in children hospitalised with influenza A(H1N1)pdm09 in 2009: a prospective national study

Clinical epidemiology and predictors of outcome in children hospitalised with influenza A(H1N1)pdm09 in 2009: a prospective national study

Neurological events related to influenza A (H1N1) pdm09

Cerebrovascular Accident in a Pediatric Patient Presenting With Influenza

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