Neuroinfluenza: evaluation of seasonal influenza associated severe neurological complications in children (a multicenter study)

Paksu, Muhammet Şükrü; Aslan, Kerim; Kendirli, Tanıl; Akyıldız, Başak Nur; Yener, Nazik; Yildizdaş, Riza; Davutoğlu, Mehmet; Yaman, Ayhan; Işıkay, Sedat; Şensoy, Gülnar; Taşdemir, Haydar Ali

doi:10.1007/s00381-017-3554-3

Cited by 43 publications

(86 citation statements)

References 40 publications

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“…In addition, younger children more frequently require intensive care support: we reported 4 cases that needed PICU admission for respiratory failure and liver impairment and all of them were children None of our children had been vaccinated for seasonal influenza, consistent with other studies [2,[6][7][8]19]. It is not proven that vaccination has a preventable role against neurological manifestation and a study to demonstrate vaccine effectiveness appears impractical, due to low case numbers.…”

Section: Discussionsupporting

confidence: 85%

“…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%

“…As regards outcome, 14 patients recovered without sequelae, and only a 2-year-old girl experienced a minimal impairment in fine motor skills at the moment of discharge. Conversely, previous reports have highlighted a high frequency of poor outcomes with deaths and significant neurologic sequelae at discharge in the survivors [2,[6][7][8]19]. In literature, adverse short-term outcomes were associated with specific acute encephalopathy syndromes: the majority of deaths occurred in children with acute necrotizing encephalopathy (ANE) [7].…”

Section: Discussionmentioning

confidence: 99%

“…Influenza accounts for 2-11% of cases in studies of childhood encephalitis. Moreover, [2,[4][5][6][7][8] in the US, the rate of influenza-related neurological complications has been estimated to be 4 per 100,000 children per year. The mean annual incidence in Australian children is 2.8 per 1,000,000 population [2].…”

Section: Introductionmentioning

confidence: 99%

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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

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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.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

“…14,15 Among those with IAE we observed, similar to previous authors 2,6,16 that CSF pleocytosis and detection of influenza in the CSF occurred in a minority (n ¼ 5; 35%, and n ¼ 1/4; 25%). 3,7,17,18 However CSF neopterin, a biomarker of inflammation, was elevated in most children with IAE (n ¼ 9, 81%). Neopterin, a catabolic product of guanosine triphosphate (GTP), is synthesized by human macrophages upon stimulation from interferon gamma and can be measured in urine, serum and CSF.…”

Section: Discussionmentioning

confidence: 99%

CSF neopterin, a useful biomarker in children presenting with influenza associated encephalopathy?

Macdonald-Laurs

Koirala

Britton

et al. 2019

European Journal of Paediatric Neurology

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Neurological complications of pandemic A(H1N1)2009pdm, postpandemic A(H1N1)v, and seasonal influenza A

et al. 2020

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Objectives Not much is known about influenza‐associated neurological complications. We aimed to describe the case series of hospitalized patients who were confirmed with influenza A and presented with neurological symptoms in order to capture the broad spectrum of influenza clinical manifestation and suggest including influenza diagnostic in some neurological conditions. Materials and methods The inclusion criteria were age ≥ 18 and laboratory‐confirmed influenza presenting with neurological symptoms. Influenza‐associated neurological complication was described as a development of neurological symptom with no other origin. The outcomes were classified into 5 categories: 1. recovery with no significant disability; 2. minor disability (able to manage on their own); 3. moderate disability (requiring some help but able to walk without assistance); 4. severe disability (unable to walk without assistance and perform daily activities); 5. death. Results In total, 12 patients (five women and seven men) were enrolled, with age range 18–71 years old. Neurological complications of pandemic A(H 1 N 1 )2009pdm influenza developed in seven out of 69 (10.1%) hospitalized patients. The most common neurological complication was encephalopathy. Neurological complications developed in two out of 24 (8.3%) hospitalized patients during postpandemic (H 1 N 1 ) V period. One patient presented with encephalopathy, another with meningoencephalitis. During the 2018 influenza season, there was one patient who has developed influenza A neurological complications. Overall, two out of 104 (1.9%) influenza A patients developed influenza‐associated neurological complications in 2019. Conclusions Every patient with unexplained neurological symptoms and signs similar to aseptic and septic meningitis/encephalitis has to be tested for influenza virus during epidemics and pandemics.

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Neuroinfluenza: evaluation of seasonal influenza associated severe neurological complications in children (a multicenter study)

Cited by 43 publications

References 40 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

CSF neopterin, a useful biomarker in children presenting with influenza associated encephalopathy?

Neurological complications of pandemic A(H1N1)2009pdm, postpandemic A(H1N1)v, and seasonal influenza A

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