Neuroinfluenza: evaluation of seasonal influenza associated severe neurological complications in children (a multicenter study)
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Although influenza primarily affects the respiratory system, in some cases, it can cause severe neurological complications. Younger children are especially at risk. Pediatric literature is limited on the diagnosis, treatment, and prognosis of influenza-related neurological complications. The aim of the study was to evaluate children who suffered severe neurological manifestation as a result of seasonal influenza infection.
The medical records of 14 patients from six hospitals in different regions of the country were evaluated. All of the children had a severe neurological manifestations related to laboratory-confirmed influenza infection.
Median age of the patients was 59 months (6 months—15.5 years) and nine (64.3%) were male. Only 4 (28.6%) of the 14 patients had a comorbid disease. Two patients were admitted to hospital with influenza-related late complications, and the remainder had acute complication. The most frequent complaints at admission were fever, altered mental status, vomiting, and seizure, respectively. Cerebrospinal fluid (CSF) analysis was performed in 11 cases, and pleocytosis was found in only two cases. Neuroradiological imaging was performed in 13 patients. The most frequent affected regions of nervous system were as follows: cerebellum, brainstem, thalamus, basal ganglions, periventricular white matter, and spinal cords. Nine (64.3%) patients suffered epileptic seizures. Two patients had focal seizure, and the rest had generalized seizures. Two patients developed status epilepticus. Most frequent diagnoses of patients were encephalopathy (n = 4), encephalitis (n = 3), and meningitis (n = 3), respectively. The rate of recovery without sequelae from was found to be 50%. At discharge, three (21.4%) patients had mild symptoms, another three (21.4%) had severe neurological sequelae. One (7.1%) patient died. The clinical findings were more severe and outcome was worse in patients <5 years old than patients >5 years old and in patients with comorbid disease than previously healthy group.
Seasonal influenza infection may cause severe neurological complications, especially in children. Healthy children are also at risk such as patients with comorbid conditions. All children who are admitted with neurological findings, especially during the influenza season, should be evaluated for influenza-related neurological complications even if their respiratory complaints are mild or nonexistent.
KeywordsInfluenza Infection Neurological complication Children
Muhammet Sukru Paksu was performed literature search and writing and submitting of the manuscript.
Kerim Aslan was evaluated neuroradiological images of study patients.
Tanil Kendirli was recorded patient medical data of hospital 2 and he edited of manuscript.
Basak Nur Akyildiz was recorded patient medical data of hospital 3 she edited of manuscript.
Nazik Yener was recorded patient medical data of hospital 1 and she searched the literature.
Riza Dincer Yildizdas was recorded patient medical data of hospital 4 and he edited of manuscript.
Mehmet Davutoglu was recorded patient medical data of hospital 5 and he edited of manuscript.
Ayhan Yaman was recorded patient medical data of hospital 6.
Sedat Isikay was recorded patient medical data of hospital 5.
Gulnar Sensoy was edited and approved the final version of the manuscript.
Haydar Ali Tasdemir was edited and approved the final version of the manuscript.
Compliance with ethical standards
This study was not funded by any institution, organization, or company. No honorarium, grant, or other form of payment was given to anyone to produce the manuscript.
Conflict of interest
The authors declare that they have no conflict of interest associated with this study.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the local ethics committee of Ondokuz Mayis University (Samsun, Turkey).
According to local ethical standards, informed consent is not needed for retrospective study.
- 12.Khandaker G, Zurynski Y, Buttery J, Marshall H, Richmond PC, Dale RC, Royle J, Gold M, Snelling T, Whitehead B, Jones C, Heron L, McCaskill M, Macartney K, Elliott EJ, Booy R (2012) Neurologic complications of influenza A(H1N1)pdm09: surveillance in 6 pediatric hospitals. Neurology 79:1474–1481PubMedPubMedCentralGoogle Scholar
- 15.Sachedina N, Donaldson LJ (2010) Paediatric mortality related to pandemic influenza a H1N1 infection in England: an observational population-based study. Lancet 376:1846–1852Google Scholar
- 17.Dawood FS, Chaves SS, Perez A, Reingold A, Meek J, Farley MM, Ryan P, Lynfield R, Morin C, Baumbach J, Bennett NM, Zansky S, Thomas A, Lindegren ML, Schaffner W, Finelli L, Emerging Infections Program N (2014) Complications and associated bacterial coinfections among children hospitalized with seasonal or pandemic influenza, United States, 2003-2010. J Infect Dis 209:686–694Google Scholar
- 19.Zeng H, Quinet S, Huang W, Gan Y, Han C, He Y, Wang Y (2013) Clinical and MRI features of neurological complications after influenza A (H1N1) infection in critically ill children. Pediatr Radiol 43:1182–1189Google Scholar
- 22.Glaser CA, Gilliam S, Schnurr D, Forghani B, Honarmand S, Khetsuriani N, Fischer M, Cossen CK, Anderson LJ, California Encephalitis P (2003) In search of encephalitis etiologies: diagnostic challenges in the California Encephalitis Project, 1998-2000. Clin Infect Dis 36:731–742PubMedPubMedCentralGoogle Scholar
- 27.Centers for Disease C, Prevention (2009) Surveillance for pediatric deaths associated with 2009 pandemic influenza A (H1N1) virus infection—United States, April-August 2009. MMWR Morb Mortal Wkly Rep 58:941–947Google Scholar
- 28.Bhat N, Wright JG, Broder KR, Murray EL, Greenberg ME, Glover MJ, Likos AM, Posey DL, Klimov A, Lindstrom SE, Balish A, Medina MJ, Wallis TR, Guarner J, Paddock CD, Shieh WJ, Zaki SR, Sejvar JJ, Shay DK, Harper SA, Cox NJ, Fukuda K, Uyeki TM, Influenza Special Investigations T (2005) Influenza-associated deaths among children in the United States, 2003-2004. N Engl J Med 353:2559–2567PubMedPubMedCentralGoogle Scholar
- 31.Prerna A, Lim JY, Tan NW, Isa MS, Oh HM, Yassin N, Low CY, Chan DW, Chong CY, Leo YS, Chow AL, Tambyah PA, Tan K (2015) Neurology of the H1N1 pandemic in Singapore: a nationwide case series of children and adults. J Neuro-Oncol 21:491–499Google Scholar
- 35.Goenka A, Michael BD, Ledger E, Hart IJ, Absoud M, Chow G, Lilleker J, Lunn M, McKee D, Peake D, Pysden K, Roberts M, Carrol ED, Lim M, Avula S, Solomon T, Kneen R (2014) Neurological manifestations of influenza infection in children and adults: results of a National British Surveillance Study. Clin Infect Dis 58:775–784PubMedPubMedCentralGoogle Scholar
- 38.Kawashima H, Togashi T, Yamanaka G, Nakajima M, Nagai M, Aritaki K, Kashiwagi Y, Takekuma K, Hoshika A (2005) Efficacy of plasma exchange and methylprednisolone pulse therapy on influenza-associated encephalopathy. J Inf Secur 51:E53–E56Google Scholar
- 39.Kimberlin DW, Shalabi M, Abzug MJ, Lang D, Jacobs RF, Storch G, Bradley JS, Wade KC, Ramilo O, Romero JR, Shelton M, Leach C, Guzman-Cottrill J, Robinson J, Abughali N, Englund J, Griffin J, Jester P, Cloud GA, Whitley RJ, Group NCAS (2010) Safety of oseltamivir compared with the adamantanes in children less than 12 months of age. Pediatr Infect Dis J 29:195–198PubMedPubMedCentralGoogle Scholar
- 40.Nagao T, Morishima T, Kimura H, Yokota S, Yamashita N, Ichiyama T, Kurihara M, Miyazaki C, Okabe N (2008) Prognostic factors in influenza-associated encephalopathy. Pediatr Infect Dis J 27:384–389Google Scholar
- 41.Randolph AG, Vaughn F, Sullivan R, Rubinson L, Thompson BT, Yoon G, Smoot E, Rice TW, Loftis LL, Helfaer M, Doctor A, Paden M, Flori H, Babbitt C, Graciano AL, Gedeit R, Sanders RC, Giuliano JS, Zimmerman J, Uyeki TM, Pediatric Acute Lung I, Sepsis Investigator’s N, the National Heart L, Blood Institute ACTN (2011) Critically ill children during the 2009-2010 influenza pandemic in the United States. Pediatrics 128:e1450–e1458PubMedPubMedCentralGoogle Scholar