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- Title
Neurological Manifestations of Influenza Infection in Children and Adults: Results of a National British Surveillance Study.
- Authors
Goenka, Anu; Michael, Benedict D.; Ledger, Elizabeth; Hart, Ian J.; Absoud, Michael; Chow, Gabriel; Lilleker, James; Lunn, Michael; McKee, David; Peake, Deirdre; Pysden, Karen; Roberts, Mark; Carrol, Enitan D.; Lim, Ming; Avula, Shivaram; Solomon, Tom; Kneen, Rachel
- Abstract
This surveillance study describes 25 adults and children with acute neurological manifestations associated with influenza, mainly A(H1N1) 2009. Several children had specific encephalopathy syndromes with characteristic neuroimaging findings and poor outcomes. A modified classification system is proposed.Background. The emergence of influenza A(H1N1) 2009 was met with increased reports of associated neurological manifestations. We aimed to describe neurological manifestations of influenza in adults and children in the United Kingdom that presented at this time.Methods. A 2-year surveillance study was undertaken through the British adult and pediatric neurological surveillance units from February 2011. Patients were included if they met clinical case definitions within 1 month of proven influenza infection.Results. Twenty-five cases were identified: 21 (84%) in children and 4 (16%) in adults. Six (29%) children had preexisting neurological disorders. Polymerase chain reaction of respiratory secretions identified influenza A in 21 (81%; 20 of which [95%] were H1N1) and influenza B in 4 (15%). Twelve children had encephalopathy (1 with movement disorder), 8 had encephalitis, and 1 had meningoencephalitis. Two adults had encephalopathy with movement disorder, 1 had encephalitis, and 1 had Guillain-Barré syndrome. Seven individuals (6 children) had specific acute encephalopathy syndromes (4 acute necrotizing encephalopathy, 1 acute infantile encephalopathy predominantly affecting the frontal lobes, 1 hemorrhagic shock and encephalopathy, 1 acute hemorrhagic leukoencephalopathy). Twenty (80%) required intensive care, 17 (68%) had poor outcome, and 4 (16%) died.Conclusions. This surveillance study described a cohort of adults and children with neurological manifestations of influenza. The majority were due to H1N1. More children than adults were identified; many children had specific encephalopathy syndromes with poor outcomes. None had been vaccinated, although 8 (32%) had indications for this. A modified classification system is proposed based on our data and the increasing spectrum of recognized acute encephalopathy syndromes.
- Subjects
UNITED Kingdom; NEUROLOGIC manifestations of general diseases; BRAIN diseases; BRAIN imaging; H1N1 influenza; POLYMERASE chain reaction; FOLLOW-up studies (Medicine)
- Publication
Clinical Infectious Diseases, 2014, Vol 58, Issue 6, p775
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/cit922