Neurological manifestations of influenza infection in children and adults: results of a national British surveillance study.

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Neurological manifestations of influenza infection in children and adults: results of a national British surveillance study.

Clin Infect Dis. 2013 Dec 18;

Authors: 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

Abstract
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 UK 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. Cases were included if they met clinical case definitions within 1 month of proven influenza infection. Results. Twenty-five cases were identified; 21 (84%) children and 4 (16%) adults. Six (29%) children had pre-existing neurological disorders. Polymerase chain reaction of respiratory secretions identified influenza A in 21 (81%) [20 (95%) 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 (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%) with poor outcome; 4 (16%) died. Conclusion. 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.

PMID: 24352349 [PubMed - as supplied by publisher]

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