Neurological complications of pandemic influenza (H1N1) in children

Department of Pediatric Intensive Care, Çukurova University School of Medicine, Adana, Turkey.
European Journal of Pediatrics (Impact Factor: 1.89). 11/2010; 170(6):779-88. DOI: 10.1007/s00431-010-1352-y
Source: PubMed


The aim of this study was to determine the clinical characteristics of children demonstrating neurological complications with pandemic influenza (H1N1). We reviewed the medical and laboratory records of all children who were hospitalized with neurological symptoms and who had proven influenza virus infection by reverse transcriptase-polymerase chain reaction on nasal and throat swabs. Eight children aged between 10 months and 7 years had neurological complications due to pandemic influenza (H1N1) and five of them were female. Four of them were previously healthy; there was chronic renal failure (CRF) in one and neurologic disease in three patients. Seven of them had seizure and altered consciousness. Seven of them were followed in pediatric intensive care units. We performed lumbar puncture in four patients and their cerebrospinal fluid examinations showed pleocytosis in one and no cell in three specimens. Neuroimaging was performed in four patients and three of them had abnormalities. We diagnosed aseptic meningitis in one, acute disseminated encephalomyelitis (ADEM) in one, acute necrotizing encephalopathy (ANE) in one, meningoencephalitis in one, and status epilepticus in four patients. All patients were treated with oseltamivir and antiepileptic drugs. One patient with CRF died; four previously healthy patients recovered fully, and three patients who had neurologic disorder returned to their previous neurological status. In conclusion, during pandemic influenza (H1N1) infection, neurological complications may be seen in addition to the respiratory infection. The type of neurological involvement may be variable such as triggering seizure, aseptic meningitis, encephalitis, ADEM, and ANE. Neurological complications frequently recover fully especially in previously healthy children, but sometimes a severe clinical course occurs.

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    • "Case Age, gender H 1 N 1 vaccination or infection Type of demyelination Time lag to vaccination or proven infection a Comorbid conditions Therapy Outcome Reference 1 2 Y, M Vaccination ADEM 4 d None Methylprednisolone Recovered completely Lapphra et al. 2011 [21] 2 27 Y, F Vaccination TM 4 d Remote cervical spine fusion Corticosteroids Plasmapheresis Recovered completely Akkad et al. 2010 [11] 3 56 Y, F Infection ADEM ? None NS Recovered completely Yang et al. 2010 [28] 4 40 Y, M Infection ADEM 1 m None Oseltamivir Valproic acid Plasmapheresis Methylprednisolone Severely disabled state Fugate et al. 2010 [16] 5 38 Y, M Vaccination ADEM 10 d None Methylprednisolone Recovered completely Denholm et al. 2010 [14] 6 19 Y, F Vaccination ADEM 21 d None Methylprednisolone Persistent paresthesia Denholm et al. 2010 [14] 7 22 Y, M Infection ADEM 3 d None J-globulins Methylprednisolone Oseltamivir Recovered completely Wang et al. 2011 [27] 8 77 Y, F Vaccination TM 1 d Rectal cancer Immunoglobulins Methylprednisolone Severe neurological damage Sato et al. 2011 [25] 9 5 Y, M Vaccination ADEM 2 d None Corticosteroids Unknown Fernandes and Marchiori 2011 [15] 10 14 Y, M Infection TM 2 w None NS Recovered completely Landau et al. 2011 [20] 11 6 Y, M Infection ADEM 2 d None Oseltamivir Immunoglobulins Acyclovir Midazolam Phenytoin Recovered completely Yildizdas et al. 2011 [29] 12 34 m, M Vaccination ADEM 5 d None Dexamethasone Recovered completely Lee et al. 2011 [22] 13 13 Y, M Vaccination TM 6 d None Methylprednisolone Physical therapy Acupuncture (Moderate??) neurological damage Gui et al. 2011 [4] 14 44 Y, M Vaccination TM 1 m None Methylprednisolone Recovered completely Korn-Lubetzki et al. 2011 [19] 15 ?, F Vaccination TM 4 d None ? Unknown Arcondo et al. 2011 [12] 16 36 Y, M Vaccination ADEM & GBS 10 d None Methylprednisolone Persistent mild weakness and numbness of the distal extremities Hoshino et al. 2012 [18] 17 60 Y, M Infection ADEM 25 d None Osteltamavir Methylprednisolone 1 g 5 d Prednisolone 60 mg Recovered completely Athauda et al. 2012 [13] 18 2 Y, M Vaccination ADEM 25 d None Methylprednisolone Recovered completely Fujii et al. 2012 [17] 19 33 Y, F Vaccination ADEM 15 d None Methylprednisolone IV Prednisolone PO Recovered completely Maeda and Idehara 2012 [23] 20 7 Y, M Infection ADEM 5 d None Acyclovir Ceftriaxone Oseltamivir Methylprednisolone Prednisone Immunoglobulin IV Anarthria Quadriparesis Ozkale et al. 2012 [24] 21 52 Y, M Vaccination TM 7 d None ? "
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    ABSTRACT: Objectives: To illustrate that acute, even dramatic, demyelination of the central nervous system and encephalitis can occur after viral, i.e., influenza A/H1N1 vaccination or infection. Patients and methods: We describe a case of encephalitis/acute disseminated encephalomyelitis associated with vaccination against influenza A/H1N1 and review the available literature. Results: We report a case of a 26-year-old female who developed symptoms of acute encephalitis 5 days after vaccination against the pandemic 2009 A/H1N1 influenza. MRI of the brain showed confluent T2-hyperintense signal intensity changes in the deep white matter which further confirmed the diagnosis of encephalitis/acute disseminated encephalomyelitis. Despite therapy with immunoglobulins and corticosteroids, her persistent vegetative state continued. In light of the dramatic cause of this case, we reviewed all 21 other previously reported cases of central nervous system demyelination related to H1N1 vaccination and/or infection. Conclusions: The available data suggest that even severe central nervous system demyelination i.e. acute encephalitis/disseminated encephalomyelitis and transverse myelitis may very rarely be associated with vaccination against novel influenza A/H1N1 or with A/H1N1 infection itself.
    Full-text · Article · Jun 2014 · Clinical Neurology and Neurosurgery
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    • "Yıldızdas ß et al. [11] "
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    ABSTRACT: Introduction: In 2009, pandemic influenza A H1N1 emerged in Mexico and subsequently spread worldwide. In Malaysia, there were more than a thousand of confirmed cases among children. The general clinical characteristics of these children have been well-published. However, the description of neurologic complications is scarce. Objective: This study aims to describe the characteristics of neurologic manifestations and complications in a national paediatric cohort with pandemic influenza A H1N1. Methods: During the pandemic, children (12years or less) admitted for novel influenza A H1N1 in 68 Malaysian public hospitals, were prospectively enrolled into national database. The clinical, laboratory and neuro-imaging data for children with neurologic manifestations, hospitalized from 15th June 2009 till 30th November 2009, was reviewed. Results: Of 1244 children with influenza A H1N1 during the study period, 103 (8.3%) presented with influenza-related neurological manifestations. The mean age of our study cohort was 4.2years (SD: 3.3years). Sixty percent of them were males. Sixty-nine (66.9%) were diagnosed as febrile seizures, 16 (15.5%) as breakthrough seizures with underlying epilepsy, 14 (13.6%) as influenza-associated encephalopathy or encephalitis (IAE) and 4 (3.9%) as acute necrotizing encephalopathy of childhood (ANEC). All 4 available CSF specimens were negative for influenza viral PCR. Among 14 children with brain-imaging done, 9 were abnormal (2: cerebral oedema, 4: ANEC and 3: other findings). There were four deaths and three cases with permanent neurological sequelae. Conclusion: About one-tenth of children with pandemic influenza A H1N1 presented with neurologic complications. The most common diagnosis was febrile seizures. One-fifth of those children with neurologic presentation had IAE or ANEC, which carried higher mortality and morbidity. This large national study provides us useful data to better manage children with neurologic complications in the future pandemic influenza outbreaks.
    Full-text · Article · Apr 2014 · Brain & development
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    • "The World Health Organization (WHO) declared the pandemic over on August 10, 2010. At that time, the death toll exceeded 18,000 (1). During the pandemic, on November 3, 2009, the Korean government raised the national disaster phase from "alert" to "severe (red)" and the Korean Center for Disease Control and Prevention (KCDC) reported peak H1N1 outbreak from November 15 to December 5, 2009. "
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    ABSTRACT: Neurologic complications of children with influenza A H1N1 2009 pandemic, diagnosed in two consecutive influenza seasons were retrospectively reviewed to seek better outcomes in future outbreaks. Patient demographics, clinical manifestations and neurologic outcomes were reviewed. A total of 1,389 children were diagnosed with influenza A H1N1 by real-time reverse transcriptase-polymerase chain reaction. Of these, 23 (1.7%) patients had neurologic involvement. Their mean age was 5.9 ± 3.6 yr (range, 6 months to 11 yr) and 16 (69.9%) were boys. None of the 23 patients had been vaccinated for influenza A H1N1 and seasonal influenzas. Twenty-two of the 23 patients presented with seizures. Clinical features included febrile convulsion (n = 19), afebrile convulsion (n = 1), aseptic meningitis (n = 1), encephalopathy (n = 1), and acute necrotizing encephalopathy (n = 1). They all were treated with Oseltamivir twice daily for 5 days immediately after nasal and throat swab testing. Twenty-one of the subjects recovered fully, but the youngest two infants experienced severe neurological sequelae. The results indicate that neurologic complications associated with influenza A H1N1 2009 pandemic were mostly mild, but rarely were serious. Prompt intervention leads to a better outcome and vaccination may prevent the disease, thus staving off serious neurological complications following influenza, especially in young infants.
    Full-text · Article · Apr 2012 · Journal of Korean medical science
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