Giuseppe
Emeritus
[Source: Clinical Infectious Diseases, full page: (LINK). Abstract, edited.]
Neurological manifestations of influenza infection in children and adults: results of a national British surveillance study
Anu Goenka 1, Benedict D. Michael 1, Elizabeth Ledger 2, Ian J. Hart 3, Michael Absoud 4, Gabriel Chow 5, James Lilleker 6, Michael Lunn 7, David McKee 8, Deirdre Peake 9, Karen Pysden 10, Mark Roberts 6, Enitan D. Carrol 1, Ming Lim 4, Shivaram Avula 11, Tom Solomon 1, and Rachel Kneen 1
<SUP>1</SUP>Institute of Infection and Global Health, University of Liverpool, Liverpool, UK - <SUP>2</SUP>Department of Pediatrics, University Hospitals Bristol NHS Foundation Trust, Bristol, UK - <SUP>3</SUP>Department of Microbiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK - <SUP>4</SUP>Department of Pediatric Neurology, Evelina Children's Hospital, London, UK - <SUP>5</SUP>Department of Pediatric Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK - <SUP>6</SUP>Department of Neurology, Salford Royal NHS Foundation Trust, Salford, UK - <SUP>7</SUP>Department of Neurology, University College London Hospitals NHS Foundation Trust, London, UK - <SUP>8</SUP>Department of Neurology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK - <SUP>9</SUP>Department of Pediatric Neurology, Belfast Health and Social Care Trust, Belfast, UK - <SUP>10</SUP>Department of Pediatric Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK - <SUP>11</SUP>Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
Corresponding Author: Dr. Rachel Kneen, Institute of Infection & Global Health, The Ronald Ross Building, Liverpool, L69 7BE, UK, rachel.kneen{at}liverpool.ac.uk, Tel: (+44) 07734 150666, Fax: (+44) 0151 795 5529, Dr. Anu Goenka, Institute of Infection & Global Health, The Ronald Ross Building, Liverpool, L69 7BE, UK, anugoenka{at}nhs.net, Tel: (+44) 07815 907441, Fax: (+44) 0151 795 5529
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-Barr? 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.
Received September 28, 2013. Accepted November 27, 2013.
? The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions{at}oup.com.
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Neurological manifestations of influenza infection in children and adults: results of a national British surveillance study
Anu Goenka 1, Benedict D. Michael 1, Elizabeth Ledger 2, Ian J. Hart 3, Michael Absoud 4, Gabriel Chow 5, James Lilleker 6, Michael Lunn 7, David McKee 8, Deirdre Peake 9, Karen Pysden 10, Mark Roberts 6, Enitan D. Carrol 1, Ming Lim 4, Shivaram Avula 11, Tom Solomon 1, and Rachel Kneen 1
<SUP>1</SUP>Institute of Infection and Global Health, University of Liverpool, Liverpool, UK - <SUP>2</SUP>Department of Pediatrics, University Hospitals Bristol NHS Foundation Trust, Bristol, UK - <SUP>3</SUP>Department of Microbiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK - <SUP>4</SUP>Department of Pediatric Neurology, Evelina Children's Hospital, London, UK - <SUP>5</SUP>Department of Pediatric Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK - <SUP>6</SUP>Department of Neurology, Salford Royal NHS Foundation Trust, Salford, UK - <SUP>7</SUP>Department of Neurology, University College London Hospitals NHS Foundation Trust, London, UK - <SUP>8</SUP>Department of Neurology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK - <SUP>9</SUP>Department of Pediatric Neurology, Belfast Health and Social Care Trust, Belfast, UK - <SUP>10</SUP>Department of Pediatric Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK - <SUP>11</SUP>Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
Corresponding Author: Dr. Rachel Kneen, Institute of Infection & Global Health, The Ronald Ross Building, Liverpool, L69 7BE, UK, rachel.kneen{at}liverpool.ac.uk, Tel: (+44) 07734 150666, Fax: (+44) 0151 795 5529, Dr. Anu Goenka, Institute of Infection & Global Health, The Ronald Ross Building, Liverpool, L69 7BE, UK, anugoenka{at}nhs.net, Tel: (+44) 07815 907441, Fax: (+44) 0151 795 5529
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-Barr? 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.
Received September 28, 2013. Accepted November 27, 2013.
? The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions{at}oup.com.
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