Acute Encephalopathy in Children Associated with Influenza A: A Retrospective Case Series

Introduction

Each year 5–20% of the population in Germany suffers from respiratory infections caused by influenza A virus [The Robert Koch Institute, Berlin. 2013]. In a retrospective cohort study in children 120 out of 100 000 influenza infected children got hospitalized [Forster J, Pediatr Infect Dis J. 2003; 22: 215–217]. Influenza virus associated encephalopathy typically presents with reduced consciousness, seizures and coma [Surtees R et al., Arch Dis Child 2006; 91: 455–456]. One of the most serious complications is an acute necrotizing encephalopathy (ANE). ANE is rarely seen in Caucasians and has mostly been reported in Japan [Shinjoh M et al., Clin Infect Dis. 2000; 2: 611–613]. The diagnostic criteria include a sudden onset, along with convulsions, alteration in consciousness or coma, bilateral symmetrical, multifocal, haemorrhagic lesion of the thalami and the absence of cerebrospinal fluid pleocytosis (and often increase in cerebrospinal protein).

The pathogenesis is still unknown. The neurologic outcome varies and might be poor [Neilson DE, Curr Opin Pediatr 2010; 22: 751–757]. Sufficient treatment options are yet missing. Although influenza-associated ANE is rare, it can be prevented by influenza vaccination.

Here we report one patient who suffered from ANE (Patient 1) and 2 patients with acute encephalopathy (Patient 2 and 3).