Neurological Manifestations of Influenza A (H1N1): Clinical Features, Intensive Care Needs, and Outcome
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ORIGINAL ARTICLE
Neurological Manifestations of Influenza A (H1N1): Clinical Features, Intensive Care Needs, and Outcome Lalit Takia 1 & Lokesh Saini 1 & Shivan Keshavan 1 & Suresh Kumar Angurana 1 & Karthi Nallasamy 1 & Renu Suthar 1 & Sanjay Verma 1 & Paramjeet Singh 2 & Kapil Goyal 3 & RK Ratho 3 & Muralidharan Jayashree 1 Received: 28 August 2019 / Accepted: 7 April 2020 # Dr. K C Chaudhuri Foundation 2020
Abstract Objectives To describe neurological manifestations in children with Influenza A (H1N1). Methods This retrospective study was conducted in the Pediatric intensive care unit (PICU) and Pediatric Neurology unit of a tertiary care teaching hospital in North India involving children with PCR confirmed Influenza A (H1N1) with neurological manifestations during 2019 outbreak. Results Six children (5 females, 1 male) were enrolled. All presented with neurological symptoms (seizures and altered sensorium) accompanied with fever and respiratory symptoms with duration of illness of 2–7 d. The admission Glasgow Coma Scale ranged from 4 to 12. Only 2 cases showed cerebrospinal fluid pleocytosis. Neuroimaging was suggestive of diffuse cerebral edema, acute necrotizing encephalopathy of childhood, and acute disseminated encephalomyelitis. All were treated with Oseltamivir. Four cases had clinical features of raised intracranial pressure (ICP) and were managed in PICU, 3 of them needed mechanical ventilation, 3 needed vasoactive drugs, 3 received 3% saline infusion, 1 underwent invasive ICP monitoring, and 3 (cases 4, 5 and 6) received intravenous methylprednisolone (30 mg/kg) for 5 d. Total duration of hospital stay was 10–30 d. Case 2 expired due to refractory raised ICP. Among survivors, 3 children had residual neurological deficits and the remaining 2 had achieved premorbid condition. Conclusions Influenza A (H1N1) can present with isolated or predominant neurological manifestations which can contribute to poor outcome. The authors suggest to rule out H1N1 in any child who presents with unexplained neurological manifestations during seasonal outbreaks of H1N1. Keywords Encephalitis . Demyelination . Influenza . Raised intracranial pressure
Introduction Influenza A (H1N1) virus usually involves respiratory system and is known for self-limiting flu like illness including fever, cough, rhinorrhea, and sore throat. Multiorgan involvement can occur in patients with influenza, leading to unusual Lalit Takia and Lokesh Saini are combined first authors * Suresh Kumar Angurana [email protected] 1
Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
2
Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
3
Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
presentations and severe complications causing significant morbidity and mortality [1–3]. Uncommonly, H1N1 also causes a wide plethor
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