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Acute influenza virus-associated encephalitis and encephalopathy in adults: a challenging diagnosis.

ABSTRACT: Background: Acute influenza-associated encephalopathy/encephalitis (IAE) in adults is a rare but well-known complication of influenza virus infection. The diagnosis is difficult to make due to the absence of distinctive clinical symptoms and validated diagnostic criteria. We present an illustrative case and a case review on acute IAE in adults. Methods: We performed a Medline search of the English literature using the terms influenz*, encephal* and adult, and constructed a database of detailed descriptions of patients with influenza virus infection with influenza-like symptoms at the onset of neurological symptoms. Results: A total of 44 patients were included. Confusion and seizures were the most prevalent neurological symptoms, present in 12 (27?%) and 10 (23?%) patients, respectively. Magnetic resonance imaging (MRI) was performed in 21 patients and anomalies were found in 13 (62?%), with lesions located throughout the brain. Influenza virus RNA was detected in cerebrospinal fluid (CSF) in 5 (16?%) of 32 patients. Eight (18?%) of the forty-four patients died. The benefits of antiviral and immunomodulatory therapy have not been well studied. Discussion: Our results show that many different neurological symptoms can be present in patients with acute onset IAE. Therefore, the diagnosis should be considered in patients with fever and neurological symptoms, especially during the influenza season. Laboratory diagnosis consists of demonstration of influenza virus RNA in brain tissue, CSF or respiratory samples, and demonstration of intrathecal antibody production against influenza virus. The presence of brain lesions in MRI and influenza virus in CSF appear to be of prognostic value.

SUBMITTER: Meijer WJ

PROVIDER: S-EPMC5343125 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

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Acute influenza virus-associated encephalitis and encephalopathy in adults: a challenging diagnosis.

Meijer Wouter J WJ Linn Francisca H H FH Wensing Anne M J AM Leavis Helen L HL van Riel Debby D GeurtsvanKessel Corine H CH Wattjes Mike P MP Murk Jean-Luc JL

JMM case reports 20161219 6

<b>Background</b>: Acute influenza-associated encephalopathy/encephalitis (IAE) in adults is a rare but well-known complication of influenza virus infection. The diagnosis is difficult to make due to the absence of distinctive clinical symptoms and validated diagnostic criteria. We present an illustrative case and a case review on acute IAE in adults. <b>Methods</b>: We performed a Medline search of the English literature using the terms influenz*, encephal* and adult, and constructed a database ...[more]

PMID: 28348797

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Project description:BackgroundInfluenza virus-associated encephalopathy (IAE) can lead to neurological sequela and mortality among children. Therefore, instant recognition and therapeutic intervention for IAE are crucial. In some clinical subtypes of IAE, steroid pulse therapy might be beneficial, especially when it is administered in the early phase. However, early identification of patients who may benefit from steroid pulse therapy is sometimes difficult. We aimed to assess the effectiveness of early steroid pulse therapy among children with IAE.MethodsIn this retrospective observational study, we used a national database that covers half of the acute care inpatients across Japan to identify inpatients aged ≤ 18 years with a diagnosis of IAE between July 2010 and March 2017. Unfavorable outcome was defined as a composite outcome of sequela including Japan Coma Scale ≥ 10 at discharge, requiring tracheostomy, mechanical ventilation, enteral tube feeding, rehabilitation at discharge, or in-hospital death. Propensity score matching was performed to compare unfavorable outcome and in-hospital mortality between patients with and without steroid pulse therapy within 2 days of admission.ResultsAmong 692 patients included in the study, the mean age was 5.8 years, and 55.8% were male. The overall in-hospital mortality was 1.3%, and the proportion of the unfavorable outcome was 15.0%. We observed no significant difference in the unfavorable outcome between matched patients (168 patients in each group) with and without early steroid pulse therapy (13.7% vs 8.3%; P = 0.16) or in-hospital mortality (0.6% vs 1.2%; P = 1.0).ConclusionsWe did not observe the effectiveness of early steroid pulse therapy on patient outcomes among children with IAE in our study population including all clinical subtypes of IAE. Further studies considering severity of illness are warranted to determine whether steroid pulse therapy is beneficial, especially for specific clinical subtypes of IAE.

Project description:BackgroundThe pathogenesis of acute measles encephalitis (AME) is poorly understood. Treatment with immune-modulators is based on theories that post-infectious autoimmune responses cause demyelination. The clinical course and immunological parameters of AME were examined during an outbreak in Vietnam.Methods and findingsFifteen measles IgM-positive patients with confusion or Glasgow Coma Scale (GCS) score below 13, and thirteen with uncomplicated measles were enrolled from 2008-2010. Standardized clinical exams were performed and blood collected for lymphocyte and measles- and auto-antibody analysis. The median age of AME patients was 21 years, similar to controls. Eleven reported receiving measles vaccination when aged one year. Confusion developed a median of 4 days after rash. Six patients had GCS <8 and four required mechanical ventilation. CSF showed pleocytosis (64%) and proteinorrhachia (71%) but measles virus RNA was not detected. MRI revealed bilateral lesions in the cerebellum and brain stem in some patients. Most received dexamethasone +/- IVIG within 4 days of admission but symptoms persisted for ?3 weeks in five. The concentration of voltage gated calcium channel-complex-reactive antibodies was 900 pM in one patient, and declined to 609 pM ? 3 months later. Measles-reactive IgG antibody avidity was high in AME patients born after vaccine coverage exceeded 50% (? 25 years earlier). AME patients had low CD4 (218/µl, p?=?0.029) and CD8 (200/µl, p?=?0.012) T-cell counts compared to controls.ConclusionYoung adults presenting with AME in Vietnam reported a history of one prior measles immunization, and those aged <25 years had high measles-reactive IgG avidity indicative of prior vaccination. This suggests that one-dose measles immunization is not sufficient to prevent AME in young adults and reinforces the importance of maintaining high coverage with a two-dose measles immunization schedule. Treatment with corticosteroids and IVIG is common practice, and should be assessed in randomized clinical trials.

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Acute influenza virus-associated encephalitis and encephalopathy in adults: a challenging diagnosis.

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Acute influenza virus-associated encephalitis and encephalopathy in adults: a challenging diagnosis.

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