A bad dose of the 'flu

Successful Treatment of Influenza-Associated Acute Necrotizing Encephalitis in an Adult Using High-Dose Oseltamivir and Methylprednisolone: Case Report and Literature Review

A case of influenza-associated acute necrotizing encephalitis (ANE) is described in an otherwise healthy adult. The patient was treated successfully with a combination of high-dose methylprednisolone and high-dose oseltamivir. The patient relapsed after discontinuing 150 mg twice daily oseltamivir but quickly improved and eventually recovered after reinitiation of high-dose oseltamivir for an additional 2 weeks. The clinical presentation, pathogenesis, and treatment of influenza-associated ANE is reviewed. The use of high-dose oseltamivir in combination with methylprednisolone may offer additional therapeutic benefit for this rare and poorly understood complication of influenza infection.

Successful Treatment of Influenza-Associated Acute Necrotizing Encephalitis in an Adult Using High-Dose Oseltamivir and Methylprednisolone: Case Report and Literature Review

A case of influenza-associated acute necrotizing encephalitis (ANE) is described in an otherwise healthy adult. The patient was treated successfully with a combination of high-dose methylprednisolone and high-dose oseltamivir. The patient relapsed after discontinuing 150 mg twice daily oseltamivir but quickly improved and eventually recovered after reinitiation of high-dose oseltamivir for an additional 2 weeks. The clinical presentation, pathogenesis, and treatment of influenza-associated ANE is reviewed. The use of high-dose oseltamivir in combination with methylprednisolone may offer additional therapeutic benefit for this rare and poorly understood complication of influenza infection.

Delirious behavior in children with acute necrotizing encephalopathy

OBJECTIVE

To clarify the features of delirious behavior in patients with acute necrotizing encephalopathy.

METHODS

We retrospectively evaluated the clinical course of 38 children with acute necrotizing encephalopathy diagnosed on the basis of neuroradiological findings. The patients were divided into two groups according to the presence or absence of delirious behavior. We compared clinical features, laboratory data, neuroimaging findings, and outcome between those with and without delirious behavior. In patients with delirious behavior, chronological sequence of neurological symptoms and the characteristics of delirious behavior were investigated.

RESULTS

Delirious behavior was observed in 8 patients. Patient characteristics or most laboratory data on admission were not significantly different between those with and without delirious behavior. Brainstem lesions were more frequent in patients with delirious behavior than in those without. In contrast, lesions in lentiform nuclei, cerebral hemisphere, or cerebellum were relatively more frequent in patients without delirious behavior. It was the initial neurological symptom in 7 of 8 patients. Stupor and seizures were observed after delirious behavior in most patients.

CONCLUSIONS

Delirious behavior was not uncommon in children with acute necrotizing encephalopathy. Brainstem lesions may be related to the development of delirious behavior of children with acute necrotizing encephalopathy.

Outcome of acute necrotizing encephalopathy in relation to treatment with corticosteroids and gammaglobulin

OBJECTIVE

To examine the relation between outcome and treatment with steroids and gammaglobulin in children with acute necrotizing encephalopathy.

METHODS

We retrospectively evaluated the clinical course and outcome of 34 children with acute necrotizing encephalopathy. They were divided into two groups; 17 patients with brainstem lesion and 17 patients without brainstem lesion. Early steroid use was defined as when steroids were administered within 24h after the onset. The outcome was judged as good when a patient had no or mild cognitive impairment and poor when a patient had more severe sequelae, or died.

RESULTS

Among patients without brainstem lesions, the outcome was good in 7 of 12 with early steroid, whereas it was poor in all 5 patients without early steroid. There was no significant difference in sex, age, and laboratory data between patients with and without early steroid. The outcome was not correlated with gammaglobulin treatment. As to patients without brainstem lesions, the outcome was not correlated with early steroid or gammaglobulin treatment.

CONCLUSIONS

Steroid within 24 h after the onset was related to better outcome of children with acute necrotizing encephalopathy without brainstem lesions. Early steroid treatment will be an important option of the treatment for acute necrotizing encephalopathy.

Neurologic complications associated with influenza A in children during the 2003-2004 influenza season in Houston, Texas

OBJECTIVES

Our objectives were to (1) describe the clinical characteristics of and viruses isolated from patients who presented with neurologic symptoms associated with influenza A infection and were hospitalized at Texas Children's Hospital during October and November 2003 and (2) to raise awareness of the neurologic complications of influenza among US children.

METHODS

We reviewed the medical and laboratory records of all children who were hospitalized with neurologic symptoms and who also had evidence of influenza virus infection by rapid antigen testing or viral isolation.

RESULTS

Eight children aged 5 months to 9 years with neurologic complications associated with influenza A were identified. None of the children had received the influenza vaccine. Four presented with seizures, 3 with mental status changes, and 1 with mutism. All but 1 of the patients had influenza A viral antigen detected in nasal wash samples. Influenza A virus was isolated in culture from nasal wash specimens obtained from 6 of the patients; influenza A virus was also isolated from the cerebrospinal fluid of 1 of these patients. None of the patients had serum metabolic abnormalities or other cerebrospinal fluid abnormalities. Three of the patients had brain imaging abnormalities. Five of the patients were treated with antivirals. All 8 of the patients survived, 6 with complete recovery and 2 with sequelae (1 mild and 1 severe).

CONCLUSIONS

Neurologic symptoms and sequelae were associated with influenza A virus infection in children during the 2003-2004 influenza season in Houston, Texas. Influenza should be considered in the differential diagnosis in patients with seizures and mental status changes, especially if they present with respiratory symptoms or during an influenza outbreak.