Abstract

Background: Seasonal influenza associated neurological complications had high mortality and morbidity rates in children. In this study, we aimed to investigate the clinical characteristics and mortality risk factors in children with influenza-associated encephalopathy. Methods: Retrospectively analyze the clinical data, laboratory tests, and imaging examinations of 68 children diagnosed with influenza-associated encephalopathy from January 2016 to December 2019 at Guangzhou Women and Children’s Medical Center, and the cases were divided into survival and non-survival groups by disease outcome and analyzed between two groups. Chi-square test or Mann-Whitney rank sum test was used for comparison between groups, and multivariate Logistic regression analysis was used for the analysis of risk factors for death. Results: Among the 68 children with influenza-associated encephalopathy, 40 were male, and 28 were female, aged from 3 months to 13 years, of which 66.18% (45/68) were under 5 years old. Pathogenetic tests showed that influenza virus type A accounted for 63.24% (43/68), and influenza virus type B accounted for 36.76% (25/68). Typical brain MRI changes in childhood influenza-associated encephalopathy were bilateral symmetrical lesions of the thalamus, basal ganglia, brainstem, and cerebellum. 68 patients had a mortality rate of 20.59% (14/68), with a significantly higher proportion of fever peak > 39°C, Acute Disturbance of Consciousness (ADOC), and cardiac arrest in the non-survival group than in the survival group (P Conclusions: Children under 5 years of age with influenza are prone to combine neurological complications and have a higher mortality rate. Significant elevations in ALT, AST, LDH, and CSF proteins predict death from influenza-associated encephalopathy in children.

Highlights

  • Influenza, belonging to the family Orthomyxoviridae, primarily affects the respiratory system and represents one of the most frequent causes of acute upper respiratory tract infections during the winter season [1] [2]

  • Retrospectively analyze the clinical data, laboratory tests, and imaging examinations of 68 children diagnosed with influenza-associated encephalopathy from January 2016 to December 2019 at Guangzhou Women and Children’s Medical Center, and the cases were divided into survival and non-survival groups by disease outcome and analyzed between two groups

  • The common types of nervous system injury caused by influenza are Influenza-Associated Encephalopathy (IAE) [5], Reye’s Syndrome, Guillain Barré Syndrome, Hemorrhagic Shock Encephalopathy Syndrome [6], and Acute Necrotizing Encephalopathy (ANE) [5] [7], among which ANE is the most serious

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Summary

Introduction

Influenza, belonging to the family Orthomyxoviridae, primarily affects the respiratory system and represents one of the most frequent causes of acute upper respiratory tract infections during the winter season [1] [2]. Neurological complication, often defined as Influenza-Associated Encephalitis/Encephalopathy (IAE), is rare but an important complication of influenza infection with approximatively three-quarters of cases regarding children and leading up to 30% of mortality in children [1] [4] [5]. The common types of nervous system injury caused by influenza are Influenza-Associated Encephalopathy (IAE) [5], Reye’s Syndrome, Guillain Barré Syndrome, Hemorrhagic Shock Encephalopathy Syndrome [6], and Acute Necrotizing Encephalopathy (ANE) [5] [7], among which ANE is the most serious. Seasonal influenza associated neurological complications had high mortality and morbidity rates in children. We aimed to investigate the clinical characteristics and mortality risk factors in children with influenza-associated encephalopathy. Typical brain MRI changes in childhood influenza-associated encephalopathy were bilateral symmetrical lesions of the thalamus, basal ganglia, brainstem, and cerebellum. 68 patients had a mortality

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