Abstract
Background: Neurological complications of influenza viral infection have rarely been discussed in current literature. In the era of recent outbreaks of this potentially serious viral illness, understanding of possible extrapulmonary clinical manifestations is crucially needed. Case report: We are reporting two toddler girls who have been endorsed as previously healthy. Both patients have presented with a febrile respiratory illness followed by severe encephalopathy needing intensive care unit admission. They have been found to have novel H1N1 infection. Their neuroimaging studies were consistent with severe acute disseminated encephalomyelitis (ADEM). Good response to immunotherapy has been luckily achieved. Discussion: ADEM is an acute autoimmune encephalopathy disease which is commonly triggered by viral illnesses. However, particular correlation with novel H1N1 viral infection is not well described. Whether H1N1 triggers more severe clinical and radiological variant of ADEM is not yet precisely known, though has been observed in our study. Current knowledge in regard to neurological burden of H1N1 infection is reviewed. Conclusion: It is likely that H1N1 can trigger a more severe form of ADEM in children. Early suspicion and isolation of H1N1 virus in children who present with acute unexplained encephalopathy in the context of any viral illness seems to be a recommended practice.
Highlights
Neurological events related to the pandemic swine-delivered H1N1 strains of influenza virus infections have gained a lot of researchers’ interest recently
Most CNS neurological complications of H1N1 involve a picture of clinical encephalopathy and often tend to affect patients at the extreme age groups, making children among the high risk categories [6]
Possible genetic mutations or metabolic disorders might be to be unraveled [12]. Calitri and his group have estimated that up to 5% of children hospitalized for H1N1 infection had encountered neurological complications, mainly encephalitis and acute disseminated encephalomyelitis (ADEM) [13]
Summary
Most CNS neurological complications of H1N1 involve a picture of clinical encephalopathy and often tend to affect patients at the extreme age groups, making children among the high risk categories [6]. A little is known about whether the specific viral treatment has been contributing to the improvement of these patientscohort, the practice that we have followed in our reported patients It is not fully understood why some children went into full blown picture of severe encephalopathy, while others did not. With early recognition and proper utilization of intensive care support and aggressive immunotherapy, some cases have almost reached to a complete recovery [29,30] Another emerging related hot topic is post H1N1 vaccine neurological complications [31]. Our understanding of such complex correlation is expected to improve in the near future
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