Early ReportPCR on cerebrospinal fluid to show influenza-associated acute encephalopathy or encephalitis
Introduction
Acute encephalitis or encephalopathy is known as a rare complication of influenza infection. The association of influenza and central-nervous-system disease has been disputed in children, except for Reye's syndrome. In mid- January, 1997, several children presented with encephalopathy or encephalitis associated with influenzalike illness in Nagoya City. We did a multicentre study of such patients, partly prospectively and retrospectively.
There is mounting evidence that PCR for viruses in cerebrospinal fluid is the most reliable clinical indicator of viral meningitis and encephalitis.1 No reports are available on PCR for the influenza virus in cerebrospinal fluid of acute encephalopathy or encephalitis.
We describe the clinical and laboratory data of the patients diagnosed as having influenza-associated acute encephalopathy or encephalitis.
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Methods
Ten children with encephalopathy or encephalitis associated with influenza-like illness were admitted to the departments of paediatrics of nine hospitals in Nagoya, Japan, from April, 1996, to March, 1997. These nine hospitals serve about a half of the population on Nagoya City, in which the population is about 2·1 million. We collected samples of blood and cerebrospinal fluid and clinical data from the ten patients.
Influenza-associated acute encephalopathy or encephalitis is defined as an
Results
Seven of the ten patients had some evidence of recent influenza infection and were diagnosed as having influenza-associated acute encephalopathy or encephalitis. Six patients had type-A or Hong Kong (H3N2) infection and one had type-B infection. Four patients had significant increase in haemagglutination-inhibition tests for influenza types A (H3N2) or B. The influenza virus was isolated from throat or bronchial secretions in two patients. PCR for influenza type A was positive in the
Clinical and laboratory data
The seasonal peak of influenza-associated encephalopathy or encephalitis was winter. Six of the seven patients with influenza-associated encephalopathy or encephalitis experienced the onset between late December, 1996, and mid-February, 1997.
Patients were aged from 22 months to 4 years. There were four girls and three boys. Six patients had been healthy before this illness, and one had a history of febrile convulsion. None had received influenza vaccine. Before the onset of encephalopathy or
Discussion
According to clinical symptoms and laboratory data, two specific forms of acute encephalopathy associated with influenza infection are known; Reye's syndrome is characterised by a rapidly progressive non-inflammatory encephalopathy and fatty infiltration of the liver, probably associated with a dysfunction of mitochondria.4 This syndrome frequently follows influenza-virus and varicella-virus infection. Our patient two had similar clinical features to Reye's syndrome. Acute necrotising
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