1887

Abstract

: 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.

: 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.

: 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.

: 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.

Loading

Article metrics loading...

/content/journal/jmmcr/10.1099/jmmcr.0.005076
2016-11-01
2024-03-19
Loading full text...

Full text loading...

/deliver/fulltext/jmmcr/3/6/jmmcr005076.html?itemId=/content/journal/jmmcr/10.1099/jmmcr.0.005076&mimeType=html&fmt=ahah

References

  1. Ak Ö., Biteker F., Cag Y., Öcal G., Benzonana N., Ciblak M. A., Özer S. 2012; Influenza B-associated encephalopathy in two adults. J Infect Chemother 18:961–964 [View Article][PubMed]
    [Google Scholar]
  2. Akins P. T., Belko J., Uyeki T. M., Axelrod Y., Lee K. K., Silverthorn J. 2010; H1N1 encephalitis with malignant edema and review of neurologic complications from influenza. Neurocrit Care 13:396–406 [View Article][PubMed]
    [Google Scholar]
  3. Alakare J., Jurkko R., Kaukonen K. M., Saastamoinen K. P., Bäcklund T., Kaartinen J., Kolho E., Harjola V. P. 2010; Viral encephalitis associated with pandemic 2009 (H1N1) influenza A. BMJ Case Rep 5:bcr.02.2010.2772
    [Google Scholar]
  4. Bartynski W. S., Upadhyaya A. R., Boardman J. F. 2009; Posterior reversible encephalopathy syndrome and cerebral vasculopathy associated with influenza A infection: report of a case and review of the literature. J Comput Assist Tomogr 33:917–922 [View Article][PubMed]
    [Google Scholar]
  5. Bulakbasi N., Kocaoglu M., Tayfun C., Ucoz T. 2006; Transient splenial lesion of the corpus callosum in clinically mild influenza-associated encephalitis/encephalopathy. AJNR Am J Neuroradiol 27:1983–1986[PubMed]
    [Google Scholar]
  6. Chen Y. C., Lo C. P., Chang T. P. 2010; Novel influenza A (H1N1)-associated encephalopathy/encephalitis with severe neurological sequelae and unique image features — a case report. J Neurol Sci 298:110–113 [View Article][PubMed]
    [Google Scholar]
  7. Cheng A., Kuo K. H., Yang C. J. 2011; Pandemic (H1N1) 2009 encephalitis in woman, Taiwan. Emerg Infect Dis 17:1925–1927 [View Article][PubMed]
    [Google Scholar]
  8. Cunha B. A., Corbett M., Mickail N. 2012; Influenza A presenting as viral encephalitis in an adult. Heart Lung 41:308–309 [View Article][PubMed]
    [Google Scholar]
  9. Fujimoto Y., Shibata M., Tsuyuki M., Okada M., Tsuzuki K. 2000; Influenza A virus encephalopathy with symmetrical thalamic lesions. Eur J Pediatr 159:319–321 [View Article][PubMed]
    [Google Scholar]
  10. Fukami S., Wakakura M., Inouye J. 2005; Influenza retinitis: association with influenza encephalitis. Ophthalmologica 219:119–121 [View Article][PubMed]
    [Google Scholar]
  11. Gadoth A., Aizenstein O., Mosek A. 2010; Influenza a/H1N1 encephalitis. Neurology 75:666–667 [View Article][PubMed]
    [Google Scholar]
  12. Glaser C. A., Honarmand S., Anderson L. J., Schnurr D. P., Forghani B., Cossen C. K., Schuster F. L., Christie L. J., Tureen J. H. 2006; Beyond viruses: clinical profiles and etiologies associated with encephalitis. Clin Infect Dis 43:1565–1577 [View Article][PubMed]
    [Google Scholar]
  13. Glaser C. A., Winter K., DuBray K., Harriman K., Uyeki T. M., Sejvar J., Gilliam S., Louie J. K. 2012; A population-based study of neurologic manifestations of severe influenza A(H1N1)pdm09 in California. Clin Infect Dis 55:514–520 [View Article][PubMed]
    [Google Scholar]
  14. Goenka A., Michael B. D., Ledger E., Hart I. J., Absoud M., Chow G., Lilleker J., Lunn M., McKee D. et al. 2014; Neurological manifestations of influenza infection in children and adults: results of a National British Surveillance Study. Clin Infect Dis 58:775–784 [View Article][PubMed]
    [Google Scholar]
  15. Gonzalez B. E., Brust D. G. 2009; Novel influenza A (H1N1) presenting as an acute febrile encephalopathy in a mother and daughter. Clin Infect Dis 49:1966–1967 [View Article][PubMed]
    [Google Scholar]
  16. Gu J., Xie Z., Gao Z., Liu J., Korteweg C., Ye J., Lau L. T., Lu J., Gao Z. et al. 2007; H5N1 infection of the respiratory tract and beyond: a molecular pathology study. Lancet 370:1137–1145 [View Article][PubMed]
    [Google Scholar]
  17. Gu Y., Shimada T., Yasui Y., Tada Y., Kaku M., Okabe N. 2013; National surveillance of influenza-associated encephalopathy in Japan over six years, before and during the 2009-2010 influenza pandemic. PLoS One 8:e54786 [View Article][PubMed]
    [Google Scholar]
  18. Hakoda S., Nakatani T. 2000; A pregnant woman with influenza A encephalopathy in whom influenza A/Hong Kong virus (H3) was isolated from cerebrospinal fluid. Arch Intern Med 160:1041–1045 [View Article][PubMed]
    [Google Scholar]
  19. Hawkins S. A., Lyttle J. A., Connolly J. H. 1987; Two cases of influenza B encephalitis. J Neurol Neurosurg Psychiatry 50:1236–1237 [View Article][PubMed]
    [Google Scholar]
  20. Hjalmarsson A., Blomqvist P., Brytting M., Linde A., Sköldenberg B. 2009; Encephalitis after influenza in Sweden 1987-1998: a rare complication of a common infection. Eur Neurol 61:289–294 [View Article][PubMed]
    [Google Scholar]
  21. Iijima H., Wakasugi K., Ayabe M., Shoji H., Abe T. 2002; A case of adult influenza A virus-associated encephalitis: magnetic resonance imaging findings. J Neuroimaging 12:273–275 [View Article][PubMed]
    [Google Scholar]
  22. Ishii N., Mochizuki H., Moriguchi-Goto S., Shintaku M., Asada Y., Taniguchi A., Shiomi K., Nakazato M. 2015; An autopsy case of elderly-onset acute necrotizing encephalopathy secondary to influenza. J Neurol Sci 354:129–130 [View Article][PubMed]
    [Google Scholar]
  23. Ito S., Shima S., Ueda A., Kawamura N., Asakura K., Mutoh T. 2011; Transient splenial lesion of the corpus callosum in H1N1 influenza virus-associated encephalitis/encephalopathy. Intern Med 50:915–918 [View Article][PubMed]
    [Google Scholar]
  24. Jeganathan N., Fox M., Schneider J., Gurka D., Bleck T. 2013; Acute hemorrhagic leukoencephalopathy associated with influenza A (H1N1) virus. Neurocrit Care 19:218–221 [View Article][PubMed]
    [Google Scholar]
  25. Jhee S. S., Yen M., Ereshefsky L., Leibowitz M., Schulte M., Kaeser B., Boak L., Patel A., Hoffmann G. et al. 2008; Low penetration of oseltamivir and its carboxylate into cerebrospinal fluid in healthy Japanese and Caucasian volunteers. Antimicrob Agents Chemother 52:3687–3693 [View Article][PubMed]
    [Google Scholar]
  26. Kamei S., Sekizawa T., Shiota H., Mizutani T., Itoyama Y., Takasu T., Morishima T., Hirayanagi K. 2005; Evaluation of combination therapy using aciclovir and corticosteroid in adult patients with herpes simplex virus encephalitis. J Neurol Neurosurg Psychiatry 76:1544–1549 [View Article][PubMed]
    [Google Scholar]
  27. Khosla P., Aggarwal M., Jain S. 2011; Swine flu encephalitis-first adult case report from india. J Assoc Physicians India 59:677–678[PubMed]
    [Google Scholar]
  28. Kim M., Yu J. E., Lee J. H., Chang B. J., Song C. S., Lee B., Paik D. J., Nahm S. S. 2013; Comparative analyses of influenza virus receptor distribution in the human and mouse brains. J Chem Neuroanat 52:49–57 [View Article][PubMed]
    [Google Scholar]
  29. Kimura E., Okamoto S., Uchida Y., Hirahara T., Ikeda T., Hirano T., Uchino M. 2008; A reversible lesion of the corpus callosum splenium with adult influenza-associated encephalitis/encephalopathy: a case report. J Med Case Rep 2:220 [View Article][PubMed]
    [Google Scholar]
  30. Koskiniemi M., Rantalaiho T., Piiparinen H., von Bonsdorff C. H., Färkkilä M., Järvinen A., Kinnunen E., Koskiniemi S., Mannonen L. et al. 2001; Infections of the central nervous system of suspected viral origin: a collaborative study from Finland. J Neurovirol 7:400–408 [View Article][PubMed]
    [Google Scholar]
  31. Lee N., Wong C. K., Chan P. K., Lindegardh N., White N. J., Hayden F. G., Wong E. H., Wong K. S., Cockram C. S. et al. 2010; Acute encephalopathy associated with influenza A infection in adults. Emerg Infect Dis 16:139–142 [View Article][PubMed]
    [Google Scholar]
  32. McDaneld L. M., Fields J. D., Bourdette D. N., Bhardwaj A. 2010; Immunomodulatory therapies in neurologic critical care. Neurocrit Care 12:132–143 [View Article][PubMed]
    [Google Scholar]
  33. Osterholm M. T., Kelley N. S., Sommer A., Belongia E. A. 2012; Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. Lancet Infect Dis 12:36–44 [View Article][PubMed]
    [Google Scholar]
  34. Rantalaiho T., Färkkilä M., Vaheri A., Koskiniemi M. 2001; Acute encephalitis from 1967 to 1991. J Neurol Sci 184:169–177 [View Article][PubMed]
    [Google Scholar]
  35. Reiber H., Lange P. 1991; Quantification of vitus-specific antibodies in cerebrospinal fluid and serum: sensitive and specific detection of antibody synthesis in brain. Clin Chem 37:1153–1160[PubMed]
    [Google Scholar]
  36. Salonen O., Koshkiniemi M., Saari A., Myllylä V., Pyhälä R., Airaksinen L., Vaheri A. 1997; Myelitis associated with influenza A virus infection. J Neurovirol 3:83–85 [View Article][PubMed]
    [Google Scholar]
  37. Santini M., Kutleša M., Zarković K., Draženović V., Barsic B. 2012; Influenza A 2009 H1N1 encephalitis in adults with viral RNA in cerebrospinal fluid. Scand J Infect Dis 44:992–996 [View Article][PubMed]
    [Google Scholar]
  38. Simon M., Hernu R., Cour M., Casalegno J. S., Lina B., Argaud L. 2013; Fatal influenza A(H1N1)pdm09 encephalopathy in immunocompetent man. Emerg Infect Dis 19:1005–1007 [View Article][PubMed]
    [Google Scholar]
  39. Sindic C. J., Van Antwerpen M. P., Goffette S. 2001; The intrathecal humoral immune response: laboratory analysis and clinical relevance. Clin Chem Lab Med 39:333–340 [View Article][PubMed]
    [Google Scholar]
  40. Sivertsen B., Christensen P. B. 1996; Acute encephalitis. Acta Neurol Scand 93:156–159 [View Article][PubMed]
    [Google Scholar]
  41. Solomon T., Michael B. D., Smith P. E., Sanderson F., Davies N. W., Hart I. J., Holland M., Easton A., Buckley C. et al. 2012; Management of suspected viral encephalitis in adults — Association of British Neurologists and British Infection Association National Guidelines. J Infect 64:347–373 [View Article][PubMed]
    [Google Scholar]
  42. Steinberg D., Hirsch S. R., Marston S. D., Reynolds K., Sutton R. N. 1972; Influenza infection causing manic psychosis. Br J Psychiatry 120:531–535 [View Article][PubMed]
    [Google Scholar]
  43. Steininger C., Popow-Kraupp T., Laferl H., Seiser A., Gödl I., Djamshidian S., Puchhammer-Stöckl E. 2003; Acute encephalopathy associated with influenza A virus infection. Clin Infect Dis 36:567–574 [View Article][PubMed]
    [Google Scholar]
  44. Studahl M. 2003; Influenza virus and CNS manifestations. J Clin Virol 28:225–232 [View Article][PubMed]
    [Google Scholar]
  45. Studahl M., Bergström T., Hagberg L. 1998; Acute viral encephalitis in adults-a prospective study. Scand J Infect Dis 30:215–220[PubMed] [CrossRef]
    [Google Scholar]
  46. Tsai J. P., Baker A. J. 2013; Influenza-associated neurological complications. Neurocrit Care 18:118–130 [View Article][PubMed]
    [Google Scholar]
  47. Tsai C. K., Lai Y. H., Yang F. C., Chen C. Y., Peng G. S. 2011; Clinical and radiologic manifestations of H1N1 virus infection associated with neurological complications: a case report. Neurologist 17:228–231 [View Article][PubMed]
    [Google Scholar]
  48. Venkatesan A., Tunkel A. R., Bloch K. C., Lauring A. S., Sejvar J., Bitnun A., Stahl J. P., Mailles A., Drebot M. et al. 2013; Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis consortium. Clin Infect Dis 57:1114–1128 [View Article][PubMed]
    [Google Scholar]
  49. Wang J., Duan S., Zhao J., Zhang L. 2011; Acute disseminated encephalomyelitis associated with influenza A H1N1 infection. Neurol Sci 32:907–909 [View Article][PubMed]
    [Google Scholar]
  50. Wang J., Stewart E., Dapaah-Afriyie K., Finn A. 2015; Mild encephalopathy with reversible splenial lesion in a patient with influenza A infection — first report in an adult patient in the USA. BMJ Case Rep 2015:bcr2015210197 [View Article][PubMed]
    [Google Scholar]
  51. Yamashita S., Kouzaki Y., Kawano R., Tokunaga M., Uchino M. 2008; Acute ophthalmoparesis accompanied with influenza A infection. Intern Med 47:1627–1629 [View Article][PubMed]
    [Google Scholar]
  52. Yao L., Korteweg C., Hsueh W., Gu J. 2008; Avian influenza receptor expression in H5N1-infected and noninfected human tissues. FASEB J 22:733–740 [View Article][PubMed]
    [Google Scholar]
  53. Yokota S., Imagawa T., Miyamae T., Ito S., Nakajima S., Nezu A., Mori M. 2000; Hypothetical pathophysiology of acute encephalopathy and encephalitis related to influenza virus infection and hypothermia therapy. Pediatr Int 42:197–203 [View Article][PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmmcr/10.1099/jmmcr.0.005076
Loading
/content/journal/jmmcr/10.1099/jmmcr.0.005076
Loading

Data & Media loading...

Supplements

Supplementary File 1

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error