Adult influenza A (H1N1) related encephalitis: A case report
Devinder Midha, Pratibha Vasudev, Zafar Iqbal
Keywords :
Adult, encephalitis, H1N1
Citation Information :
Midha D, Vasudev P, Iqbal Z. Adult influenza A (H1N1) related encephalitis: A case report. Indian J Crit Care Med 2018; 22 (5):384-387.
The year 2009–2010 saw H1N1 influenza outbreaks occurring in almost all countries of the world, causing the WHO to declare it a pandemic of an alert level of 6. In India, H1N1 influenza outbreaks were again reported in late 2014 and early 2015. Since then, sporadic cases of H1N1 influenza have been reported. H1N1 influenza usually presents itself with respiratory tract symptoms. In a minority of patients, abdominal symptoms may occur as well. Acute influenza-associated encephalopathy/encephalitis mostly occurs in the pediatric population, whereas in adults, it is a rare complication. The incidence of neurological complications appears to have increased after the 2009 H1N1 influenza A virus pandemic. We would like to draw attention to an adult patient case who initially presented with respiratory symptoms but then deteriorated and developed encephalitis, which is rarely reported. As per literature reviewed by Victoria Bangualid and Judith Berger on PubMed, only 21 cases of neurological complications were found in adult influenza A patients, out of whom 8 had encephalopathy.
Rothberg MB, Haessler SD. Complications of seasonal and pandemic influenza. Crit Care Med 2010;38:e91-7.
Glaser CA, Winter K, DuBray K, Harriman K, Uyeki TM, Sejvar J, et al. Apopulation-based study of neurologic manifestations of severe influenza A (H1N1) pdm09 in California. Clin Infect Dis 2012;55:514-20.
Gu Y, Shimada T, Yasui Y, Tada Y, Kaku M, Okabe N, et al. National surveillance of influenza-associated encephalopathy in Japan over six years, before and during the 2009-2010 influenza pandemic. PLoS One 2013;8:e54786.
Bengualid V, Berger J. Neurologic complications of acute influenza in adults: Case report and review of the literature. J Neurosci Clin Res 2017;2:1.
Togashi T, Matsuzono Y, Narita M, Morishima T. Influenza-associated acute encephalopathy in Japanese children in 1994-2002. Virus Res 2004;103:75-8.
Maricich SM, Neul JL, Lotze TE, Cazacu AC, Uyeki TM, Demmler GJ, et al. Neurologic complications associated with influenza A in children during the 2003-2004 influenza season in Houston, Texas. Pediatrics 2004;114:e626-33.
Price DA, Postlethwaite RJ, Longson M. Influenzavirus A2 infections presenting with febril convulsions and gastrointestinal symptoms in young children. Clin Pediatr (Phila) 1976;15:361-7.
Studahl M. Influenza virus and CNS manifestations. J Clin Virol 2003;28:225-32.
Meijer WJ, Linn FH, Wensing AM, Leavis HL, van Riel D, Geurts van Kessel CH, et al. Acute influenza virus-associated encephalitis and encephalopathy in adults: A challenging diagnosis. JMM Case Rep 2016;3:e005076.
Fukumoto Y, Okumura A, Hayakawa F, Suzuki M, Kato T, Watanabe K, et al. Serum levels of cytokines and EEG findings in children with influenza associated with mild neurological complications. Brain Dev 2007;29:425-30.
Centers for Disease Control and Prevention. Neurologic complications associated with novel influenza A (H1N1) virus infection in children – Dallas, Texas, May 2009. MMWR Morb Mortal Wkly Rep 2009;58:773-8.
Chen YC, Lo CP, Chang TP. Novel influenza A (H1N1)-associated encephalopathy/encephalitis with severe neurological sequelae and unique image features – A case report. J Neurol Sci 2010;298:110-3.
Akins PT, Belko J, Uyeki TM, Axelrod Y, Lee KK, Silverthorn J, et al. H1N1 encephalitis with malignant edema and review of neurologic complications from influenza. Neurocrit Care 2010;13:396-406.
Kimura S, Ohtuki N, Nezu A, Tanaka M, Takeshita S. Clinical and radiological variability of influenza-related encephalopathy or encephalitis. Acta Paediatr Jpn 1998;40:264-70.
Fujimoto S, Kobayashi M, Uemura O, Iwasa M, Ando T, Katoh T, et al. PCR on cerebrospinal fluid to show influenza-associated acute encephalopathy or encephalitis. Lancet 1998;352:873-5.
