MMWR Morb Mortal Wkly Rep. 2009 Jul 24;58(28):773-8.
Neurologic complications, including seizures, encephalitis, encephalopathy, Reye syndrome, and other neurologic disorders, have been described previously in association with respiratory tract infection with seasonal influenza A or B viruses, but not with novel influenza A (H1N1) virus. On May 28, 2009, the Dallas County Department of Health and Human Services (DCHHS) notified CDC of four children with neurologic complications associated with novel influenza A (H1N1) virus infection admitted to hospitals in Dallas County, Texas, during May 18-28. This report summarizes the clinical characteristics of those four cases. Patients were aged 7-17 years and were admitted with signs of influenza-like illness (ILI) and seizures or altered mental status. Three of the four patients had abnormal electroencephalograms (EEGs). In all four patients, novel influenza A (H1N1) viral RNA was detected in nasopharyngeal specimens but not in cerebrospinal fluid (CSF). Antiviral therapy included oseltamivir (four patients) and rimantadine (three patients). All four patients recovered fully and had no neurologic sequelae at discharge. These findings indicate that, as with seasonal influenza, neurologic complications can occur after respiratory tract infection with novel influenza A (H1N1) virus. For children who have ILI accompanied by unexplained seizures or mental status changes, clinicians should consider acute seasonal influenza or novel influenza A (H1N1) virus infection in the differential diagnosis, send respiratory specimens for appropriate diagnostic testing, and promptly initiate empirical antiviral treatment, especially in hospitalized patients.
先前已有报道称，包括癫痫、脑炎、脑病、瑞氏综合征及其他神经系统疾病在内的神经系统并发症与季节性甲型或乙型流感病毒引起的呼吸道感染有关，但与新型甲型H1N1流感病毒无关。2009年5月28日，达拉斯县卫生与公众服务部（DCHHS）向美国疾病控制与预防中心（CDC）通报，5月18日至28日期间，得克萨斯州达拉斯县有4名儿童因新型甲型H1N1流感病毒感染住院，出现了神经系统并发症。本报告总结了这4例病例的临床特征。患者年龄在7至17岁之间，因流感样疾病（ILI）体征及癫痫发作或精神状态改变入院。4名患者中有3名脑电图（EEG）异常。在所有4名患者的鼻咽标本中均检测到新型甲型H1N1流感病毒RNA，但脑脊液（CSF）中未检测到。抗病毒治疗包括使用奥司他韦（4名患者）和金刚乙胺（3名患者）。所有4名患者均完全康复，出院时无神经系统后遗症。这些发现表明，与季节性流感一样，新型甲型H1N1流感病毒引起呼吸道感染后也可能出现神经系统并发症。对于伴有无法解释的癫痫发作或精神状态改变的ILI儿童，临床医生在鉴别诊断时应考虑急性季节性流感或新型甲型H1N1流感病毒感染，送检呼吸道标本进行适当的诊断检测，并及时开始经验性抗病毒治疗，尤其是住院患者。
