Davis Larry E, Koster Fredrick, Cawthon Andrew
Neurology Service, New Mexico VA Health Care System and Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM, USA.
Lovelace Respiratory Research Institute, Albuquerque, NM, USA.
Handb Clin Neurol. 2014;123:619-45. doi: 10.1016/B978-0-444-53488-0.00030-4.
Although influenza A and B viruses are primarily known as respiratory viruses and mainly infected only the upper respiratory tract in humans, patients with influenza often develop signs and symptoms that are not due to the respiratory system. Frequently individuals with influenza develop headaches, meningismus, and even seizures in addition to their typical respiratory symptoms. In the past decades, influenza viruses have also been associated with serious non-respiratory signs. The famous 1918 strain of influenza was associated with von Economo's encephalitis lethargica and postencephalitic parkinsonism. In the 1960s influenza virus infections in children were associated with Reye's syndrome characterized often by fatty non-inflammatory hepatic disease and an encephalopathy with marked non-inflammatory cerebral edema. Intermittently children with influenza develop focal myalgia and myositis. Guillain–Barré syndrome was epidemiologically associated with the 1978 killed influenza vaccine but not subsequent vaccines. Although occasional children with influenza have developed encephalopathy, from 2000 through 2004 there was an increase in the number of serious cases of acute necrotizing encephalopathy accompanying infection with the influenza A 2009 strain. The current H5N1 strain of bird influenza occasionally infects humans with a high mortality rate and some appear to have central nervous signs. This chapter explores what is known about these influenza neurologic associations.
虽然甲型和乙型流感病毒主要被认为是呼吸道病毒，在人类中主要仅感染上呼吸道，但流感患者常常出现并非由呼吸系统引起的体征和症状。流感患者除了典型的呼吸道症状外，还常常出现头痛、颈项强直，甚至癫痫发作。在过去几十年里，流感病毒还与严重的非呼吸道体征有关。著名的1918年流感毒株与冯·埃科诺莫昏睡性脑炎和脑炎后帕金森症有关。在20世纪60年代，儿童流感病毒感染与瑞氏综合征有关，其特征通常为脂肪性非炎性肝病和伴有明显非炎性脑水肿的脑病。患有流感的儿童偶尔会出现局灶性肌痛和肌炎。格林-巴利综合征在流行病学上与1978年的流感灭活疫苗有关，但与随后的疫苗无关。虽然偶尔有患流感的儿童出现脑病，但从2000年到2004年，感染2009年甲型流感毒株后出现急性坏死性脑病严重病例的数量有所增加。目前的H5N1禽流感毒株偶尔感染人类，死亡率很高，一些患者似乎有中枢神经系统体征。本章探讨了关于这些流感与神经系统关联的已知情况。
