Britton Philip N, Dale Russell C, Blyth Christopher C, Macartney Kristine, Crawford Nigel W, Marshall Helen, Clark Julia E, Elliott Elizabeth J, Webster Richard I, Cheng Allen C, Booy Robert, Jones Cheryl A
From the *Sydney Medical School, University of Sydney, NSW, Australia; †Marie Bashir Institute of Infectious Diseases and Biosecurity Institute, University of Sydney, NSW, Australia; ‡The Children's Hospital at Westmead, NSW, Australia; §Department of Infectious Diseases, Princess Margaret Hospital, Subiaco, Western Australia, Australia; ¶School of Medicine, University of Western Australia, Australia; ‖Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Australia; **National Centre for Immunisation Research and Surveillance, NSW, Australia; ††Royal Children's Hospital, Melbourne, Victoria, Australia; ‡‡Murdoch Children's Research Institute and University of Melbourne, Victoria, Australia; §§Women's and Children's Hospital, Robinson Research Institute and School of Medicine, University of Adelaide, Adelaide, South Australia, Australia; ¶¶Infection Management and Prevention service, Lady Cilento Children's Hospital, Queensland, Australia; ‖‖Australian Paediatric Surveillance Unit, NSW, Australia; ***School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; and †††Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Victoria, Australia.
Pediatr Infect Dis J. 2017 Nov;36(11):1021-1026. doi: 10.1097/INF.0000000000001650.
Influenza-associated encephalitis/encephalopathy (IAE) is an important cause of acute encephalitis syndrome in children. IAE includes a series of clinicoradiologic syndromes or acute encephalopathy syndromes that have been infrequently reported outside East Asia. We aimed to describe cases of IAE identified by the Australian Childhood Encephalitis study.
Children ≤ 14 years of age with suspected encephalitis were prospectively identified in 5 hospitals in Australia. Demographic, clinical, laboratory, imaging, and outcome at discharge data were reviewed by an expert panel and cases were categorized by using predetermined case definitions. We extracted cases associated with laboratory identification of influenza virus for this analysis; among these cases, specific IAE syndromes were identified where clinical and radiologic features were consistent with descriptions in the published literature.
We identified 13 cases of IAE during 3 southern hemisphere influenza seasons at 5 tertiary children's hospitals in Australia; 8 children with specific acute encephalopathy syndromes including: acute necrotizing encephalopathy, acute encephalopathy with biphasic seizures and late diffusion restriction, mild encephalopathy with reversible splenial lesion, and hemiconvulsion-hemiplegia syndrome. Use of influenza-specific antiviral therapy and prior influenza vaccination were infrequent. In contrast, death or significant neurologic morbidity occurred in 7 of the 13 children (54%).
The conditions comprising IAE are heterogeneous with varied clinical features, magnetic resonance imaging changes, and outcomes. Overall, outcome of IAE is poor emphasizing the need for optimized prevention, early recognition, and empiric management.
流感相关性脑炎/脑病（IAE）是儿童急性脑炎综合征的重要病因。IAE包括一系列临床放射学综合征或急性脑病综合征，在东亚以外地区鲜有报道。我们旨在描述澳大利亚儿童脑炎研究中确诊的IAE病例。
在澳大利亚的5家医院对14岁及以下疑似脑炎的儿童进行前瞻性识别。一个专家小组对人口统计学、临床、实验室、影像学和出院时的结局数据进行了审查，并根据预先确定的病例定义对病例进行分类。我们提取了与流感病毒实验室鉴定相关的病例进行此次分析；在这些病例中，当临床和放射学特征与已发表文献中的描述一致时，确定了特定的IAE综合征。
在澳大利亚5家三级儿童医院的3个南半球流感季节中，我们确诊了13例IAE；8名儿童患有特定的急性脑病综合征，包括：急性坏死性脑病、伴有双相癫痫发作和晚期弥散受限的急性脑病、伴有可逆性胼胝体病变的轻度脑病以及偏瘫-偏瘫综合征。很少使用流感特异性抗病毒治疗和预先接种流感疫苗。相比之下，13名儿童中有7名（54%）发生了死亡或严重的神经功能障碍。
构成IAE的病症具有异质性，临床特征、磁共振成像变化和结局各不相同。总体而言，IAE的预后较差，这强调了优化预防、早期识别和经验性管理的必要性。
