Chen Li-Wen, Teng Chao-Ku, Tsai Yi-Shan, Wang Jieh-Neng, Tu Yi-Fang, Shen Ching-Fen, Liu Ching-Chuan
Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Brain Dev. 2018 Oct;40(9):799-806. doi: 10.1016/j.braindev.2018.05.019. Epub 2018 Jun 8.
Seasonal influenza-associated neurological complications had high mortality and morbidity rates in recent studies. We reported influenza-associated encephalitis/encephalopathy in children during 2014-2017 in Taiwan, focusing on neurological presentations, neuroimaging correlations, and critical care managements.
MATERIALS/SUBJECTS: During January 1st 2014 to June 30th 2017, pediatric patients reported to the Taiwan Centers for Disease Control surveillance system for severe complicated influenza infections in the hospital were retrospectively reviewed. Children with influenza-associated encephalitis/encephalopathy were inspected for clinical presentations, laboratory data, neuroimaging studies, treatment modalities, and neurological outcomes.
Ten children with median age 5.9 years were enrolled for analysis. Influenza-associated encephalitis/encephalopathy appeared in the spring and summer, with a delayed peak comparing with the occurrence of pneumonia and septic shock. The neurological symptoms developed rapidly within median 1 day after the first fever episode. All patients had consciousness disturbance. Seven patients (70%) had seizures at initial presentation, and six of them had status epilepticus. Anti-viral treatments were applied in all patients, with median door-to-drug time 0.9 h for oseltamivir and 6.0 h for peramivir. Multi-modality treatments also included steroid pulse therapy, immunoglobulin treatment, and target temperature management, with 85.2% of the major treatments administered within 12 h after admission. Nine of the ten patients recovered without neurological sequelae. Only one patient had epilepsy requiring long-term anticonvulsants and concomitant cognitive decline.
In highly prevalent area, influenza-associated encephalitis/encephalopathy should be considered irrespective of seasons. Our study suggested the effects of timely surveillance and multi-modality treatments in influenza-associated encephalitis/encephalopathy.
在最近的研究中，季节性流感相关的神经系统并发症具有较高的死亡率和发病率。我们报告了2014年至2017年台湾儿童流感相关的脑炎/脑病，重点关注神经学表现、神经影像学相关性及重症监护管理。
材料/对象：回顾性分析2014年1月1日至2017年6月30日期间向台湾疾病控制中心医院严重复杂流感感染监测系统报告的儿科患者。对患有流感相关脑炎/脑病的儿童进行临床表现、实验室数据、神经影像学研究、治疗方式及神经学转归的检查。
纳入10名中位年龄为5.9岁的儿童进行分析。流感相关脑炎/脑病出现在春季和夏季，与肺炎和感染性休克的发生相比有延迟的高峰。神经症状在首次发热发作后中位1天内迅速出现。所有患者均有意识障碍。7名患者（70%）在初次就诊时有癫痫发作，其中6名有癫痫持续状态。所有患者均接受了抗病毒治疗，奥司他韦的中位门到用药时间为0.9小时，帕拉米韦为6.0小时。多模式治疗还包括类固醇脉冲疗法、免疫球蛋白治疗和目标温度管理，85.2%的主要治疗在入院后12小时内进行。10名患者中有9名康复且无神经后遗症。只有1名患者患有癫痫，需要长期抗惊厥治疗并伴有认知功能下降。
在高流行地区，无论季节如何，均应考虑流感相关脑炎/脑病。我们的研究提示了及时监测和多模式治疗在流感相关脑炎/脑病中的作用。
