From the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Pediatric Division, Soroka University Medical Center, Beer Sheva, Israel.
Pediatr Infect Dis J. 2023 Jun 1;42(6):461-467. doi: 10.1097/INF.0000000000003874. Epub 2023 Feb 20.
We assessed the neurologic manifestation of influenza among hospitalized children with influenza (neuro-flu), comparing their demographic and clinical characteristics to hospitalized children without neurologic manifestation (classic-flu).
A retrospective, cohort study. All children with laboratory confirmed influenza (PCR), admitted to the Soroka University Medical Center (SUMC) between 2016 and 2019 were included.
Overall, 951 patients were identified: 201 with neuro-flu, and 750 with classic-flu. Seizures (n = 125) were the most common neurological manifestation of neuro-flu (seizure-flu): 73 simple febrile seizures, 45 atypical febrile seizures, and 7 afebrile seizures. Neurological comorbidities rates were significantly higher in neuro-flu versus classic-flu (13.0% vs. 6.0%), while respiratory and cardiac comorbidities were less common in neuro-flu (4.5% and 0.5% vs. 8.0% and 4.5%, respectively). Neuro-flu (compared with classic-flu) was associated with leukocytosis (21.0% vs. 13.0%, P < 0.001) and lower C-reactive protein (CRP) levels (2.4 ± 4.1 vs. 3.3 ± 5.4, P = 0.03). Notably, patients with classic flu had a more prominent respiratory disease, as they had more chest radiographs (CXR) performed (60.5% vs. 45.0%, P < 0.001), higher rates of pneumonia (27.0% vs. 12.0%, P < 0.001), and antibiotic (antibacterial) treatment (60.0% vs. 42.0%, P < 0.001).
Influenza can appear as a neurologic disease, manifested mainly with febrile seizures. Children with neuro-flu have more neurologic comorbidities, suggesting that neuro-flu is mainly driven by host-factors, rather than by pathogen-factors. The relatively lower rates of pneumonia in neuro-flu suggests that these patients are admitted in the early stage of the influenza infection, which triggers the neurologic response.
我们评估了流感住院患儿的神经表现（神经型流感），将其与无神经表现的流感住院患儿（经典型流感）的人口统计学和临床特征进行比较。
这是一项回顾性队列研究。纳入 2016 年至 2019 年在索罗卡大学医学中心（SUMC）因实验室确诊流感（PCR）而住院的所有患儿。
共纳入 951 例患儿：神经型流感 201 例，经典型流感 750 例。癫痫发作（n = 125）是神经型流感最常见的神经系统表现（癫痫型流感）：73 例单纯热性惊厥，45 例非典型热性惊厥，7 例无热惊厥。神经型流感的神经系统合并症发生率明显高于经典型流感（13.0% vs. 6.0%），而呼吸道合并症和心脏合并症较少见（4.5%和 0.5% vs. 8.0%和 4.5%）。与经典型流感相比，神经型流感（与经典型流感相比）与白细胞增多症（21.0% vs. 13.0%，P < 0.001）和较低的 C 反应蛋白（CRP）水平（2.4±4.1 vs. 3.3±5.4，P = 0.03）相关。值得注意的是，经典型流感患儿更易发生呼吸道疾病，因为他们进行了更多的胸部 X 光检查（60.5% vs. 45.0%，P < 0.001），肺炎发生率更高（27.0% vs. 12.0%，P < 0.001），且接受抗生素（抗菌药物）治疗（60.0% vs. 42.0%，P < 0.001）。
流感可表现为神经系统疾病，主要表现为热性惊厥。神经型流感患儿有更多的神经系统合并症，提示神经型流感主要由宿主因素引起，而不是由病原体因素引起。神经型流感肺炎发生率相对较低，提示这些患者在流感感染的早期就入院了，这引发了神经系统的反应。
