CSF neopterin, a useful biomarker in children presenting with influenza associated encephalopathy?
Encephalitis
Influenza
Influenza-associated encephalitis
Magnetic resonance imaging
Neopterin
Neuroinflammation
Status epilepticus
Journal
European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society
ISSN: 1532-2130
Titre abrégé: Eur J Paediatr Neurol
Pays: England
ID NLM: 9715169
Informations de publication
Date de publication:
Jan 2019
Jan 2019
Historique:
received:
24
04
2018
revised:
07
09
2018
accepted:
23
09
2018
pubmed:
15
10
2018
medline:
6
4
2019
entrez:
15
10
2018
Statut:
ppublish
Résumé
Neurological complications of influenza cause significant disease in children. Central nervous system inflammation, the presumed mechanism of influenza-associated encephalopathy, is difficult to detect. Characteristics of children presenting with severe neurological complications of influenza, and potential biomarkers of influenza-associated encephalopathy are described. A multi-center, retrospective case-series of children with influenza and neurological complications during 2017 was performed. Enrolled cases met criteria for influenza-associated encephalopathy or had status epilepticus. Functional outcome at discharge was compared between groups using the Modified Rankin Scale (mRS). There were 22 children with influenza studied of whom 11/22 had encephalopathy and 11/22 had status epilepticus. Only one child had a documented influenza immunization. The biomarker CSF neopterin was tested in 10/11 children with encephalopathy and was elevated in 8/10. MRI was performed in all children with encephalopathy and was abnormal in 8 (73%). Treatment of children with encephalopathy was with corticosteroids or intravenous immunoglobulin in 9/11 (82%). In all cases oseltamivir use was low (59%) while admission to the intensive care unit was frequent (14/22, 66%). Clinical outcome at discharge was moderate to severe disability (mRS score > 2) in the majority of children with encephalopathy (7/11, 64%), including one child who died. Children with status epilepticus recovered to near-baseline function in all cases. Raised CSF neopterin was present in most cases of encephalopathy, and along with diffusion restriction on MRI, is a useful diagnostic biomarker. Lack of seasonal influenza vaccination represents a missed opportunity to prevent illness in children, including severe neurological disease.
Identifiants
pubmed: 30316638
pii: S1090-3798(18)30203-4
doi: 10.1016/j.ejpn.2018.09.009
pmc: PMC7128712
pii:
doi:
Substances chimiques
Biomarkers
0
Neopterin
670-65-5
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
204-213Informations de copyright
Copyright © 2018 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.
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