Influenza-Associated Encephalitis/Encephalopathy Identified by the Australian Childhood Encephalitis Study 2013-2015

Philip N Britton, Russell C Dale, Christopher Blyth, Kristine Macartney, Nigel Crawford, Helen Marshall, Julia Clark, Elizabeth Elliott, Richard I. Webster, Allen C. Cheng, Robert Booy, Cheryl A Jones, ACE study investigators and PAEDS network

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Abstract

BACKGROUND:: Influenza associated encephalitis/encephalopathy (IAE) is an important cause of acute encephalitis syndrome in children. IAE includes a series of clinico-radiologic syndromes or acute encephalopathy syndromes that have been infrequently reported outside East Asia. We aimed to describe case of IAE identified by the Australian Childhood Encephalitis study. METHODS:: 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 influenza associated acute encephalopathy syndromes were identified where clinical and radiologic features were consistent with descriptions in the published literature RESULTS:: 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%). CONCLUSIONS:: The conditions comprising IAE are heterogenous with varied clinical features, MRI changes and outcomes. Overall, outcome of IAE is poor emphasizing the need for optimized prevention, early recognition and empiric management.

Original languageEnglish
Pages (from-to)1021-1026
Number of pages6
JournalPediatric Infectious Disease Journal
Volume36
Issue number11
DOIs
Publication statusPublished - Nov 2017

Keywords

  • encephalitis
  • encephalopathy
  • influenza
  • child

Cite this

Britton, P. N., Dale, R. C., Blyth, C., Macartney, K., Crawford, N., Marshall, H., ... ACE study investigators and PAEDS network (2017). Influenza-Associated Encephalitis/Encephalopathy Identified by the Australian Childhood Encephalitis Study 2013-2015. Pediatric Infectious Disease Journal, 36(11), 1021-1026. https://doi.org/10.1097/INF.0000000000001650
Britton, Philip N ; Dale, Russell C ; Blyth, Christopher ; Macartney, Kristine ; Crawford, Nigel ; Marshall, Helen ; Clark, Julia ; Elliott, Elizabeth ; Webster, Richard I. ; Cheng, Allen C. ; Booy, Robert ; Jones, Cheryl A ; ACE study investigators and PAEDS network. / Influenza-Associated Encephalitis/Encephalopathy Identified by the Australian Childhood Encephalitis Study 2013-2015. In: Pediatric Infectious Disease Journal. 2017 ; Vol. 36, No. 11. pp. 1021-1026.
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abstract = "BACKGROUND:: Influenza associated encephalitis/encephalopathy (IAE) is an important cause of acute encephalitis syndrome in children. IAE includes a series of clinico-radiologic syndromes or acute encephalopathy syndromes that have been infrequently reported outside East Asia. We aimed to describe case of IAE identified by the Australian Childhood Encephalitis study. METHODS:: 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 influenza associated acute encephalopathy syndromes were identified where clinical and radiologic features were consistent with descriptions in the published literature RESULTS:: 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{\%}). CONCLUSIONS:: The conditions comprising IAE are heterogenous with varied clinical features, MRI changes and outcomes. Overall, outcome of IAE is poor emphasizing the need for optimized prevention, early recognition and empiric management.",
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Britton, PN, Dale, RC, Blyth, C, Macartney, K, Crawford, N, Marshall, H, Clark, J, Elliott, E, Webster, RI, Cheng, AC, Booy, R, Jones, CA & ACE study investigators and PAEDS network 2017, 'Influenza-Associated Encephalitis/Encephalopathy Identified by the Australian Childhood Encephalitis Study 2013-2015', Pediatric Infectious Disease Journal, vol. 36, no. 11, pp. 1021-1026. https://doi.org/10.1097/INF.0000000000001650

Influenza-Associated Encephalitis/Encephalopathy Identified by the Australian Childhood Encephalitis Study 2013-2015. / Britton, Philip N; Dale, Russell C; Blyth, Christopher; Macartney, Kristine; Crawford, Nigel; Marshall, Helen; Clark, Julia; Elliott, Elizabeth; Webster, Richard I.; Cheng, Allen C.; Booy, Robert; Jones, Cheryl A; ACE study investigators and PAEDS network.

In: Pediatric Infectious Disease Journal, Vol. 36, No. 11, 11.2017, p. 1021-1026.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Influenza-Associated Encephalitis/Encephalopathy Identified by the Australian Childhood Encephalitis Study 2013-2015

AU - Britton, Philip N

AU - Dale, Russell C

AU - Blyth, Christopher

AU - Macartney, Kristine

AU - Crawford, Nigel

AU - Marshall, Helen

AU - Clark, Julia

AU - Elliott, Elizabeth

AU - Webster, Richard I.

AU - Cheng, Allen C.

AU - Booy, Robert

AU - Jones, Cheryl A

AU - ACE study investigators and PAEDS network

PY - 2017/11

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N2 - BACKGROUND:: Influenza associated encephalitis/encephalopathy (IAE) is an important cause of acute encephalitis syndrome in children. IAE includes a series of clinico-radiologic syndromes or acute encephalopathy syndromes that have been infrequently reported outside East Asia. We aimed to describe case of IAE identified by the Australian Childhood Encephalitis study. METHODS:: 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 influenza associated acute encephalopathy syndromes were identified where clinical and radiologic features were consistent with descriptions in the published literature RESULTS:: 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%). CONCLUSIONS:: The conditions comprising IAE are heterogenous with varied clinical features, MRI changes and outcomes. Overall, outcome of IAE is poor emphasizing the need for optimized prevention, early recognition and empiric management.

AB - BACKGROUND:: Influenza associated encephalitis/encephalopathy (IAE) is an important cause of acute encephalitis syndrome in children. IAE includes a series of clinico-radiologic syndromes or acute encephalopathy syndromes that have been infrequently reported outside East Asia. We aimed to describe case of IAE identified by the Australian Childhood Encephalitis study. METHODS:: 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 influenza associated acute encephalopathy syndromes were identified where clinical and radiologic features were consistent with descriptions in the published literature RESULTS:: 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%). CONCLUSIONS:: The conditions comprising IAE are heterogenous with varied clinical features, MRI changes and outcomes. Overall, outcome of IAE is poor emphasizing the need for optimized prevention, early recognition and empiric management.

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