Thread by @WuidQ

#IDgrandrounds #2
1/6
4-day old infant presents from home w/ fever and seizure. Brain MRI: diffuse diffusion restriction. All w/u (-) except multiplex PCR: influenza A!

Dx: neonatal influenza A, acute encephalopathy w/ biphasic seizures and late reduced diffusion (AESD)

2/6
Neonatal influenza
-- trans placental possible but most commonly POSTNATAL acquisition
-- more SEVERE disease than older children & adults
-- prevention: IMMUNIZATION of caregivers/family, immunization of pregnant women

#WhyIVaccinate @IDSAInfo #IDWeek2019

3/6
Influenza-associated neurological disease
-- 1st reported in 1918
-- most cases in children
-- pleocytosis is often absent
-- spectrum of disease (see pic👇)

ncbi.nlm.nih.gov/pubmed/24352349

4/6
Acute encephalopathy w/ biphasic seizures and late reduced diffusion (AESD)
-- new sx a/w influenza/HHV-6
-- 1st reported Japanese children 2006
-- prolonged seizure day 1, day 2-6 complex partial seizures
-- subcortical WM restricted diffusion

ncbi.nlm.nih.gov/pubmed/?term=b…

5/6
Medical History #1

A historical neurological illness termed: ENCEPHALITIS LETHARGICA (EL), thought to be a sequelae of the 1918 H1N1 influenza pandemic.

EL occurred & receded simultaneouly as the pandemic. Acute phase: intractable somnolence ("sleeping sickness").

6/6
Medical History #2

Later manifested by parkinsonian & prominent psychiatric symptoms.

Remains a medical enigma but the long history of research in EL paved the way for discoveries in Parkinson's disease & sleep medicine.

ncbi.nlm.nih.gov/pubmed/19144247
n.neurology.org/content/90/12/…