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CSF neopterin, a useful biomarker in children presenting with influenza associated encephalopathy?

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  • CSF neopterin, a useful biomarker in children presenting with influenza associated encephalopathy?

    Eur J Paediatr Neurol. 2018 Sep 28. pii: S1090-3798(18)30203-4. doi: 10.1016/j.ejpn.2018.09.009. [Epub ahead of print]
    CSF neopterin, a useful biomarker in children presenting with influenza associated encephalopathy?

    Macdonald-Laurs E1, Koirala A2, Britton PN3, Rawlinson W4, Hiew CC5, Mcrae J6, Dale RC3, Jones C7, Macartney K3, McMullan B2, Pillai S2.
    Author information

    Abstract

    PURPOSE:

    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.
    METHODS:

    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).
    RESULTS:

    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.
    CONCLUSION:

    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.
    Copyright ? 2018 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.


    KEYWORDS:

    Encephalitis; Influenza; Influenza-associated encephalitis; Magnetic resonance imaging; Neopterin; Neuroinflammation; Status epilepticus

    PMID: 30316638 DOI: 10.1016/j.ejpn.2018.09.009
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