Original ArticleNeurological and Muscular Manifestations Associated With Influenza B Infection in Children
Introduction
Each year, about 20% of children worldwide develop symptomatic influenza A and B infections [1]. Although most of the clinical manifestations are respiratory in nature, influenza infection is also associated with various neurological and muscular symptoms, which include seizure (febrile and afebrile), encephalopathy, encephalitis, aseptic meningitis, Guillain-Barré syndrome, Reye syndrome, extrapyramidal syndromes, myelitis, myositis, and myocarditis [2], [3]. The majority of studies on influenza-related neurological manifestations were concerned with influenza A, and recently H1N1 [4], [5], [6], [7]. Influenza B has been considered to have fewer complications, and most reported cases involved sporadic encephalopathies [8], [9], [10]. There are few large-scale studies on the neurological and muscular manifestations of influenza B infection [11], [12].
Our university hospital is located in Guri City, Kyung-ki province, South Korea, and serves the surrounding areas. The number of pediatric admissions in 2012 was 2041. During the first half of 2012, there was a seasonal outbreak of influenza B in South Korea. During this time, we conducted influenza antigen tests on children suspected of having influenza infection and found that a small but significant portion of the infected patients developed neurological or muscular symptoms. The purpose of this report is to describe these manifestations in children with influenza B infection in a community hospital during the 2012 winter/spring influenza epidemic.
Section snippets
Patients
The medical records of children treated in the Pediatric Department of Hanyang University Guri Hospital between September 1, 2011, and August 31, 2012, were retrospectively reviewed. All laboratory-confirmed influenza B patients with neurological and muscular manifestations were included in the study. Patients with underlying severe neurological disease or were previously diagnosed with epilepsy were excluded. The demographic data, neurological and muscular manifestations, medical histories,
Demographic data
In our hospital, influenza B was detected from week 3 of January 2012 to week 1 of May 2012 (Fig 1). The number of patients with influenza B peaked in late March. The occurrence trend was similar to the 2011-2012 influenza sentinel surveillance report of Korea Centers for Disease Control and Prevention.
There were 355 patients with laboratory-confirmed influenza B in our department. Of these, 28 (7.9%) had neurological or muscular complications. All patients were Korean. Twenty of the 28
Discussion
The wide spectrum of effects resulting from influenza infection ranges from asymptomatic and mild respiratory infection to severe pulmonary, neurological, and muscular system complications [2], [3], [4], [5], [6], [7], [13]. Neurological manifestations may be the only symptom or may appear after the respiratory symptoms. In children, the complications of influenza infection are more frequent and severe than in adults. Although both influenza A and B are associated with neurological
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