Acute seasonal influenza or novel influenza A(H1N1) should be considered in the differential diagnosis for children who present with influenzalike illness accompanied by unexplained seizures or mental status changes.

That recommendation was made by the U.S. Centers for Disease Control and Prevention in a report of four children with neurologic complications associated with novel influenza A(H1N1) virus infection seen in Dallas County, Texas, during May 2009. Aged 7-17 years, all four children were admitted with signs of influenzalike illness (ILI) and seizures and/or altered mental status. Three of the four patients had abnormal findings on EEGs. In all four patients, novel influenza A(H1N1) viral RNA was detected in nasopharyngeal specimens but not in cerebrospinal fluid, the CDC said (MMWR 2009;58:773-8).

Antiviral therapy included oseltamivir in all four patients and rimantadine in three. All four recovered fully, with no neurologic sequelae at discharge.

This is the first report of patients with neurologic complications of the novel influenza A(H1N1) virus infections. The severity of the complications in these four patients was less than described in two previous studies of neurologic complications associated with seasonal influenza, which have included reports of severe static encephalopathy and death.

The frequency of neurologic complications with the novel influenza A(H1N1) virus is not known, but it is likely that additional cases in children will be reported as the pandemic continues, especially because children appear to be infected with the novel influenza A virus more often than adults, the CDC noted.

Antiviral treatment should be initiated as soon as possible for any hospitalized patient with neurologic symptoms and suspected influenza infection of any type. Respiratory specimens should be obtained for diagnostic testing prior to administering antiviral medications, but clinicians should not wait for the results before initiating treatment, the CDC advised.

Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

儿童出现流感样症状并伴有无法解释的癫痫发作或精神状态改变时，在鉴别诊断中应考虑有急性季节性流感或者新型甲型H1N1流感的可能。

上述建议由美国疾病预防控制中心（CDC）在其一篇报告中提出，此报告是关于2009年5月德克萨斯州达拉斯的4例新型甲型H1N1病毒感染的患儿出现了神经系统的并发症。4例患儿的年龄为7~17岁，均伴有流感样症状（ILI）、癫痫发作和（或）精神状态的改变，其中3人的脑电图有异常。CDC的报告中说，全部患儿的鼻咽部样本中均检测到了新型甲型H1N1病毒RNA，而脑脊液中没有检测到（MMWR 2009:58:773-778）。

经抗病毒治疗（4例患儿均应用奥司他韦，3例应用金刚烷胺），4例患儿完全康复，出院时没有遗留神经系统后遗症。

这是第一篇关于新型甲型H1N1病毒感染导致神经系统并发症的报道。本次4例甲型H1N1流感患儿的神经系统并发症比先前2篇报道中季节性流感相关的神经系统并发症的严重程度要低，后者出现了严重的非进行性脑病和死亡。

新型甲型H1N1病毒导致神经系统并发症的发病频率尚不明确，但鉴于流感大流行正在继续，很可能会出现更多的儿童病例，特别是CDC报告中提到，儿童似乎比成人更易感染新型甲型H1N1病毒。

有神经系统症状及被疑诊为任何类型流感病毒感染的住院患者，应尽快开始抗病毒治疗。CDC报告中建议：在抗病毒治疗前，应采集呼吸道样本以进行诊断性实验，但临床医生不需等待检查结果出来即可开始抗病毒治疗。

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