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Volume 17, Number 10—October 2011

Dispatch

Pandemic (H1N1) 2009 Encephalitis in Woman, Taiwan

Aristine Cheng, Kuei-Hong Kuo, and Chia-Jui YangComments to Author 
Author affiliations: Far Eastern Memorial Hospital, New Taipei City, Taiwan (A. Cheng, K.-H. Kuo, C.-J.Yang); National Taiwan University Hospital and College of Medicine, Taipei, Taiwan (A. Cheng)

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Table A1

Summary of published case reports for adults (age >18 y) in whom influenza subtype H1N1–related encephalopathy or encephalitis developed*

Authors, publication year (reference) Age, y/sex Ethnicity/nationality RTI S/S ILI to CNS, d Neurologic S/S Respiratory PCR CSF
PCR CSF findings MRI findings Outcome
Akins et al., 2010 (7) 20/M Hispanic RF 5 Seizure, coma Influenza A (H1N1) No Mild pleocytosis (leukocyte 53: erythrocyte 6) Malignant brain edema, with T2-hyperintensities of white matter, symmetric Mildly disabled (rigidity)
Wang et al., 2011 (8) 22/M Asian URI 3 Seizure, dysarthria, monoplegia Influenza A (H1N1) ND No pleocytosis (leukocyte 0: erythrocyte 1) ADEM-like lesion in white matter, symmetric Full recovery
Ito et al., 2011 (9) 26/M Asian URI 1 Drowsiness, amnesia, confusion Influenza A (H1N1) ND Mild pleocytosis (leukocyte 38: erythrocyte 3) ADEM-like lesions in white matter, symmetric Full recovery
Chen et al., 2010 (10) 40/M Asian RF 2 Seizure, hemiplegia Influenza A (H1N1) ND Mild pleocytosis (leukocyte 13: erythrocyte NA) Regional gray matter T2-hyperintensities, asymmetric Moderately disabled (hemiplegia)
Fugate et al., 2010 (11) 40/M American RF Not clear Coma, left gaze deviation Influenza A, not subtyped ND Hemorrhagic (leukocyte 1: erythrocyte 157) Acute hemorrhagic encephalitis, symmetric Severely disabled (vegetative)
This study 60/F Asian URI 2 Focal paresthesiae, urinary retention Influenza A, not subtyped Yes Marked pleocytosis (leukocyte 244: erythrocyte 12) Scattered white and gray matter T2-hyperintensites, asymmetric Mild residual deficits

*RTI S/S, respiratory tract infection symptoms and signs; ILI to CNS, interval from influenza-like illness to central nervous system symptoms and signs; respiratory PCR, respiratory tract specimen (e.g., nasopharyngeal swab or broncheoalveolar lavage specimen) real-time PCR for influenza A virus; CSF PCR, cerebrospinal fluid specimen real-time PCR for influenza A virus; MRI, magnetic resonance imaging; RF, respiratory failure; leukocyte:erythrocyte, leukocyte to erythrocyte ratio/mm3; URI, upper respiratory tract infection; ND, not done; ADEM, acute demyelinating encephalomyelitis.

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