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Volume 23, Number 4—April 2017

CME ACTIVITY - Synopsis

Neurologic Complications of Influenza B Virus Infection in Adults, Romania

Corneliu P. PopescuComments to Author , Simin A. Florescu, Emilia Lupulescu, Mihaela Zaharia, Gratiela Tardei, Mihaela Lazar, Emanoil Ceausu, and Simona M. Ruta
Author affiliations: Carol Davila University of Medicine and Pharmacy, Bucharest, Romania (C.P. Popescu, S.A. Florescu, E. Ceausu, S.M. Ruta); Dr. Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest (C.P. Popescu, S.A. Florescu, M. Zaharia, G. Tardei, E. Ceausu); European Society of Clinical Microbiology and Infection Study Group for Infectious Diseases of the Brain, Basel, Switzerland (C.P. Popescu, M. Zaharia); National Institute of Research Cantacuzino, Bucharest (E. Lupulescu, M. Lazar); Stefan S. Nicolau Institute of Virology, Bucharest (S.M. Ruta)

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Table

Characteristics of 7 patients with neurologic complications of influenza B virus infection, Romania*

Characteristic
Patient
1
2
3
4
5
6
7
Age,y/sex 28/F 37/F 55/F 20/F 57/M 31/F 27/F
Days from illness onset 3 2 10 5 3 4 3
Medical history Uncontrolled hyperthyroidism Unremarkable Influenza A(H3N2) virus encephalitis in 2012 Treated for Russell−Silver syndrome Unremarkable Recent breast implants Unremarkable
Leukocyte count, cells/mm3 2 2 10 5 2 3 13
CSF
Protein, g/L 0.143 0.270 2.305 0.251 0.313 0.162 7.156
Glucose, g/L 0.61 0.50 0.74 1.07 0.55 0.71 1.22
Chloride, g/L ND ND 7.60 6.78 7.10 6.80 7.02
Virus type B seq EPI_ISL_179707 B seq EPI_ISL_179711 B B B seq EPI_ISL_182519 B B seq EPI_ISL_182518
Cerebral imaging result MRI, abnormal† CT, normal MRI, abnormal‡ MRI, normal MRI, normal NA MRI, abnormal§
Diagnosis Confirmed encephalitis Possible encephalitis Confirmed encephalitis Confirmed encephalitis Possible encephalitis Cerebellar ataxia Confirmed encephalitis
Length of hospitalization, d 7 9 18 17 10 5 3
Outcome Died Complete resolution Complete resolution Complete resolution Complete resolution Complete resolution Died
Clinical findings Fever, headache, sleepiness, left upper limb motor deficit, coma, GCS score 3–4 Fever, headache, sleepiness, photophobia, vertigo, stiff neck, positive Romberg sign Fever, confusion, photophobia, dizziness, right facial paralysis, aphasia, stiff neck, coma, GCS score 8 Fever, agitation, nystagmus, stiff neck, coma, GCS score 9–10 Fever, headache, dysarthria, right side motor deficit, vomiting Fever, headache, vomiting, vertigo, photophobia, ataxia, positive Romberg sign, movement and balance disorder Fever, headache, vomiting, lethargy, aphasia, upward deviation of eyes, seizures, coma, GCS score 3

*All patients showed negative RT-PCR results for influenza B virus in CSF. CSF, cerebrospinal fluid; CT, computed tomography; GCS, Glasgow coma scale; MRI, magnetic resonance imaging; NA, not available; ND, not determined.
†MRI on day 3. See Figure 1 for a detailed description.
‡MRI on day 8. See Figure 2 for a detailed description.
§MRI on day 2 showed multiple areas of hyperintensities.

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