Differential diagnosis of delirious behavior in children with influenza

Area of Science:

• Pediatrics
• Neurology
• Infectious Diseases

Background:

• Delirious behavior (DB) in children infected with influenza is a significant symptom, often linked to encephalopathy.
• Differentiating influenza-associated DB with encephalopathy (DBE) from DB without encephalopathy (DBNE) is critical as it impacts treatment decisions.
• Influenza-associated encephalopathy requires specific therapeutic interventions, unlike cases without encephalopathy.

Purpose of the Study:

• To clarify the differences between influenza-associated DB with encephalopathy (DBE) and DB without encephalopathy (DBNE) in children.
• To identify common features of acute encephalopathy associated with influenza in pediatric patients.
• To guide clinical decision-making in distinguishing between these two conditions.

Main Methods:

• Retrospective review of 48 children diagnosed with influenza and exhibiting DB.
• Analysis of clinical course, laboratory data, MRI, EEG findings, therapy, and prognosis.
• Comparison of clinico-radiological features between the DBNE and DBE groups.

Main Results:

• Out of 48 children, 40 were in the DBNE group and 8 in the DBE group.
• While many features were similar, significant differences were noted in age at onset, initial neurological symptoms, DB duration, seizure rate, and EEG background activity.
• Specific findings like RESLE, MERS, and biphasic seizures were observed in a subset of patients, primarily in the DBNE group.

Conclusions:

• Influenza-associated DB in children can present with or without encephalopathy, necessitating careful differentiation.
• Key differences in clinical presentation and EEG findings are vital for distinguishing between DBNE and DBE.
• No neurological sequelae were observed in the studied cohort, suggesting a generally favorable prognosis with appropriate management.