Neurologic Complications of Influenza B Virus Infection in Adults, Romania

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Abstract

Infection with this virus should be considered as an etiologic factor for encephalitis.

Abstract

We characterized influenza B virus–related neurologic manifestations in an unusually high number of hospitalized adults at a tertiary care facility in Romania during the 2014–15 influenza epidemic season. Of 32 patients with a confirmed laboratory diagnosis of influenza B virus infection, neurologic complications developed in 7 adults (median age 31 years). These complications were clinically diagnosed as confirmed encephalitis (4 patients), possible encephalitis (2 patients), and cerebellar ataxia (1 patient). Two of the patients died. Virus sequencing identified influenza virus B (Yam)-lineage clade 3, which is representative of the B/Phuket/3073/2013 strain, in 4 patients. None of the patients had been vaccinated against influenza. These results suggest that influenza B virus can cause a severe clinical course and should be considered as an etiologic factor for encephalitis.

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RAxML version 8: a tool for phylogenetic analysis and post-analysis of large phylogenies

Alexandros Stamatakis (2014)

Motivation: Phylogenies are increasingly used in all fields of medical and biological research. Moreover, because of the next-generation sequencing revolution, datasets used for conducting phylogenetic analyses grow at an unprecedented pace. RAxML (Randomized Axelerated Maximum Likelihood) is a popular program for phylogenetic analyses of large datasets under maximum likelihood. Since the last RAxML paper in 2006, it has been continuously maintained and extended to accommodate the increasingly growing input datasets and to serve the needs of the user community. Results: I present some of the most notable new features and extensions of RAxML, such as a substantial extension of substitution models and supported data types, the introduction of SSE3, AVX and AVX2 vector intrinsics, techniques for reducing the memory requirements of the code and a plethora of operations for conducting post-analyses on sets of trees. In addition, an up-to-date 50-page user manual covering all new RAxML options is available. Availability and implementation: The code is available under GNU GPL at https://github.com/stamatak/standard-RAxML. Contact: alexandros.stamatakis@h-its.org Supplementary information: Supplementary data are available at Bioinformatics online.

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The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America.

Allan Tunkel, Carol A Glaser, Karen Bloch … (2008)

Guidelines for the diagnosis and treatment of patients with encephalitis were prepared by an Expert Panel of the Infectious Diseases Society of America. The guidelines are intended for use by health care providers who care for patients with encephalitis. The guideline includes data on the epidemiology, clinical features, diagnosis, and treatment of many viral, bacterial, fungal, protozoal, and helminthic etiologies of encephalitis and provides information on when specific etiologic agents should be considered in individual patients with encephalitis.

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Delayed Clearance of Viral Load and Marked Cytokine Activation in Severe Cases of Pandemic H1N1 2009 Influenza Virus Infection

Kelvin K. W. To, Ivan Hung, Iris W. S. Li … (2010)

Abstract Background. Infections caused by the pandemic H1N1 2009 influenza virus range from mild upper respiratory tract syndromes to fatal diseases. However, studies comparing virological and immunological profile of different clinical severity are lacking. Methods. We conducted a retrospective cohort study of 74 patients with pandemic H1N1 infection, including 23 patients who either developed acute respiratory distress syndrome (ARDS) or died (ARDS-death group), 14 patients with desaturation requiring oxygen supplementation and who survived without ARDS (survived-without-ARDS group), and 37 patients with mild disease without desaturation (mild-disease group). We compared their pattern of clinical disease, viral load, and immunological profile. Results. Patients with severe disease were older, more likely to be obese or having underlying diseases, and had lower respiratory tract symptoms, especially dyspnea at presentation. The ARDS-death group had a slower decline in nasopharyngeal viral loads, had higher plasma levels of proinflammatory cytokines and chemokines, and were more likely to have bacterial coinfections (30.4%), myocarditis (21.7%), or viremia (13.0%) than patients in the survived-without-ARDS or the mild-disease groups. Reactive hemophagocytosis, thrombotic phenomena, lymphoid atrophy, diffuse alveolar damage, and multiorgan dysfunction similar to fatal avian influenza A H5N1 infection were found at postmortem examinations. Conclusions. The slower control of viral load and immunodysregulation in severe cases mandate the search for more effective antiviral and immunomodulatory regimens to stop the excessive cytokine activation resulting in ARDS and death.

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Author and article information

Journal

Journal ID (nlm-ta): Emerg Infect Dis

Journal ID (iso-abbrev): Emerging Infect. Dis

Journal ID (publisher-id): EID

Title: Emerging Infectious Diseases

Publisher: Centers for Disease Control and Prevention

ISSN (Print): 1080-6040

ISSN (Electronic): 1080-6059

Publication date (Print): April 2017

Volume: 23

Issue: 4

Pages: 574-581

Affiliations

[1]Carol Davila University of Medicine and Pharmacy, Bucharest, Romania (C.P. Popescu, S.A. Florescu, E. Ceausu, S.M. Ruta);

[2]Dr. Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest (C.P. Popescu, S.A. Florescu, M. Zaharia, G. Tardei, E. Ceausu);

[3]European Society of Clinical Microbiology and Infection Study Group for Infectious Diseases of the Brain, Basel, Switzerland (C.P. Popescu, M. Zaharia);

[4]National Institute of Research Cantacuzino, Bucharest (E. Lupulescu, M. Lazar);

[5]Stefan S. Nicolau Institute of Virology, Bucharest (S.M. Ruta)

Author notes

Address for correspondence: Corneliu P. Popescu, Carol Davila University of Medicine and Pharmacy, Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Sos Mihai Bravu 281, Sector 3, Bucharest, Romania; email: cornel160@ 123456yahoo.com

Article

Publisher ID: 16-1317

DOI: 10.3201/eid2304.161317

PMC ID: 5367398

PubMed ID: 28322689

SO-VID: 4e56d9e5-4c9d-4a4b-b1a7-a8a8989ca5cf

Neurologic Complications of Influenza B Virus Infection in Adults, Romania

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Most cited references 42

RAxML version 8: a tool for phylogenetic analysis and post-analysis of large phylogenies

The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America.

Delayed Clearance of Viral Load and Marked Cytokine Activation in Severe Cases of Pandemic H1N1 2009 Influenza Virus Infection

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