SARS-CoV-2 Encephalitis versus Influenza Encephalitis: More Similarities than Differences


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Abstract

Background:From time to time, physicians face challenging diagnostic and therapeutic issues concerning the acute management of children with viral encephalitis.

Objective:The aim of this article is to provide an updated narrative review on the similarities and differences between SARS-CoV-2 and influenza encephalitis.

Methods:A PubMed search was performed with the function "Clinical Queries" using the key terms "SARS-CoV-2" OR "Influenza" AND "Encephalitis". The search strategy included meta-analyses, clinical trials, randomized controlled trials, reviews and observational studies. The search was restricted to the English literature and pediatric population. This article compares similarities and contrasts between SARS-CoV-2 and influenza-associated encephalitis.

Results:Encephalitis is an uncommon manifestation of both influenza and SARS-CoV-2. Both vi-ruses are associated with fever and respiratory symptoms. However, SARS-CoV-2 patients may on-ly have mild symptoms or be asymptomatic as silent carriers, rendering the disease spread difficult to control. Influenza patients usually have more severe symptomatology and are often bed bound for several days limiting its spread. Influenza is associated with seasonal and annual outbreaks, whereas SARS-CoV-2 has become endemic. Complications of encephalitis are rare in both viral infections but, when present, may carry serious morbidity and mortality. Many long-term sequelae of COVID-19 infections (long COVID-19) have been described but not with influenza infections. Mortality as-sociated with encephalitis appears higher with influenza than with SARS-CoV-2. Prophylaxis by immunization is available for both influenza and SARS-CoV-2. Specific efficacious antivirals are also available with oseltamivir for influenza and nirmatrelvir/ritonavir for SARS-CoV-2. Steroids are indicated with more severe SARS-CoV-2 but their role is not distinct in influenza disease.

Conclusion:Encephalitis is a rare complication of influenza and SARS-CoV-2 infections. Both carry significant morbidity and mortality. Efficacious vaccines for prophylaxis and antivirals for treatment are available for both viruses.

About the authors

Kam Hon

Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital

Author for correspondence.
Email: info@benthamscience.net

Alexander Leung

Department of Pediatrics, The University of Calgary, and The Alberta Children’s Hospital,

Email: info@benthamscience.net

Yok Tan

Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital

Email: info@benthamscience.net

Karen Leung

Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital,

Email: info@benthamscience.net

Paul Chan

Department of Microbiolog, The Chinese University of Hong Kong,

Email: info@benthamscience.net

References

  1. Hon KL, Leung AKC, Leung KKY, Wong AHC. Impact of "long covid" on children: Global and Hong Kong perspectives. Curr Pediatr Rev 2022. doi: 10.2174/1573396319666221021154949 PMID: 36281870
  2. Hon KL, Tan YW, Leung KKY, et al. Pediatric COVID-19 acute encephalopathy and mortality. Curr Pediatr Rev 2022. doi: 10.2174/1573396318666220617161606 PMID: 35718976
  3. Hon KL. Successful treatment of influenza A encephalopathy. Hong Kong Med J 2020; 26(2): 154. doi: 10.12809/hkmj208417 PMID: 32300080
  4. Yilmaz H. Investigation of respiratory tract coinfections in Coronavirus disease 2019 infected and suspected cases. North Clin Istanb 2022; 9: 421-8. doi: 10.14744/nci.2022.82608
  5. Pizzato Tondo L, Beck Paglioli Neto E, Arpini S, Passos G, Becker J. Encephalopathy due to COVID-19 with great response to glucocorticoids. Cureus 2021; 13(9): e17845. doi: 10.7759/cureus.17845 PMID: 34660051
  6. Hon KL, Leung AKC, Leung WH, Leung KKY, Cheong KN, Lee PPW. Drugs for paediatric hyperinflammatory syndromes. Drugs Context 2022; 11: 1-11. doi: 10.7573/dic.2022-2-1 PMID: 35720057
  7. Costa BK, Sato DK. Viral encephalitis: a practical review on diagnostic approach and treatment. J Pediatr (Rio J) 2020; 96(Suppl 1) (Suppl. 1): 12-9. doi: 10.1016/j.jped.2019.07.006 PMID: 31513761
  8. Islam MA, Cavestro C, Alam SS, Kundu S, Kamal MA, Reza F. Encephalitis in patients with COVID-19: A systematic evidence-based analysis. Cells 2022; 11(16): 2575. doi: 10.3390/cells11162575 PMID: 36010650
  9. Lin MC, Chi H, Chiu NC, Huang FY, Ho CS. Factors for poor prognosis of neonatal bacterial meningitis in a medical center in Northern Taiwan. J Microbiol Immunol Infect 2012; 45(6): 442-7. doi: 10.1016/j.jmii.2011.12.034 PMID: 22571998
  10. Ku LC, Boggess KA, Cohen-Wolkowiez M. Bacterial meningitis in infants. Clin Perinatol 2015; 42(1): 29-45. vii-viii. doi: 10.1016/j.clp.2014.10.004 PMID: 25677995
  11. Alamarat Z, Hasbun R. Management of acute bacterial meningitis in children. Infect Drug Resist 2020; 13: 4077-89. doi: 10.2147/IDR.S240162 PMID: 33204125
  12. Ellul MA, Benjamin L, Singh B, et al. Neurological associations of COVID-19. Lancet Neurol 2020; 19(9): 767-83. doi: 10.1016/S1474-4422(20)30221-0 PMID: 32622375
  13. Garg RK, Paliwal VK, Gupta A. Encephalopathy in patients with COVID‐19: A review. J Med Virol 2021; 93(1): 206-22. doi: 10.1002/jmv.26207 PMID: 32558956
  14. Liotta EM, Batra A, Clark JR, et al. Frequent neurologic manifestations and encephalopathy‐associated morbidity in Covid‐19 patients. Ann Clin Transl Neurol 2020; 7(11): 2221-30. doi: 10.1002/acn3.51210 PMID: 33016619
  15. Uginet M, Breville G, Assal F, et al. COVID‐19 encephalopathy: Clinical and neurobiological features. J Med Virol 2021; 93(7): 4374-81. doi: 10.1002/jmv.26973 PMID: 33782993
  16. Britton PN, Dale RC, Blyth CC, et al. Influenza-associated encephalitis/encephalopathy identified by the australian childhood encephalitis study 2013-2015. Pediatr Infect Dis J 2017; 36(11): 1021-6. doi: 10.1097/INF.0000000000001650 PMID: 28654561
  17. Surtees R, DeSousa C. Influenza virus associated encephalopathy. Arch Dis Child 2006; 91(6): 455-6. doi: 10.1136/adc.2005.092890 PMID: 16714714
  18. Song X, Delaney M, Shah RK, Campos JM, Wessel DL, DeBiasi RL. Comparison of clinical features of COVID-19 vs. seasonal influenza A and B in US children. JAMA Netw Open 2020; 3(9): e2020495. doi: 10.1001/jamanetworkopen.2020.20495 PMID: 32897374
  19. Wu Y, Kang L, Guo Z, Liu J, Liu M, Liang W. Incubation period of COVID-19 caused by unique SARS-CoV-2 strains. JAMA Netw Open 2022; 5(8): e2228008. doi: 10.1001/jamanetworkopen.2022.28008 PMID: 35994285
  20. Pormohammad A, Ghorbani S, Khatami A, et al. Comparison of influenza type A and B with COVID‐19: A global systematic review and meta‐analysis on clinical, laboratory and radiographic findings. Rev Med Virol 2021; 31(3): e2179. doi: 10.1002/rmv.2179 PMID: 33035373
  21. Hon KL, Leung KKY, Hui WF, Ng DKK. Applying lessons from influenza pandemics to the COVID‐19 pandemic. Pediatr Pulmonol 2021; 56(9): 3071-4. doi: 10.1002/ppul.25571 PMID: 34288587
  22. Hon KL, Leung KKY. From influenza to COVID‐19 vaccinations: Counselling anxious parents about deaths following influenza immunizations in Korea. Pediatr Pulmonol 2021; 56(6): 1779-81. doi: 10.1002/ppul.25260 PMID: 33765351
  23. Hoang A, Chorath K, Moreira A, et al. COVID-19 in 7780 pediatric patients: A systematic review. EClinicalMedicine 2020; 24: 100433. doi: 10.1016/j.eclinm.2020.100433 PMID: 32766542
  24. Jeng MJ. Coronavirus disease 2019 in children: Current status. J Chin Med Assoc 2020; 83(6): 527-33. doi: 10.1097/JCMA.0000000000000323 PMID: 32502117
  25. Choi SH, Kim HW, Kang JM, Kim DH, Cho EY. Epidemiology and clinical features of coronavirus disease 2019 in children. Clinical and Experimental Pediatrics 2020; 63(4): 125-32. doi: 10.3345/cep.2020.00535 PMID: 32252139
  26. Ahmed M, Advani S, Moreira A, et al. Multisystem inflammatory syndrome in children: A systematic review. EClinicalMedicine 2020; 26: 100527. doi: 10.1016/j.eclinm.2020.100527 PMID: 32923992
  27. Leung KKY, Hon KL, Wang MHT, Ng DDKK, Ip P. Paediatric multisystem inflammatory syndrome and COVID-19: another novel syndrome? Hong Kong Med J 2021; 27(2): 161-2. doi: 10.12809/hkmj208681
  28. Rajapakse N, Dixit D. Human and novel coronavirus infections in children: a review. Paediatr Int Child Health 2021; 41(1): 36-55. doi: 10.1080/20469047.2020.1781356 PMID: 32584199
  29. Sharma C, Ganigara M, Galeotti C, et al. Multisystem inflammatory syndrome in children and Kawasaki disease: a critical comparison. Nat Rev Rheumatol 2021; 17(12): 731-48. doi: 10.1038/s41584-021-00709-9 PMID: 34716418
  30. COVID-19: The impact on pediatric emergency care. Pediatr Emerg Med Pract 2020; 17(Suppl 6-1): 1-27.
  31. Rowley AH. Understanding SARS-CoV-2-related multisystem inflammatory syndrome in children. Nat Rev Immunol 2020; 20(8): 453-4. doi: 10.1038/s41577-020-0367-5 PMID: 32546853
  32. Similarities and differences between flu and COVID-19. Available from: https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm
  33. Duarte-Salles T, Vizcaya D, Pistillo A, Casajust P, Sena AG, Lai LYH. Baseline characteristics, management, and outcomes of 55,270 children and adolescents diagnosed with COVID-19 and 1,952,693 with influenza in France, Germany, Spain, South Korea and the United States: an international network cohort study. MedRxiv 2020. doi: 10.1101/2020.10.29.20222083
  34. Chua GT, Xiong X, Choi EH, et al. COVID-19 in children across three Asian cosmopolitan regions. Emerg Microbes Infect 2020; 9(1): 2588-96. doi: 10.1080/22221751.2020.1846462 PMID: 33138739
  35. Shen K, Yang Y, Wang T, et al. Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts’ consensus statement. World J Pediatr 2020; 16(3): 223-31. doi: 10.1007/s12519-020-00343-7 PMID: 32034659
  36. Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J. SARS-CoV-2 infection in children. N Engl J Med 2020; 382(17): 1663-5. doi: 10.1056/NEJMc2005073
  37. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics 2020; 145(6): e20200702. doi: 10.1542/peds.2020-0702 PMID: 32179660
  38. Zimmermann P, Curtis N. Coronavirus infections in children including COVID-19. Pediatr Infect Dis J 2020; 39(5): 355-68. doi: 10.1097/INF.0000000000002660 PMID: 32310621
  39. Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management. NICE. 2015: Feb.ISBN-13: 978-1-4731-3040-1. https://www.ncbi.nlm.nih.gov/books/NBK555182/
  40. Paul SP, Kini PK, Tibrewal SR, Heaton PA. NICE guideline review: fever in under 5s: assessment and initial management (NG143). Arch Dis Child Educ Pract Ed 2021; 107(3): edpract-2021-321718. doi: 10.1136/archdischild-2021-321718 PMID: 34244233
  41. Berlit P, Bösel J, Gahn G, et al. "Neurological manifestations of COVID-19" - guideline of the German society of neurology. Neurological Research and Practice 2020; 2(1): 51. doi: 10.1186/s42466-020-00097-7 PMID: 33283160
  42. Pilotto A, Masciocchi S, Volonghi I, et al. Clinical presentation and outcomes of severe acute respiratory syndrome coronavirus 2-related encephalitis: The ENCOVID multicenter study. J Infect Dis 2021; 223(1): 28-37. doi: 10.1093/infdis/jiaa609 PMID: 32986824
  43. Lewis A, Frontera J, Placantonakis DG, et al. Cerebrospinal fluid in COVID-19: A systematic review of the literature. J Neurol Sci 2021; 421: 117316. doi: 10.1016/j.jns.2021.117316 PMID: 33561753
  44. Mögling R, Fischer C, Stanoeva KR, et al. Sensitivity of detection and variant typing of SARS-CoV-2 in european laboratories. J Clin Microbiol 2022; 60(12): e01261-22. doi: 10.1128/jcm.01261-22 PMID: 36445090
  45. Sanders PJLT, van Waardenburg DA, Vermeulen RJ. Influenza A-associated acute necrotising encephalopathy in a 10-year-old child. BMJ Case Rep 2020; 13(8): e233541. doi: 10.1136/bcr-2019-233541 PMID: 32843445
  46. Wang GF, Li W, Li K. Acute encephalopathy and encephalitis caused by influenza virus infection. Curr Opin Neurol 2010; 23(3): 305-11. doi: 10.1097/WCO.0b013e328338f6c9 PMID: 20455276
  47. Yen J, Al Moamen A, Margolesky J. Influenza B-associated encephalitis with rapid improvement with oseltamivir. Neurol Sci 2021; 42(2): 745-7. doi: 10.1007/s10072-020-04793-9 PMID: 33047196
  48. Choi GJ, Park JY, Choi JS, et al. Influenza-associated neurologic complications in hospitalized pediatric patients. Pediatr Infect Dis J 2021; 40(12): e466-71. doi: 10.1097/INF.0000000000003332 PMID: 34609108
  49. Hammond J, Leister-Tebbe H, Gardner A, et al. Oral nirmatrelvir for high-risk, nonhospitalized adults with covid-19. N Engl J Med 2022; 386(15): 1397-408. doi: 10.1056/NEJMoa2118542 PMID: 35172054
  50. Pugin D, Vargas MI, Thieffry C, et al. COVID-19-related encephalopathy responsive to high-dose glucocorticoids. Neurology 2020; 95(12): 543-6. doi: 10.1212/WNL.0000000000010354 PMID: 32680950
  51. Pilotto A, Odolini S, Masciocchi S, et al. Steroid‐responsive encephalitis in coronavirus disease 2019. Ann Neurol 2020; 88(2): 423-7. doi: 10.1002/ana.25783 PMID: 32418288
  52. Qaseem A, Yost J, Miller MC, Andrews R, Jokela JA, Forciea MA. Outpatient treatment of confirmed COVID-19: Living, rapid practice points from the american college of physicians (version 1). Ann Intern Med 2023; 176: 115-24. doi: 10.7326/M21-3272 PMID: 36442061
  53. Nakano A, Yamasaki R, Miyazaki S, Horiuchi N, Kunishige M, Mitsui T. Beneficial effect of steroid pulse therapy on acute viral encephalitis. Eur Neurol 2003; 50(4): 225-9. doi: 10.1159/000073864 PMID: 14634267
  54. Howard A, Uyeki TM, Fergie J. Influenza-associated acute necrotizing encephalopathy in siblings. J Pediatric Infect Dis Soc 2018; 7(3): e172-7. doi: 10.1093/jpids/piy033 PMID: 29741717
  55. Li XF, Ai B, Ye JW, et al. Clinical analysis of seven cases of H1N1 influenza-associated encephalopathy in children. Zhonghua Er Ke Za Zhi 2019; 57(7): 538-42. doi: 10.3760/CMA.J.ISSN.0578-1310.2019.07.009 PMID: 31269554
  56. Takia L, Saini L, Keshavan S, et al. Neurological manifestations of influenza A (H1N1): Clinical features, intensive care needs, and outcome. Indian J Pediatr 2020; 87(10): 803-9. doi: 10.1007/s12098-020-03297-w PMID: 32358785
  57. Kim MG, Stein AA, Overby P, et al. Fatal cerebral edema in a child with COVID-19. Pediatr Neurol 2021; 114: 77-8. doi: 10.1016/j.pediatrneurol.2020.10.005 PMID: 33246133
  58. Ninan S, Thompson P, Gershon T, Ford N, Mills W, Jewells V. Fatal pediatric COVID-19 case with seizures and fulminant cerebral edema. Child Neurol Open 2021; 8: 2329048X211022532. doi: 10.1177/2329048X211022532
  59. Hon KLE, Tsang YCK, Chan LCN, et al. Outcome of encephalitis in pediatric intensive care unit. Indian J Pediatr 2016; 83(10): 1098-103. doi: 10.1007/s12098-016-2068-4 PMID: 27053179
  60. Au CC, Hon KL, Leung AKC, Torres AR. Childhood infectious encephalitis: An overview of clinical features, investigations, treatment, and recent patents. Recent Pat Inflamm Allergy Drug Discov 2021; 14(2): 156-65. doi: 10.2174/1872213X14999201124195724 PMID: 33238854
  61. Rismanchi N, Gold JJ, Sattar S, et al. Neurological outcomes after presumed childhood encephalitis. Pediatr Neurol 2015; 53(3): 200-6. doi: 10.1016/j.pediatrneurol.2015.05.017 PMID: 26220354
  62. Morishima T, Togashi T, Yokota S, et al. Encephalitis and encephalopathy associated with an influenza epidemic in Japan. Clin Infect Dis 2002; 35(5): 512-7. doi: 10.1086/341407 PMID: 12173123
  63. Leung KKY, Hon KL. Lessons from animal culling during human pandemics: Is vaccination a viable option for animals? Curr Pediatr Rev 2023; 19(1): 2-4. doi: 10.2174/1573396318666220316124155 PMID: 35297351
  64. Leung TF, Chan PK, Hon KL, Li AM. Surveillance of human- and swine-origin influenza in Hong Kong children. Hong Kong Med J 2018; 24(5) (Suppl. 6): 16-8. PMID: 30229730
  65. Hon KL, Leung KKY, Tang JW, Leung AKC, Li Y. COVID-19 in Hong Kong – Public health, food safety, and animal vectors perspectives. J Virol Methods 2021; 290: 114036. doi: 10.1016/j.jviromet.2020.114036 PMID: 33285191
  66. Smith C, Odd D, Harwood R, et al. Deaths in children and young people in England after SARS-CoV-2 infection during the first pandemic year. Nat Med 2022; 28(1): 185-92. doi: 10.1038/s41591-021-01578-1 PMID: 34764489
  67. LaRovere KL, Riggs BJ, Poussaint TY, et al. Neurologic involvement in children and adolescents hospitalized in the United States for COVID-19 or multisystem inflammatory syndrome. JAMA Neurol 2021; 78(5): 536-47. doi: 10.1001/jamaneurol.2021.0504 PMID: 33666649

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