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2016 ; 9
(ä): 99-102
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Influenza Virus-Associated Fatal Acute Necrotizing Encephalopathy: Role of
Nonpermissive Viral Infection?
#MMPMID27812294
Mungaomklang A
; Chomcheoy J
; Wacharapluesadee S
; Joyjinda Y
; Jittmittraphap A
; Rodpan A
; Ghai S
; Saraya A
; Hemachudha T
Clin Med Insights Case Rep
2016[]; 9
(ä): 99-102
PMID27812294
show ga
In 2014, two unusual peaks of H1N1 influenza outbreak occurred in Nakhon
Ratchasima Province, in Thailand. Among 2,406 cases, one of the 22 deaths in the
province included a 6-year-old boy, who initially presented with acute
necrotizing encephalopathy. On the other hand, his sibling was mildly affected by
the same influenza virus strain, confirmed by whole-genome sequencing, with one
silent mutation. Absence of acute necrotizing encephalopathy and other
neurological illnesses in the family and the whole province, with near identical
whole viral genomic sequences from the two siblings, and an absence of
concomitant severe lung infection (cytokine storm) at onset suggest nonpermissive
infection as an alternative pathogenetic mechanism of influenza virus.