A 10-year-old boy died of acute necrotizing encephalitis associated with influenza A/H3 virus infection, March 2000 - Kagawa
(IASR 2000; 21: 97-98)

On March 13, 2000, nasal discharge and stool were collected from a 10 year-old boy who was diagnosed as acute necrotic encephalitis. Specimens were inoculated on MDCK cell, and influenza A/H3 was isolated. The boy died on the same day. Following is a clinical course.

On March 11, the boy presented 37.5C fever initially, but in the evening he developed high fever, so that antipyremics was given. His father had an episode of 38-40C fever since March 9. On 5pm of March 12, the boy complained nausea, vomiting, and dizziness like "being in an earthquake". He visited a nearby physician, and he presented snoring-like abnormal respiration with wheezing and consciousness disturbance. Intravenous route was established, and he was transferred to an emergency room on 7:30pm. He was immediately admitted in intensive care unit.

Upon admission, he was in semicoma (Japan coma scale 200) to delirium; respiration 80-90 per minute; body temperature 40.7C; pulse 207 per minute; remarkable sweating; epistaxis; pupil 3mm with positive light reflex; normal chest and abdominal sound; SpO₂ 98-100 Torr under O₂ supply.

Blood chemistry revealed WBC 3,190/mm³ (Stab 2%, Segment 37%, Monocyte 3%, Lymphocyte 58%), RBC 4.85 million/mm³, Ht 39.8%, Platelet 0.192 million/mm³, Total protein 7.4 g/dL, GOT 146 IU/L, GPT 131 IU/L, LDH 488IU/L, ALP 580 IU/L, Total Bilirubin 0.16 mg/dL, BUN 12.1 mg/dL, Creatinine 1.1 mg/dL, CPK 164 IU/L, Anmonia 71 microgram/dL, lactic acid 52.5 mg/dL, Pyruvic acid 2.27 mg/dL, CRP 2.78 mg/dL; negative antibody titer against influenza A/B, Japanese encephalitis, herpes simplex virus; venous blood gas pH 7.312, Base excess -6.6, pCO₂ 37.7 Torr, pO₂ 43.1 Torr, HCO₃ 18.5 Torr. Generalized large and slow waves were observed by electroencephalogram. Magnetic Resonace Image depicted low signal areas in both thalamus and brain stem by T1 enhanced image, and high signal areas in both thalamus, brainstem, cerebellum, basal ganglia and cerebrum by T2 enhanced image. He was continuously in consciousness disorders with bleeding tendency, such as epistaxis, watery diarrhea to bloody stool, intratracheal bleeding, occult blood in urine (+++). He developed convulsion of the upper limbs and opisthotonus. Although general conditions became stable until 2am of March 13, hypertension and tachcardia were observed on 4:30am, followed by hypotension on 5:50am, and he died on 7:29am.

Influenza-like illness (ILI) was almost over at the Week 10 in Kagawa Prefecture, however 2.63 ILI per sentinel site were reported at that time. Small number of influenza A/H3 and A/H1 isolation was reported to local surveillance.

Reported by: Syouichi Endou, Takashige Okada, and Seikyou Furukawa, Dept. of Pediatrics, National Kagawa Children's Hospital; Taeko Kameyama, Kazuo Miki, and Shigeki Yamanishi, Kagawa Prefectural Institute of Public Health.

Correspondence: National Kagawa Children's Hospital;
Fax: +81-877-62-5384
Kagawa Prefectural Institute of Public Health;
Fax: +81-878-25-0408

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