Recently, there have been waves of influenza, and many parents are worried that their children's body temperature will not go away, especially in the first 1-2 days after the onset of the disease, the body temperature does not go back and forth, which is understandable.
In fact, in clinical practice, pediatricians are most worried not about the flu fever itself, but about these two complications, which may be directly life-threatening if not identified in time.
So today I will talk to you about the two major complications of influenza in children (acute myocarditis and necrotizing encephalopathy), which are worth your attention.
One. Acute myocarditis.
Healthy children with influenza are usually able to develop complications on their own, especially the complications of acute myocarditis, especially influenza A, which is particularly prone to complications of acute myocarditis.
The clinical manifestations of acute myocarditis in children are diverse, not only cardiovascular symptoms, because there are usually different clinical manifestations at different ages, and it is easy to be misdiagnosed or missed.
Early manifestations of viral infection: fever, fatigue, lack of energy, decreased appetite, muscle aches, etc. Respiratory or gastrointestinal symptoms: cough, shortness of breath, chest pain, wheezing, vomiting and diarrhea, abdominal pain symptoms, can easily be misdiagnosed as pneumonia, asthmatic bronchitis, acute gastroenteritis, and even appendicitis. Symptoms of impaired cardiovascular function: dyspnea, exercise intolerance, syncope, tachypnea, sustained tachycardia, and hepatomegaly. Arrhythmic presentations: patients may have supraventricular and ventricular arrhythmias and complete heart block. Fulminant myocarditis: hypotension, decreased pulse, poor perfusion, acidosis, and hepatomegaly occur within a short period of time, which can progress to cardiovascular collapse.
Two. Necrotizing encephalopathy.
A cross-sectional study of 29,000 children hospitalized with influenza from 2015 to 2020 showed that 76% of children have neurological complications, but the vast majority are common complications of febrile seizures, and they generally recover well, but necrotizing encephalopathy is a serious disease that is either death or disability, and it must be recognized.
First proposed by Mizuguchi et al. in 1995, acute necrotizing encephalopathy is a rare but unique type of acute encephalopathy that is primarily triggered by viral infections. Its ** and pathogenesis are not fully understood.
Typically, acute necrotizing encephalopathy is secondary to viral infections, including influenza A and B, parainfluenza, chickenpox, human herpesvirus 6 and herpesvirus 7, enterovirus, novel reovirus strains, rotavirus, herpes simplex virus, rubella, coxsackie A9, and measles virus, among others, with influenza virus and human herpes-6 being the most common.
The diagnostic criteria for acute necrotizing encephalopathy are as follows:
Acute encephalopathy preceding viral febrile illness;Rapid deterioration in level of consciousness, persistent convulsions;Cerebrospinal fluid (CSF) protein is elevated, but leukocyte is not increasedNeuroimaging findings of symmetrical, multifocal brain lesions involving bilateral thalamus, periventricular white matter, internal capsule, putamen, upper brainstem tegmentum, and cerebellar medulla, without involving other central nervous system regions;
Serum aminotransferase levels are elevated to varying degrees, but serum ammonia is normal;Other similar conditions are excluded. Regardless of the ** method, acute necrotizing encephalopathy is a progressive and destructive disease. The mortality rate is estimated to be about 30%, and less than 10% of patients are complete**, while the incidence of neurological sequelae is high among survivors.
Children's flu comes and goes, and if possible, it is better to get the flu vaccine in time, and it is recommended that everyone get the flu vaccine from the first wave, because there may be spring flu and summer flu next.
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