Over the last one month, paediatric neurologists have treated at least five to six cases of H1N1 in children who have shown primary symptoms of neurological complications, instead of fever, cough and throat infection. Two of these children continue to be hospitalised. Neuro experts have advised physicians to think of H1N1 while treating unexplained seizures or inflammation in the brain. All the babies required ventilation and ICU care. The Goregaon infant was brought to Surya Child Care Hospital in Santacruz about three weeks ago in an extremely critical condition. The baby was unconscious, breathing with difficulty and almost slipping into coma. While a cerebrospinal fluid (CSF) test on the Goregaon infant ruled out dengue and other infections such as herpes, the MRI scan was the red flag.
“It showed bleeding in the thalamus, an important region that relays sensory and motor signals. We diagnosed the baby with acute necrotising encephalopathy of childhood (ANEC), a kind of brain damage, which can be caused by viral infections. In this case, it was H1N1. Viral infections have been associated with ANEC but they are extremely rare,” said paediatric neurologist Dr Omkar Hajirnis, who consults at Surya Hospital. He said the baby was moved out of ICU recently but he has lost his sense of recognition. “ANEC is also known to cause loss of vision which we are yet to confirm in this child,” he said, adding that he has treated four children with brain involvement.
A four-year-old child from south Mumbai was taken to the emergency of Jaslok Hospital, Peddar Road, with continuous seizures about three weeks ago. Paediatric neurologist Dr Anaita Hegde recalled that the boy came in a state of shock with altered sensorium. “We suspected H1N1 and he tested positive.He was also from a compromised category, as he had an underlying rare metabolic disorder, known to cause seizures.We kept him in isolation and treated with oseltamivir.” The doctor added that the boy was fortunate to escape any brain damage. “His MRI was normal.Luckily , his mother brought him in time. A few more hours at home could have changed the picture completely,” she said, adding that the child was discharged from the hospital last week after about ten days of hospitalization.
Doctors say better diagnosis is bringing complications to light. “We know H1N1 by involvement of lungs but we must consider that very few H1N1 could have involvement of the brain,” said Dr Bhupendra Avasthi, director of Surya Hospital. Besides Surya, a child with brain complication is currently undergoing treatment at Fortis Hospital, Mulund. Another child, who was undergoing treatment at Jupiter Hospital, Thane, recently went home.
The twin brother of the Goregaon child, who, too, was infected, has recovered. Paediatric neurologist Dr Vrajesh Udani, who consults at Mahim’s PD Hinduja Hospital, said that about 30% of H1N1affected patients have neurological symptoms like headache, irritability, but encephalopathy is extremely rare. “We will probably see it in one out of 1 to 2 lakh cases,” he said. Explaining what causes it, he said, “It’s difficult to pin point, but cytokines or things that come up in the blood against the virus, probably attack the brain,” he said. Dr Udani added that virus-associated encephalopathy is not uncommon in India. “But since the complication is associated with high disability and mortality rate, parents must consider vaccinating their children against H1N1,” he said.
Maharashtra has been reeling under an H1N1 outbreak this year. The death toll for the state touched 300 on Sunday .State epidemiologist Dr Pradeep Awate said that mortality among children is less than 10%. “We haven’t heard of neurological complications so far but gastrointestinal and cardiac manifestations have been seen,” he said. Doctors say children with underlying medical condition are more at risk to suffer complications of H1N1.