Neurologic Manifestations of Pandemic (H1N1) 2009 Virus Infection | CDC EID

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Volume 16, Number 3–March 2010
Letter
Neurologic Manifestations of Pandemic (H1N1) 2009 Virus Infection
Sarawut Kitcharoen, Moragot Pattapongsin, Kittisak Sawanyawisuth, Vincent Angela, and Somsak Tiamkao
Author affiliations: Khon Kaen University, Khon Kaen, Thailand (S. Kitcharoen, K. Sawanyawisuth, S. Tiamkao); Chaiyaphum Hospital, Chaiyaphum, Thailand (M. Pattapongsin); and University of Oxford, Oxford, UK (V. Angela)

Suggested citation for this article

To the Editor: In April 2009, the outbreak of influenza A pandemic (H1N1) 2009 virus was reported. Subsequently, the disease spread throughout the world, and the pandemic alert level was raised to level 6 in June by the World Health Organization. Pandemic (H1N1) 2009 virus infection spread to Thailand and is now found throughout Thailand. Similar to the effects of other viruses, pandemic (H1N1) 2009 virus may cause neurologic complications. Associated neurologic symptoms were first reported from Dallas, Texas, USA: 4 children experienced unexplained seizures or had an alteration of consciousness level that was associated with this virus (1). We report an adult patient with pandemic (H1N1) 2009 infection who had neurologic complications.

A 34-year-old man, previously healthy, was admitted to Chaiyaphum Hospital in Chaiyaphum, Thailand, on August 24, 2009, with influenza-like symptoms. Two days after admission, progressive quadriparesis with bilateral, symmetric paresthesia (glove-and-stocking pattern), and areflexia developed. His motor weakness (grades III/V) began in both legs and then involved both arms and hands. Other neurologic examinations showed limitation of extraocular movement in all directions, normal pupil size and light reflex, and facial diplegia. A lumbar puncture was performed, and cerebrospinal fluid (CSF) contained neither leukocytes nor erythrocytes, with a protein level of 19.5 mg/dL.

On day 3 after the patient's admission, acute respiratory failure developed. A nasopharyngeal aspirate specimen was positive for pandemic (H1N1) 2009 virus by PCR. The patient received oseltamivir, zanamivir, and ventilator support. His chest radiograph showed diffuse alveolar infiltration. On day 10, his motor weakness worsened to grade 0, and his consciousness level was diminished to a drowsy state.

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Suggested Citation for this Article
Kitcharoen S, Pattapongsin M, Sawanyawisuth K, Angela V, Tiamkao S. Neurologic manifestations of pandemic (H1N1) 2009 virus infection [letter]. Emerg Infect Dis [serial on the Internet]. 2010 Mar [date cited]. http://www.cdc.gov/content/EID/16/3/569.htm
DOI: 10.3201/eid1603.091699