Modern Pediatrics. Ukraine. (2024). 4(140): 126-130. doi: 10.15574/SP.2024.140.126
Volianska L. A.¹, Burbela E. I.¹, Bugel L. V.², Kizan S. V.², Boyarchuk O. R.^1
1I. Horbachevsky Ternopil National Medical University, Ukraine
²Ternopil Regional Children's Hospital, Ukraine

For citation: Volianska LA, Burbela EI, Bugel LV, Kizan SV, Boyarchuk OR. (2024). Acute necrotizing encephalitis caused by a viral duet. Modern Pediatrics. Ukraine. 4(140): 126–130. doi: 10.15574/SP.2024.140.126.
Article received: Mar 12, 2024. Accepted for publication: May 14, 2024.

The SARS-CoV-2 pandemic has challenged humanity and set before it a number of tasks, the solution of which will depend on its future existence. The combination of SARS-CoV-2 and other common respiratory viruses, especially influenza A virus, which presents with similar symptoms and causes a resonance of shared clinical effects, is of concern.
The aim of the study is to increase the awareness of doctors about the peculiarities of the co-infection of the influenza A virus and SARS-CoV-2 based on the analysis of a clinical case in a young child.
A clinical case of the implementation of flucovid with severe neurological disorders is described, which coincided in time with the post-vaccination period after vaccination with the MMR (measles, mumps, and rubella) in a 1-year-old boy. 4 months Coinfection (influenza A + SARS-CoV-2), which occurred on the 8th day after vaccination with the PDA vaccine in a young child, had a severe course with dominant extrapulmonary manifestations in the form of necrotizing encephalitis. Timely antiviral therapy in combination with human immunoglobulin and adequate symptomatic therapy (anticonvulsants, antibiotics, parenteral detoxification) minimized the consequences of brain tissue damage
The research was carried out in compliance with the principles of the Declaration of Helsinki. Written consent of the patient's mother was obtained for the study and publication of its results.
The authors declare no conflict of interest.
Keywords: influenza A, SARS-CoV-2, child, acute necrotizing encephalitis.
REFERENCES

1. Adams K, Tastad KJ, Huang S et al. (2022, Dec 16). Prevalence of SARS-CoV-2 and Influenza Coinfection and Clinical Characteristics Among Children and Adolescents Aged <18 Years Who Were Hospitalized or Died with Influenza – United States, 2021-22 Influenza Season. MMWR Morb Mortal Wkly Rep. 71(50): 1589-1596. https://doi.org/10.15585/mmwr.mm7150a4; PMid:36520656 PMCid:PMC9762905

2. Agrawal S, Farfel JM, Arfanakis K et al. (2022, Dec 17). Brain autopsies of critically ill COVID-19 patients demonstrate heterogeneous profile of acute vascular injury, inflammation and age-linked chronic brain diseases. Acta Neuropathol Commun. 10(1): 186. https://doi.org/10.1186/s40478-022-01493-7; PMid:36528671 PMCid:PMC9758667

3. Antoon JW, Hall M, Howard LM et al. (2021). COVID-19 and Acute Neurologic Complications in Children. Pediatrics. 150(5): e2022058167. https://doi.org/10.1542/peds.2022-058167; PMid:35949041 PMCid:PMC9633383

4. Bai L, Zhao Y, Dong J et al. (2021). Coinfection with influenza A virus enhances SARS-CoV-2 infectivity. Cell Res. 31: 395-403. https://doi.org/10.1038/s41422-021-00473-1; PMid:33603116 PMCid:PMC7890106

5. Bellavite P. (2020). Causality assessment of adverse events following immunization: the problem of multifactorial pathology. F1000Res. Mar 9; 9: 170. https://doi.org/10.12688/f1000research.22600.1; PMid:32269767 PMCid:PMC7111503

6. Benevides ML, Elias S, Fagundes DA, et al. (2022). Acute Hemorrhagic Leukoencephalopathy Triggered by COVID-19 Infection. The Neurohospitalist. 12(3):524-528. https://doi.org/10.1177/19418744221077735; PMid:35747764 PMCid:PMC8899826

7. Boyarchuk OR, Pavlyshak VV. (2023). Acute hepatitis of unknown origin in children: analysis of probable etiologies. Child's Health. 18(4): 312-322. https://doi.org/10.22141/2224-0551.18.4.2023.1605

8. Boyarchuk O, Predyk L, Yuryk I. (2021). COVID-19 in patients with juvenile idiopathic arthritis: frequency and severity. Reumatologia. 59(3): 197-199. https://doi.org/10.5114/reum.2021.107590; PMid:34538947 PMCid:PMC8436806

9. Boyarchuk O, Volianska L. (2023). Autoimmunity and long COVID in children. Reumatologia. 61(6): 492-501. https://doi.org/10.5114/reum/176464; PMid:38322108 PMCid:PMC10839920

10. Britton PN, Dale RC, Blyth CC et al. (2020). Jones, for the Australian Childhood Encephalitis Study Investigators and the Paediatric Active Enhanced Disease Surveillance Network, Causes and Clinical Features of Childhood Encephalitis: A Multicenter, Prospective Cohort Study. Clinical Infectious Diseases. 70(12); 15: 2517-2526. https://doi.org/10.1093/cid/ciz685

11. Chen Q, Li P, Li S et al. (2020). Brain Complications with Influenza Infection in Children. Journal of Behavioral and Brain Science. 10: 129-152. https://doi.org/10.4236/jbbs.2020.103008

12. Clark JJ, Penrice-Randal R, Sharma P et al. (2023). Sequential infection with influenza A virus followed by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leads to more severe disease and encephalitis in a mouse model of COVID-19. bioRxiv preprint. https://doi.org/10.1101/2020.10.13.334532

13. Geier DA, Geier MR. (2021). A longitudinal cohort study of childhood MMR vaccination and seizure disorder among American children, Brain and Development. 43(2): 251-267. https://doi.org/10.1016/j.braindev.2020.09.001; PMid:32981784

14. Handa R, Nanda S, Prasad A et al. (2020). Covid-19-associated acute haemorrhagic leukoencephalomyelitis. Neurol Sci. Nov. 41(11): 3023-3026. https://doi.org/10.1007/s10072-020-04703-z; PMid:32876775 PMCid:PMC7462963

15. Hoque MN, Akter S, Mishu ID. (2021). Microbial co-infections in COVID-19: Associated microbiota and underlying mechanisms of pathogenesis, Microbial Pathogenesis. 156: 104941. https://doi.org/10.1016/j.micpath.2021.104941; PMid:33962007 PMCid:PMC8095020

16. Hutto SK, Rapalino O, Venna N. (2022). Spinomedullary Weston Hurst Syndrome After COVID-19 and Influenza Co-Infection: A Case Report. The Neurohospitalist. 12(2): 337-340. https://doi.org/10.1177/19418744211047773; PMid:35401917 PMCid:PMC8977754

17. Jha NK, Ojha S, Jha SK et al. (2021, Nov). Evidence of Coronavirus (CoV) Pathogenesis and Emerging Pathogen SARS-CoV-2 in the Nervous System: A Review on Neurological Impairments and Manifestations. J Mol Neurosci. 71(11): 2192-2209. https://doi.org/10.1007/s12031-020-01767-6; PMid:33464535 PMCid:PMC7814864

18. Mastrolia MV, Rubino C, Resti M et al. (2019). Characteristics and outcome of influenza-associated encephalopathy/encephalitis among children in a tertiary pediatric hospital in Italy, 2017-2019. BMC Infect Dis. 19: 1012. https://doi.org/10.1186/s12879-019-4636-5; PMid:31783806 PMCid:PMC6884834

19. Maury A, Lyoubi A, Peiffer-Smadja N et al. (2021, Jan-Feb). Neurological manifestations associated with SARS-CoV-2 and other coronaviruses: A narrative review for clinicians. Rev Neurol (Paris). 177(1-2): 51-64. https://doi.org/10.1016/j.neurol.2020.10.001; PMid:33446327 PMCid:PMC7832485

20. McAbee GN, Brosgol Y, Pavlakis S et al. (2020). Encephalitis Associated with COVID-19 Infection in an 11-Year-Old Child. Pediatr Neurol. 109: 94. https://doi.org/10.1016/j.pediatrneurol.2020.04.013; PMid:32586676 PMCid:PMC7180343

21. Moriguchi T, Harii N, Goto J et al. (2020) A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis. 94: 55-58. https://doi.org/10.1016/j.ijid.2020.03.062; PMid:32251791 PMCid:PMC7195378

22. Paterson RW, Brown RL, Benjamin L et al. (2020, Oct 1). The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings. Brain. 143(10): 3104-3120.

23. Siracusa L, Cascio A, Giordano S et al. (2021). Neurological complications in pediatric patients with SARS-CoV-2 infection: a systematic review of the literature. Ital J Pediatr. 47: 123. https://doi.org/10.1186/s13052-021-01066-9; PMid:34078441 PMCid:PMC8170632

24. Su S, Liu Z, Jiang S. (2021). Double insult: flu bug enhances SARS-CoV-2 infectivity. Cell Res. 31: 491-492. https://doi.org/10.1038/s41422-021-00498-6; PMid:33758364 PMCid:PMC7986639

25. Swets MC, Russell CD, Harrison EM et al. (2022). SARS-CoV-2 co-infection with influenza viruses, respiratory syncytial virus, or adenoviruses. 399: 1463-1464. https://doi.org/10.1016/S0140-6736(22)00383-X; PMid:35344735

26. Volianska LA, Burbela EI, Kosovska TM, Perestiuk VO, Boyarchuk OR. (2023). Long COVID in children: frequency and diagnostic challenges. Ukrainian Journal of Perinatology and Pediatrics. 95(3): 101-106. https://doi.org/10.15574/PP.2023.95.101

27. Xiang P, Xu XM, Gao LL et al. (2020). First case of 2019 novel coronavirus disease with encephalitis. ChinaXiv. 2020; Huang YH, Jiang D, Huang JT. SARS-CoV-2 detected in cerebrospinal fluid by PCR in a Case of COVID-19 Encephalitis. Brain Behav Immun. 87: 149. https://doi.org/10.1016/j.bbi.2020.05.012; PMid:32387508 PMCid:PMC7202824