#18,425
This afternoon (EDT) the HCM Health Department announced (h/t FluTrackers) a rare case of H5N1 encephalitis in an 8 year-old child in Tay Ninh. The syntax of the translation is a bit kludgy, but the child - who was admitted with an initial diagnosis of Meningococcal Meningitis - appears to be stable but receiving ventilation assistance.
A bit unusually, the child's nose and throat samples tested negative for influenza A, but H5N1 was detected in the patient's cerebrospinal fluid.
This sounds similar to a case we looked at nearly three years ago in Clinical Features of the First Critical Case of Acute Encephalitis Caused by Avian Influenza A (H5N6) Virus, which reported on the severe neurological impact of the virus on a 6 year-old girl in China.
While certainly not the typical presentation of H5Nx infection in humans, the authors wrote:
In view of the fact that the clinical manifestations of this novel H5N6 reassortant are acute encephalitis, rather than previous respiratory symptoms, once these reassortants obtained the ability of human-to-human transmission through reassortment or mutations, it will bring great health threat for human.
Last September, in Cell: The Neuropathogenesis of HPAI H5Nx Viruses in Mammalian Species Including Humans, we reviewed a number of past case reports of neuroinfluenza, and looked at a recent study published in Trends in Neurosciences, that looked at the history, and recent trends, of neuropathogenesis of avian H5 in mammals.
The (translated) announcement from the HCM Health Department follows.
Updated: 17:42, April 18, 2025 Readings: 1069
Fast facts about H5N1 avian influenza virus encephalitis being treated at Children's Hospital 1The TPHCM Department of Health has just made a quick report to the Ministry of Health in the case of a girl born in 2017, in Tay Ninh, the diagnosis of H5N1 avian encephalitis is being actively treated at Children's Hospital 1.
Specifically, pediatric LBA, female, born in 2017, residing in the Wharf, Tay Ninh was transferred by Tay Ninh Provincial Hospital to Children's BV on April 13, 2025 with the diagnosis of Meningococcal Meningitis.
On April 11, 2025, BN onset of fever, headache, tinting several times, entering province BV for 2 days treatment status did not decrease. On April 13, 2025, patients were transferred to Children's BV 1 with chicken sleep, mixed, mild neck at hospitalization and diagnosed with encephalitis.
Children's Hospital 1 sampled cerebrospinal fluid and respiratory disease to the Tropical Hospital Hospital Testing Department. On April 17, 2025, the results of the positive cerebrospinal fluid PCR test for influenza A/H5; Acid positive respiratory PCR test for influenza. Children's Hospital 1 continues to send samples to the Pasteur Institute of Ho Chi Minh City to redefine the diagnosis. As of April 18, 2025, Ho Chi Minh City Pasteur Institute confirmed positive test results for A/H5N1 flu on cerebrospinal fluid samples, and negative influenza virus on nose and throat samples, and the Institute had Express fire dispatch reporting to the Department of Health Ministry.
The patient is currently undergoing isolation from treatment at the Department of Resuscitation of Children's Hospital 1 in a state of breathing evenly according to the ventilator, natural eye opening, 38.5oC fever, stable temporary birth.
As soon as the preliminary test results were obtained, the Department of Health directed the TPHCM Disease Control Center (HCDC) in collaboration with Children's Hospital 1 and the Tay Ninh Provincial Disease Control Center to conduct epidemiological investigations. Study and handle the outbreak as prescribed. Initial information recorded that the child was exposed to a dead chicken in his grandmother's house two weeks ago. The patient is the 2nd child in the family, has a history of congenital heart (ventricular) who has been operating at Children's BV at 2 months of age.
As noted by infectious experts, this is a rare case in which the A/H5N1 avian influenza virus damages the central nervous system and does not attack the respiratory tract. Usually the avian influenza A/H5N1 virus causes disease in poultry and poultry, people are infected with the virus when exposed to dead infected poultry. The main manifestation of avian influenza infection is very severe pneumonia (ARDS-grade respiratory depression syndrome) with a mortality rate of over 50%. Fortunately so far, the influenza A/H5N1 virus has not been transmitted from person to person.
Cases of H5N1 flu encephalitis have been noted in world medicine. In Dong Thap during the 2004 H5N1 avian influenza outbreak in humans, the Oxford DH Clinical Research Unit (OUCRU) team in collaboration with the Tropical Hospital and Children's Hospital 1 has found the virus A/H5N1 in cerebrospinal fluid of 2 children with severe diarrhea symptoms, coma convulsions and death, no respiratory disease manifestations. This result was published in the 2005 New England Journal of Medicine (https://www.nejm.org/doi/full/10.1056/NEJMoa044307).
The Department of Health has dispatched a report to the Ministry of Health, and directed Children's Hospital 1 to actively treat patients, strictly follow the rules against infection and continue to coordinate with infectious experts. Tropical Hospital and OUCRU deep research learn about this special case.
In order to proactively prevent, prevent influenza A (H5N1) from being transmitted from poultry to humans, the following measures should be implemented:
1. Do not eat poultry, sick poultry products, die and unknown origin.
2.Limit contact, slaughter, eat wildlife, especially birds.
3. No slaughter, transportation, purchase of poultry and poultry products of unknown origin.
4. When a sick, absolute dead poultry is not slaughtered, used, but must immediately notify the local authorities and veterinary unit on the venue.
5. Eat cooked, drink cooked; Wash hands with soap before eating.
6. When there is an influenza expression such as fever, cough, chest pain, shortness of breath related to poultry, immediate medical facility.
HEALTH DEPARTMENT TP.HCM
For more on unusual or atypical presentations of influenza A, you may wish to revisit:
Neuroinfluenza: A Review Of Recently Published Studies
CJ ID & MM: Case Study Of A Neurotropic H5N1 Infection - Canada
