title: Severe influenza resembling hemorrhagic shock and encephalopathy syndrome.
abstract: Influenza-associated encephalopathy is a clinically diverse syndrome and severe cases are not well documented outside Japan. Clinical, pathological and molecular aspects are described of two fatal cases presenting during 2004 and 2005 winter seasons in The Netherlands. Results showed that severe influenza can resemble hemorrhagic shock and encephalopathy syndrome, and proper testing for influenza virus should be considered in similar cases. The failure to detect viral replication in non-pulmonary organs including the brain would support the pathogenesis of this syndrome is based on proinflammatory cytokine responses.
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands. j.gooskens@lumc.nl
authors.forename: J
authors.initials: J
authors.lastname: Gooskens
authors.forename: T
authors.initials: T
authors.lastname: Kuiken
authors.forename: E C
authors.initials: EC
authors.lastname: Claas
authors.forename: H I
authors.initials: HI
authors.lastname: Harinck
authors.forename: J C
authors.initials: JC
authors.lastname: Thijssen
authors.forename: H J
authors.initials: HJ
authors.lastname: Baelde
authors.forename: A C
authors.initials: AC
authors.lastname: Kroes
mesh_terms: D000293:Adolescent; D002648:Child; D003937:Diagnosis, Differential; D018792:Encephalitis, Viral / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D009980:Influenza A virus / Q000302:isolation & purification; D009981:Influenza B virus / Q000302:isolation & purification; D007251:Influenza, Human / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D007564:Japan; D008297:Male; D009426:Netherlands; D016133:Polymerase Chain Reaction; D012771:Shock, Hemorrhagic / Q000175:diagnosis* / Q000473:pathology