Persistent influenza A RNA detection in a fatal pediatric case of influenza-associated encephalopathy.
Zengrui Lin, Junyu Chen, Guoyun Su et al.
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Case in brief
A 9-year-old boy developed fulminant influenza-associated encephalopathy, a life-threatening complication of influenza. Despite life-sustaining support, intensive immunomodulatory treatment, and antiviral therapy, influenza A (H3N2) RNA remained detectable after an initial dose of baloxavir marboxil. This prompted salvage treatment with oseltamivir, baloxavir marboxil, peramivir, and onradivir, but RNA detection persisted for more than 1 month. The report describes a fatal case and suggests that severe neurological injury, immunosuppression, and impaired airway clearance may have contributed to prolonged detection.
What made this case unusual
Influenza A (H3N2) RNA remained detectable for more than 1 month despite a multi-targeted antiviral salvage regimen in a child with fulminant encephalopathy.
Diagnostic / clinical pearl
In fulminant influenza-associated encephalopathy, persistent influenza RNA detection may continue despite multi-agent antiviral therapy; the report proposes severe neurological injury, immunosuppression, and impaired airway clearance as possible contributors.