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Abstract
Purpose
Influenza B-associated myositis is an infrequent and poorly known complication of influenza B virus infection in children. The aim of this study was to describe the clinical and laboratory manifestations, diagnosis, and outcomes of influenza B-associated myositis in Korean children.
Methods
A retrospective analysis was conducted in patients aged <16 years who had been diagnosed with influenza B-associated myositis at the Catholic University Bucheon Saint Marys' Hospital between April 2010 and May 2010.
Results
Overall, 16 cases were analyzed. Influenza B-associated myositis typically occurred in preschool-aged children with a 3:1 male predominance. The mean age was 4.6 years (range, 3 to 7 years). The median interval between onset of influenza infection and onset of influenza B-associated myositis was 3 days (range, 1 to 7 days). Only the calf muscles were involved in all patients. Blood creatine phosphokinase concentration was elevated in most patients. Median duration to clinical recovery was 3 days (range, 1 to 4 days). No patient had rhabdomyolysis, renal failure, or related sequelae. All patients had a favorable outcome without administration of antiviral drugs.
References
1. Carrat F, Vergu E, Ferguson NM, Lemaitre M, Cauchemez S, Leach S, et al. Time lines of infection and disease in human influenza: a review of volunteer challenge studies. Am J Epidemiol. 2008; 167:775–85.
2. Doyle WJ, Skoner DP, Hayden F, Buchman CA, Seroky JT, Fireman P. Nasal and otologic effects of experimental influenza A virus infection. Ann Otol Rhinol Laryngol. 1994; 103:59–69.
3. Hobbins TE, Hughes TP, Rennels MB, Murphy BR, Levine MM. Bronchial reactivity in experi-mental infections with influenza virus. J Infect Dis. 1982; 146:468–71.
4. Abe M, Higuchi T, Okada K, Kaizu K, Matsumoto K. Clinical study of influenza-associated rhabdomyolysis with acute renal failure. Clin Nephrol. 2006; 66:166–70.
5. Dietzman DE, Schaller JG, Ray CG, Reed ME. Acute myositis associated with influenza B infection. Pediatrics. 1976; 57:255–8.
6. Hu JJ, Kao CL, Lee PI, Chen CM, Lee CY, Lu CY, et al. Clinical features of influenza A and B in children and association with myositis. J Microbiol Immunol Infect. 2004; 37:95–8.
7. Mackay MT, Kornberg AJ, Shield LK, Dennett X. Benign acute childhood myositis: laboratory and clinical features. Neurology. 1999; 53:2127–31.
8. Zafeiriou DI, Katzos G, Gombakis N, Kontopoulos EE, Tsantali C. Clinical features, laboratory findings and differential diagnosis of benign acute childhood myositis. Acta Paediatr. 2000; 89:1493–4.
9. Meier PW, Bianchetti MG. An 8-year-old boy with a 4-day history of fever, cough and malaise, and a 2-day history of painful calves and difficulty walking. Eur J Pediatr. 2003; 162:731–2.
10. Lundberg A. Myalgia cruris epidemica. Acta Paediatr. 1957; 46:18–31.
11. Middleton PJ, Alexander RM, Szymanski MT. Severe myositis during recovery from influenza. Lancet. 1970; 2:533–5.
12. Cawkwell GM. Inflammatory myositis in children, including differential diagnosis. Curr Opin Rheumatol. 2000; 12:430–4.
13. Ruff RL, Secrist D. Viral studies in benign acute childhood myositis. Arch Neurol. 1982; 39:261–3.
14. Koliou M, Hadjiloizou S, Ourani S, Demosthenous A, Hadjidemetriou A. A case of benign acute childhood myositis associated with influenza A (H1N1) virus infection. Clin Microbiol Infect. 2010; 16:193–5.
15. Karpathios T, Kostaki M, Drakonaki S, Garoufi A, Siahanidou S, Spirou N, et al. An epidemic with influenza B virus causing benign acute myositis in ten boys and two girls. Eur J Pediatr. 1995; 154:334–6.
16. Kratochvil-Stava AJ, Haynatzki GR, Varman M. Retrospective review of influenza-associated acute myositis at a regional children's hospital. Infect Dis Clin Pract (Baltim Md). 2010; 18:183–7.
17. Agyeman P, Duppenthaler A, Heininger U, Aebi C. Influenza-associated myositis in children. Infection. 2004; 32:199–203.
18. Kawarai T, Nishimura H, Taniguchi K, Saji N, Shimizu H, Tadano M, et al. Magnetic resonance imaging of biceps femoris muscles in benign acute childhood myositis. Arch Neurol. 2007; 64:1200–1.
19. Panghaal V, Ortiz-Romero S, Lovinsky S, Levin TL. Benign acute childhood myositis: an unusual cause of calf pain. Pediatr Radiol. 2008; 38:703–5.
20. Watanabe T, Yoshikawa H, Abe Y, Yamazaki S, Uehara Y, Abe T. Renal involvement in children with influenza A virus infection. Pediatr Nephrol. 2003; 18:541–4.
21. Heiner JD, Ball VL. A child with benign acute childhood myositis after influenza. J Emerg Med. 2010; 39:316–9.
Table. 1
Characteristics of the Study Population (n=16)
| Variable | Value |
|---|---|
| Gender (M/F) | 12/4 (75/25) |
| Age (yr) | 4.6 1.1 (3 ± −7) |
| Time∗ (day) | 3.6 1.5 (1 ± −7) |
| Duration† (day) | 2.6 1.0 (1 ± −4) |
| Hospital stay (day) | 5.0 1.0 (4 ± −7) |
Table.
2. Clinical Manifestations of Influenza B-Associated Myositis in Children (n=16)
| Symptom/sign | No. of patients (%) |
|---|---|
| Calf pain | 16 (100) |
| Cough | 12 (75) |
| Fever | 9 (56) |
| Sore throat | 4 (25) |
| Headache | 1 (6) |
Table.
3. Laboratory Findings on Admission
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