To add to my first two post's today,this paper by de Jong and colleagues in the New England Journal of Medicine details a 4-year old male (4M) who presented with a 2-day history of fever, headache and diarrhoea which after admission progressed; cough, then to coma and death.
4M was found to have systemic influenza A(H5N1) virus infection (viable virus was isolated from cerebrospinal fluid, throat and rectal swabs and were RT-PCR positive).4M and his sister (9F who died 2-weeks previously but had no diagnostic specimens collected) were diagnosed with acute encephalitis.
Chest X-rays were normal and 4M exhibited some lung sounds suggestive of infection after transfer to a paediatric referral hospital and he went on to respiratory failure.
This highlight my earlier points: respiratory viruses could spread from gastrointestinal disease and encephalitis has a lot of causes in addition to the usual suspects.
