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Fullana Barceló MI, Artigues Serra F, Millan Pons AR, Asensio Rodriguez J, Ferre Beltran A, Del Carmen Lopez Bilbao M, Reina Prieto J, Riera Jaume M. Analysis of viral pneumonia and risk factors associated with severity of influenza virus infection in hospitalized patients from 2012 to 2016. BMC Infect Dis 2024; 24:302. [PMID: 38475703 DOI: 10.1186/s12879-024-09173-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/24/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Influenza viruses cause pneumonia in approximately one-third of cases, and pneumonia is an important cause of death. The aim was to identify risk factors associated with severity and those that could predict the development of pneumonia. METHODS This retrospective, observational study included all adult patients with confirmed influenza virus infection admitted to Son Espases University Hospital during four influenza seasons in Spain (October to May) from to 2012-2016. RESULTS Overall, 666 patients with laboratory-confirmed influenza were included, 93 (14%) of which were severe; 73 (10.9%) were admitted to Intensive Care Unit (ICU), 39 (5.8%) died, and 185 (27.7%) developed pneumonia. Compared to less severe cases, patients with severe disease: were less vaccinated (40% vs. 28%, p = 0.021); presented with more confusion (26.9% vs. 6.8%), were more hypoxemic (Horowitz index (PaO2/FiO2) 261 vs. 280), had higher C-reactive protein (CRP) (12.3 vs. 4.0), had more coinfections (26.8% vs. 6.3%) and had more pleural effusion (14% vs. 2.6%) (last six all p < 0.001). Risk factors significantly associated with severity were pneumonia [OR (95% CI) = 4.14 (2.4-7.16)], history of heart disease (1.84, 1.03-3.28), and confusion at admission (4.99, 2.55-9.74). Influenza vaccination was protective (0.53, 0.28-0.98). Compared to those without pneumonia, the pneumonia group had higher CRP (11.3 vs. 4.0, p < 0.001), lower oxygen saturation (92% vs. 94%, p < 0.001), were more hypoxic (PaO2/FiO2 266 vs. 281, p < 0.001), and incurred more mechanical ventilation, septic shock, admission to the ICU, and deaths (all four p < 0.001). Higher CRP and lower oxygen saturation were independent variables for predicting the development of pneumonia. CONCLUSIONS Pneumonia, history of heart disease, confusion and no influenza vaccination were independent variables to present complications in patients admitted with influenza infection.
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Affiliation(s)
- M I Fullana Barceló
- Internal Medicine Department, Infectious Diseases Section, Hospital Universitari Son Espases, Valldemossa Road 79, Palma de Mallorca, 07010, Spain.
| | - F Artigues Serra
- Internal Medicine Department, Infectious Diseases Section, Hospital Universitari Son Espases, Valldemossa Road 79, Palma de Mallorca, 07010, Spain
| | - A R Millan Pons
- IdISBa estadistic and methodological support, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - J Asensio Rodriguez
- Internal Medicine Department, Infectious Diseases Section, Hospital Universitari Son Espases, Valldemossa Road 79, Palma de Mallorca, 07010, Spain
| | - A Ferre Beltran
- Internal Medicine Department, Infectious Diseases Section, Hospital Universitari Son Espases, Valldemossa Road 79, Palma de Mallorca, 07010, Spain
| | | | - J Reina Prieto
- Microbiological Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - M Riera Jaume
- Internal Medicine Department, Infectious Diseases Section, Hospital Universitari Son Espases, Valldemossa Road 79, Palma de Mallorca, 07010, Spain
- IdISBa- Fundació Institut d'Investigació Sanitària Illes Balears, Palma de Mallorca, Spain
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Liu Y, Xie ZZ, Wang X, Zhu ZH, Yang C. Clinical study of invasive pulmonary aspergillosis following influenza A H1N1. Medicine (Baltimore) 2021; 100:e26434. [PMID: 34397685 PMCID: PMC8322502 DOI: 10.1097/md.0000000000026434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 06/04/2021] [Indexed: 01/04/2023] Open
Abstract
This study to analyze the clinical characteristics of patients with invasive pulmonary aspergillosis (IPA) following influenza A (H1N1) infection.We retrospectively analyzed 10 cases with IPA following H1N1 infection. The clinical manifestations, laboratory examination results, chest computed tomography, and treatments were analyzed.Clinical manifestations: all 10 cases had typical flu-like symptoms at the onset of the disease, among which 7 patients developed dyspnea in the late stage, and 8 patients had hemoptysis. Laboratory examination: the absolute and percentage of peripheral blood lymphocytes in all 10 patients were declined, among which 5 cases were with decreased CD3+ CD4+ T cells/lymphocytes; 9 cases with increased bronchoalveolar lavage fluid galactomannan; 6 cases with increased serum galactomannan; 1 case with bronchoalveolar lavage fluid cultured aspergillus fumigatus; and 2 cases with aspergillus by second-generation sequencing. Chest computed tomography: all patients showed multiple diffused ground-glass opacities at the beginning, along with linear or reticular interstitial changes. Two cases had multiple subarachnoid nodules with halo signs, 3 cases had consolidation in multiple segments of both lungs, 2 cases had cavities, and 4 cases were with pleural effusion. Treatment: 10 patients were treated with antiviral and anti-Aspergillus drugs after admission. Four patients received respiratory support. All 10 cases were cured and discharged.Early diagnosis of IPA in influenza A (H1N1) patients is the key to successful treatment.
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Easom N, Moss P, Barlow G, Samson A, Taynton T, Adams K, Ivan M, Burns P, Gajee K, Eastick K, Lillie PJ. Sixty-eight consecutive patients assessed for COVID-19 infection: Experience from a UK Regional infectious diseases Unit. Influenza Other Respir Viruses 2020; 14:374-379. [PMID: 32223012 PMCID: PMC7228236 DOI: 10.1111/irv.12739] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 01/05/2023] Open
Abstract
Background Assessment of possible infection with SARS‐CoV‐2, the novel coronavirus responsible for COVID‐19 illness, has been a major activity of infection services since the first reports of cases in December 2019. Objectives We report a series of 68 patients assessed at a Regional Infection Unit in the UK. Methods Between 29 January 2020 and 24 February 2020, demographic, clinical, epidemiological and laboratory data were collected. We compared clinical features between patients not requiring admission for clinical reasons or antimicrobials with those assessed as needing either admission or antimicrobial treatment. Results Patients assessed were aged from 0 to 76 years; 36/68 were female. Peaks of clinical assessments coincided with updates to the case definition for suspected COVID‐19. Microbiological diagnoses included SARS‐CoV‐2, mycoplasma pneumonia, influenza A, non‐SARS/MERS coronaviruses and rhinovirus/enterovirus. Nine of sixty‐eight received antimicrobials, 15/68 were admitted, 5 due to inability to self‐isolate. Patients requiring admission on clinical grounds or antimicrobials (14/68) were more likely to have fever or raised respiratory rate compared to those not requiring admission or antimicrobials. Conclusions The majority of patients had mild illness, which did not require clinical intervention. This finding supports a community testing approach, supported by clinicians able to review more unwell patients. Extensions of the epidemiological criteria for the case definition of suspected COVID‐19 lead to increased screening intensity; strategies must be in place to accommodate this in time for forthcoming changes as the epidemic develops.
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Affiliation(s)
- Nicholas Easom
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Peter Moss
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Gavin Barlow
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Anda Samson
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Thomas Taynton
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Kate Adams
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Monica Ivan
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Phillipa Burns
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Kavitha Gajee
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Kirstine Eastick
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Patrick J Lillie
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
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4
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Katsurada N, Suzuki M, Aoshima M, Yaegashi M, Ishifuji T, Asoh N, Hamashige N, Abe M, Ariyoshi K, Morimoto K. The impact of virus infections on pneumonia mortality is complex in adults: a prospective multicentre observational study. BMC Infect Dis 2017; 17:755. [PMID: 29212450 PMCID: PMC5719746 DOI: 10.1186/s12879-017-2858-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/26/2017] [Indexed: 11/29/2022] Open
Abstract
Background Various viruses are known to be associated with pneumonia. However, the impact of viral infections on adult pneumonia mortality remains unclear. This study aimed to clarify the effect of virus infection on pneumonia mortality among adults stratified by virus type and patient comorbidities. Methods This multicentre prospective study enrolled pneumonia patients aged ≥15 years from September 2011 to August 2014. Sputum samples were tested by in-house multiplex polymerase chain reaction assays to identify 13 respiratory viruses. Viral infection status and its effect on in-hospital mortality were examined by age group and comorbidity status. Results A total of 2617 patients were enrolled in the study and 77.8% was aged ≥65 years. 574 (21.9%) did not have comorbidities, 790 (30.2%) had chronic respiratory disease, and 1253 (47.9%) had other comorbidities. Viruses were detected in 605 (23.1%) patients. Human rhinovirus (9.8%) was the most frequently identified virus, followed by influenza A (3.9%) and respiratory syncytial virus (3.9%). Respiratory syncytial virus was more frequently identified in patients with chronic respiratory disease (4.7%) than those with other comorbidities (4.2%) and without comorbidities (2.1%) (p = 0.037). The frequencies of other viruses were almost identical between the three groups. Virus detection overall was not associated with increased mortality (adjusted risk ratio (ARR) 0.76, 95% CI 0.53–1.09). However, influenza virus A and B were associated with three-fold higher mortality in patients with chronic respiratory disease but not with other comorbidities (ARR 3.38, 95% CI 1.54–7.42). Intriguingly, paramyxoviruses were associated with dramatically lower mortality in patients with other comorbidities (ARR 0.10, 95% CI 0.01–0.70) but not with chronic respiratory disease. These effects were not affected by age group. Conclusions The impact of virus infections on pneumonia mortality varies by virus type and comorbidity status in adults. Electronic supplementary material The online version of this article (10.1186/s12879-017-2858-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Naoko Katsurada
- Department of Pulmonology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan.,Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Motoi Suzuki
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
| | - Masahiro Aoshima
- Department of Pulmonology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
| | - Makito Yaegashi
- Department of General Internal Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
| | - Tomoko Ishifuji
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Norichika Asoh
- Department of Internal Medicine, Juzenkai Hospital, 7-18 Kagomachi, Nagasaki, Japan
| | - Naohisa Hamashige
- Department of Internal Medicine, Chikamori Hospital, 1-1-16 Okawasuji, Kochi, Japan
| | - Masahiko Abe
- Department of General Internal Medicine, Ebetsu City Hospital, 6 Wakakusacho, Ebetsu, Hokkaido, Japan
| | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Konosuke Morimoto
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
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Morton B, Nweze K, O'Connor J, Turton P, Joekes E, Blakey JD, Welters ID. Oxygen exchange and C-reactive protein predict safe discharge in patients with H1N1 influenza. QJM 2017; 110:227-232. [PMID: 27803369 DOI: 10.1093/qjmed/hcw176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND : Pandemic influenza has potential to overwhelm healthcare resources. There is uncertainty over performance of existing triage tools for hospital admission and discharge decisions. AIM : Our aim was to identify clinical criteria that predict safe discharge from hospital and develop a pragmatic triage tool to guide physician decision-making. DESIGN : We retrospectively examined an existing database of patients who presented to the Royal Liverpool University Hospital during the 2010-11 influenza pandemic. METHODS Inclusion criteria: patients ≥18 years, with PCR confirmed H1N1 influenza. Exclusion criteria: died in the emergency department or case notes unavailable. Successful discharge was defined as discharge within 24 h of presentation and no readmission within 7 days. RESULTS Eighty-six patients were included and 16 were successfully discharged. Estimated P/F ratio and C-reactive protein predicted safe discharge in a multivariable logistic regression model (AUC 0.883). A composite univariate predictor (estimated P/F minus C-reactive protein, AUC 0.877) was created to calculate specific cut off points for sensitivity and specificity. A pragmatic decision tool was created to incorporate these thresholds and relevant guidelines. Discharge: SpO 2 (in air) ≥ 94% and CRP <50. Observe: SpO 2 ≥ 94% and CRP >50 or SpO 2 ≤ 93% and CRP <50. Admit: SpO 2 ≤ 93% and CRP >50. CONCLUSIONS We identified that oxygen exchange and CRP, a marker of acute inflammation, were the most important predictors of safe discharge. Our proposed simple triage model requires validation but has the potential to aid clinical decisions in the event of a future pandemic, and potentially for seasonal influenza.
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Affiliation(s)
- B Morton
- From the Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Critical Care Department, Aintree University Hospital NHS Foundation Trust, Aintree, UK
| | - K Nweze
- Department of Critical Care Medicine, Royal Liverpool University Hospital, Liverpool, UK
| | - J O'Connor
- Department of Critical Care Medicine, Royal Liverpool University Hospital, Liverpool, UK
| | - P Turton
- Department of Critical Care Medicine, Royal Liverpool University Hospital, Liverpool, UK
| | - E Joekes
- Department of Radiology, Royal Liverpool University Hospital, Liverpool, UK
| | - J D Blakey
- From the Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Critical Care Department, Aintree University Hospital NHS Foundation Trust, Aintree, UK
| | - I D Welters
- Department of Critical Care Medicine, Royal Liverpool University Hospital, Liverpool, UK
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
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6
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Muthuri SG, Venkatesan S, Myles PR, Leonardi-Bee J, Lim WS, Al Mamun A, Anovadiya AP, Araújo WN, Azziz-Baumgartner E, Báez C, Bantar C, Barhoush MM, Bassetti M, Beovic B, Bingisser R, Bonmarin I, Borja-Aburto VH, Cao B, Carratala J, Cuezzo MR, Denholm JT, Dominguez SR, Duarte PAD, Dubnov-Raz G, Echavarria M, Fanella S, Fraser J, Gao Z, Gérardin P, Giannella M, Gubbels S, Herberg J, Higuera Iglesias AL, Hoeger PH, Hoffmann M, Hu X, Islam QT, Jiménez MF, Kandeel A, Keijzers G, Khalili H, Khandaker G, Knight M, Kusznierz G, Kuzman I, Kwan AMC, Lahlou Amine I, Langenegger E, Lankarani KB, Leo YS, Linko R, Liu P, Madanat F, Manabe T, Mayo-Montero E, McGeer A, Memish ZA, Metan G, Mikić D, Mohn KGI, Moradi A, Nymadawa P, Ozbay B, Ozkan M, Parekh D, Paul M, Poeppl W, Polack FP, Rath BA, Rodríguez AH, Siqueira MM, Skręt-Magierło J, Talarek E, Tang JW, Torres A, Törün SH, Tran D, Uyeki TM, van Zwol A, Vaudry W, Velyvyte D, Vidmar T, Zarogoulidis P, Nguyen-Van-Tam JS. Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia: an individual participant data meta-analysis. Influenza Other Respir Viruses 2016; 10:192-204. [PMID: 26602067 PMCID: PMC4814862 DOI: 10.1111/irv.12363] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2015] [Indexed: 02/05/2023] Open
Abstract
Background The impact of neuraminidase inhibitors (NAIs) on influenza‐related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection. Methods A worldwide meta‐analysis of individual participant data from 20 634 hospitalised patients with laboratory‐confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) ‘pandemic influenza’. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids. Results Of 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95% CI 0·64–1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44–1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71–1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55–0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54–0·85; P = 0·001)]. Conclusions Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support.
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Affiliation(s)
- Stella G Muthuri
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Sudhir Venkatesan
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Puja R Myles
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Wei Shen Lim
- Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Abdullah Al Mamun
- International Centre for Diarrhoeal Diseases, Research Bangladesh (ICDDRB), Dhaka, Bangladesh
| | - Ashish P Anovadiya
- Department of Pharmacology, Government Medical College and Sir Takhtsinhji General Hospital, Bhavnagar, Gujarat, India
| | | | | | - Clarisa Báez
- Ministerio de Salud de la Provincia de Buenos Aires, Buenos Aires, Argentina
| | - Carlos Bantar
- Department of Infection Control, Hospital San Martín de Paraná, Entre Ríos, Argentina
| | - Mazen M Barhoush
- Department of Medicine, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Bojana Beovic
- Department of Infectious Diseases, University Medical Centre, Ljubljana, Slovenia
| | - Roland Bingisser
- Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | | | | | - Bin Cao
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jordi Carratala
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Bellvitge Institute for Biomedical Research, L'Hospitalet de Llobregat, Red Española de Investigación en Patología Infecciosa, University of Barcelona, Barcelona, Spain
| | | | - Justin T Denholm
- Victorian Infectious Diseases Service and Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, Parkville, Vic., Australia
| | - Samuel R Dominguez
- Department of Pediatric Infectious Diseases, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Gal Dubnov-Raz
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Marcela Echavarria
- Clinical Virology Laboratory, CEMIC University Hospital, Buenos Aires, Argentina
| | - Sergio Fanella
- Section of Pediatric Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - James Fraser
- Paediatric Intensive Care Unit, Bristol Children's Hospital, Bristol, UK
| | - Zhancheng Gao
- Department of Respiratory & Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Patrick Gérardin
- NICU/PICU, PFME, CHU Saint Pierre, Saint Pierre, La Réunion, France.,CIC 1410 (CHU/Inserm/University of La Réunion/URML-OI), CHU Saint Pierre, Saint Pierre, La Réunion, France.,UMR PIMIT (CHU/Inserm/University of La Réunion/IRD/CNRS), CYROI, Saint Denis - Reunion Island, Saint Denis, France.,NICU/PICU CHU of La Réunion, Groupe Hospitalier Sud Réunion, Saint Pierre, La Réunion, France
| | - Maddalena Giannella
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sophie Gubbels
- Department of Infectious Disease Epidemiology, Sector for National Health Documentation and Research, Statens Serum Institut, Copenhagen, Denmark
| | - Jethro Herberg
- Section of Paediatrics, Division of Infectious Disease, Imperial College, London, UK
| | - Anjarath L Higuera Iglesias
- Epidemiology Research Unit, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, Mexico City, Mexico
| | - Peter H Hoeger
- Cath. Children's Hospital Wilhelmstift, Hamburg, Germany
| | - Matthias Hoffmann
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Xiaoyun Hu
- Peking Union Medical College Hospital, Beijing, China
| | | | - Mirela F Jiménez
- Departamento de Ginecologia e Obstetrícia - UFCSPA, Preceptora da Residência Médica do Hospital Fêmina, Porto Alegre, Brazil
| | | | | | - Hossein Khalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Gulam Khandaker
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, University of Sydney, Sydney, NSW, Australia
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gabriela Kusznierz
- National Institute of Respiratory Diseases 'Emilio Coni' ANLIS "C. Malbran", Santa Fe, Argentina
| | - Ilija Kuzman
- School of Medicine, University Hospital for Infectious Diseases, University of Zagreb, Zagreb, Croatia
| | - Arthur M C Kwan
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Idriss Lahlou Amine
- Faculty of Medicine and Pharmacy, Mohammed V Military Teaching Hospital, Biosafety Level 3 and Research Laboratory, University Mohammed V-Souissi, Rabat, Morocco
| | - Eduard Langenegger
- Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg, Stellenbosch, South Africa
| | - Kamran B Lankarani
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Yee-Sin Leo
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rita Linko
- Helsinki University Hospital, Helsinki, Finland
| | - Pei Liu
- Department of Infectious Diseases, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Faris Madanat
- Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan
| | - Toshie Manabe
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Elga Mayo-Montero
- Instituto de Medicina Preventiva de la Defensa, Capitan Medico Ramon y Cajal (IMPDEF), Ministerio de Defensa, Madrid, Spain
| | - Allison McGeer
- Toronto Invasive Bacterial Diseases Network, University of Toronto, Toronto, ON, Canada
| | - Ziad A Memish
- Ministry of Health, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Gokhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Dragan Mikić
- Military Medical Academy, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia
| | - Kristin G I Mohn
- Section for Infectious Diseases, Medical Department, and Department of Research and Development, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, The Influenza Centre, University of Bergen, Bergen, Norway
| | - Ahmadreza Moradi
- The Division of Ocular Immunology, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,National Research Institute for Tuberculosis and Lung Disease, Massih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pagbajabyn Nymadawa
- National Influenza Center, National Center of Communicable Diseases, Ministry of Health, Ulaanbaatar, Mongolia
| | - Bulent Ozbay
- Department of Pulmonary and Critical Care, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | - Mehpare Ozkan
- Clinic of Pediatric Neurology, Dr. Sami Ulus Research and Training Hospital of Women's and Children's Health and Diseases, Ankara, Turkey
| | - Dhruv Parekh
- Critical Care and Pain Perioperative, Critical Care and Trauma Trials Group, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - Mical Paul
- Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | | | - Fernando P Polack
- Department of Pediatrics, Vanderbilt Vaccine Center, Vanderbilt University, Nashville, TN, USA.,Fundacion INFANT, Buenos Aires, Argentina
| | - Barbara A Rath
- Division of Pneumonology-Immunology, Department of Pediatrics, Charité University Medical Center, Berlin, Germany
| | - Alejandro H Rodríguez
- Critical Care Department, Hospital Joan XXIII, IISPV, URV, CIBERES, Tarragona, Spain
| | - Marilda M Siqueira
- Laboratory of Respiratory Viruses, Oswaldo Cruz Institute/Fiocruz, Rio de Janeiro, Brazil
| | | | - Ewa Talarek
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Julian W Tang
- Division of Microbiology/Molecular Diagnostic Centre, Department of Laboratory Medicine, National University Hospital, Singapore, Singapore.,Alberta Provincial Laboratory for Public Health, University of Alberta Hospital, Edmonton, Canada.,Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
| | - Antoni Torres
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERES, Barcelona, Spain
| | - Selda H Törün
- Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul, Turkey
| | - Dat Tran
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Annelies van Zwol
- Department of Pediatric Intensive Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Wendy Vaudry
- Division of Infectious Diseases, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Daiva Velyvyte
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Paul Zarogoulidis
- Unit of Infectious Diseases, University General Hospital of Alexandroupolis, Democritus University Thrace, Dragana, Greece
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H1N1 Status Cannot Be Reliably Predicted by Chest X-ray and Complete Blood Count Findings. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2015. [DOI: 10.1097/ipc.0000000000000189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Pfister R, Kochanek M, Leygeber T, Brun-Buisson C, Cuquemelle E, Machado MB, Piacentini E, Hammond NE, Ingram PR, Michels G. Procalcitonin for diagnosis of bacterial pneumonia in critically ill patients during 2009 H1N1 influenza pandemic: a prospective cohort study, systematic review and individual patient data meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:R44. [PMID: 24612487 PMCID: PMC4056761 DOI: 10.1186/cc13760] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 03/06/2014] [Indexed: 12/23/2022]
Abstract
Introduction Procalcitonin (PCT) is helpful for diagnosing bacterial infections. The diagnostic utility of PCT has not been examined thoroughly in critically ill patients with suspected H1N1 influenza. Methods Clinical characteristics and PCT were prospectively assessed in 46 patients with pneumonia admitted to medical ICUs during the 2009 and 2010 influenza seasons. An individual patient data meta-analysis was performed by combining our data with data from five other studies on the diagnostic utility of PCT in ICU patients with suspected 2009 pandemic influenza A(H1N1) virus infection identified by performing a systematic literature search. Results PCT levels, measured within 24 hours of ICU admission, were significantly elevated in patients with bacterial pneumonia (isolated or coinfection with H1N1; n = 77) (median = 6.2 μg/L, interquartile range (IQR) = 0.9 to 20) than in patients with isolated H1N1 influenza pneumonia (n = 84; median = 0.56 μg/L, IQR = 0.18 to 3.33). The area under the curve of the receiver operating characteristic curve of PCT was 0.72 (95% confidence interval (CI) = 0.64 to 0.80; P < 0.0001) for diagnosis of bacterial pneumonia, but increased to 0.76 (95% CI = 0.68 to 0.85; P < 0.0001) when patients with hospital-acquired pneumonia and immune-compromising disorders were excluded. PCT at a cut-off of 0.5 μg/L had a sensitivity (95% CI) and a negative predictive value of 80.5% (69.9 to 88.7) and 73.2% (59.7 to 84.2) for diagnosis of bacterial pneumonia, respectively, which increased to 85.5% (73.3 to 93.5) and 82.2% (68.0 to 92.0) in patients without hospital acquired pneumonia or immune-compromising disorder. Conclusions In critically ill patients with pneumonia during the influenza season, PCT is a reasonably accurate marker for detection of bacterial pneumonia, particularly in patients with community-acquired disease and without immune-compromising disorders, but it might not be sufficient as a stand-alone marker for withholding antibiotic treatment.
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Redlberger-Fritz M, Hirk S, Buchinger D, Haberl R, Hell M, Perkmann-Nagele N, Kundi M, Popow-Kraupp T. Distinct differences in clinical manifestation and viral laboratory parameters between children and adults with influenza A(H1N1)pdm09 infection--a retrospective comparative analysis. J Med Virol 2014; 86:1048-55. [PMID: 24615722 DOI: 10.1002/jmv.23912] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2014] [Indexed: 01/24/2023]
Abstract
During the influenza pandemic 2009 children and adults differed in the clinical course of the influenza disease. In following the question arose, if the case definitions used within the national and international organizations are an adequate tool for the clinical diagnosis of influenza in children as well as in adults. Therefore medical charts from 146 children and 229 adults were retrospectively analyzed. In addition, the initial viral loads of all 375 patients and the duration of virus shedding of a subset of 79 patients were also investigated. Children show a wider clinical spectrum including gastro enteric symptoms and also a different spectrum of laboratory parameters like elevated CRP-levels, leucocytosis, and higher viral loads. Further, children show significantly more often complications, for example, myositis that may be underdiagnosed. In patients receiving antiviral-therapy complications occurred significantly less often and the presence of symptoms was significantly shorter compared to the untreated group (2.3 days vs. 6.0 days). In summary, the differences in the clinical picture between children and adults should be taken into consideration for the clinical diagnosis of influenza and also for a future discussion on age specific influenza case definitions.
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10
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Influenza infection screening tools fail to accurately predict influenza status for patients during pandemic H1N1 influenza season. Can Respir J 2014; 20:e55-9. [PMID: 23762891 DOI: 10.1155/2013/762140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Following the severe acute respiratory syndrome outbreak in 2003, hospitals have been mandated to use infection screening questionnaires to determine which patients have infectious respiratory illness and, therefore, require isolation precautions. Despite widespread use of symptom-based screening tools in Ontario, there are no data supporting the accuracy of these screening tools in hospitalized patients. OBJECTIVE To measure the performance characteristics of infection screening tools used during the H1N1 influenza season. METHODS The present retrospective cohort study was conducted at The Ottawa Hospital (Ottawa, Ontario) between October and December, 2009. Consecutive inpatients admitted from the emergency department were included if they were ≥18 years of age, underwent a screening tool assessment at presentation and had a most responsible diagnosis that was cardiac, respiratory or infectious. The gold-standard outcome was laboratory diagnosis of influenza. RESULTS The prevalence of laboratory-confirmed influenza was 23.5%. The sensitivity and specificity of the febrile respiratory illness screening tool were 74.5% (95% CI 60.5% to 84.8%) and 32.7% (95% CI 25.8% to 40.5%), respectively. The sensitivity and specificity of the influenza-like illness screening tool were 75.6% (95% CI 61.3% to 85.8%) and 46.3% (95% CI 38.2% to 54.7%), respectively. CONCLUSIONS The febrile respiratory illness screening tool missed 26% of active influenza cases, while 67% of noninfluenza patients were unnecessarily placed under respiratory isolation. Results of the present study suggest that infection-control practitioners should re-evaluate their strategy of screening patients at admission for contagious respiratory illness using symptom- and sign-based tests. Future efforts should focus on the derivation and validation of clinical decision rules that combine clinical features with laboratory tests.
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11
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Viasus D, Marinescu C, Villoslada A, Cordero E, Gálvez-Acebal J, Fariñas MC, Gracia-Ahufinger I, Fernández-Navarro A, Niubó J, Ortega L, Muñez-Rubio E, Romero-Gómez MP, Carratalà J. Community-acquired pneumonia during the first post-pandemic influenza season: a prospective, multicentre cohort study. J Infect 2013; 67:185-93. [PMID: 23747416 PMCID: PMC7112525 DOI: 10.1016/j.jinf.2013.05.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 04/08/2013] [Accepted: 05/24/2013] [Indexed: 12/18/2022]
Abstract
Objectives To determine the aetiology, clinical features and prognosis of CAP during the first post-pandemic influenza season. We also assessed the factors associated with severe disease and tested the ability of a scoring system for identifying influenza A (H1N1)pdm09-related pneumonia. Methods Prospective cohort study carried out at 10 tertiary hospitals of Spain. All adults hospitalised with CAP from December 01, 2010 to March 31, 2011 were analysed. Results A total of 747 adults with CAP required hospitalisation. The aetiology was determined in 315 (42.2%) patients, in whom 154 (21.9%) were due to bacteria, 125 (16.7%) were due to viruses and 36 (4.8%) were mixed (due to viruses and bacteria). The most frequently isolated bacteria were Streptococccus pneumoniae. Among patients with viral pneumonia, the most common organism identified were influenza A (H1N1)pdm09. Independent factors associated with severe disease were impaired consciousness, septic shock, tachypnea, hyponatremia, hypoxemia, influenza B, and influenza A (H1N1)pdm09. The scoring system evaluated did not differentiate reliably between patients with influenza A (H1N1)pdm09-related pneumonia and those with other aetiologies. Conclusions The frequency of bacterial and viral pneumonia during the first post-pandemic influenza season was similar. The main identified virus was influenza A (H1N1)pdm09, which was associated with severe disease. Although certain presenting clinical features may allow recognition of influenza A (H1N1)pdm09-related pneumonia, it is difficult to express them in a reliable scoring system.
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Affiliation(s)
- Diego Viasus
- Hospital Universitari de Bellvitge - IDIBELL, University of Barcelona, Feixa Llarga s/n, 08907 Barcelona, Spain.
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12
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Noah DL, Noah JW. Adapting global influenza management strategies to address emerging viruses. Am J Physiol Lung Cell Mol Physiol 2013; 305:L108-17. [PMID: 23709619 DOI: 10.1152/ajplung.00105.2013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Death by respiratory complications from influenza infections continues to be a major global health concern. Antiviral drugs are widely available for therapy and prophylaxis, but viral mutations have resulted in resistance that threatens to reduce the long-term utility of approved antivirals. Vaccination is the best method for controlling influenza, but vaccine strategies are blunted by virus antigenic drift and shift. Genetic shift in particular has led to four pandemics in the last century, which have prompted the development of efficient global surveillance and vaccination programs. Although the influenza pandemic of 2009 emphasized the need for the rapid standardization of global surveillance methods and the preparation and dissemination of global assay standards for improved reporting and diagnostic tools, outbreaks of novel influenza strains continue to occur, and current efforts must be enhanced by aggressive public education programs to promote increased vaccination rates in the global population. Recently, a novel H7N9 avian influenza virus with potential to become a pandemic strain emerged in China and was transmitted from animals to humans with a demonstrated >20% mortality rate. Sporadic outbreaks of highly lethal avian virus strains have already increased public awareness and altered annual vaccine production strategies to prevent the natural adaption of this virus to human-to-human transmission. Additional strategies for combating influenza include advancement of new antivirals for unexploited viral or host cellular targets; novel adjuvants and alternate vaccine delivery systems; and development of universal protein, DNA, or multivalent vaccines designed to increase immune responsiveness and enhance public health response times.
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Affiliation(s)
- Diana L Noah
- Southern Research Institute, Birmingham, AL 35205, USA
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13
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Ozlu T, Bülbül Y, Taşbakan S, Kılıç H, Kuyucu T, Yıldız T, Ozdemir T, Duru S, Oztuna F, Adıgüzel N, Sağlam L, Coşkun AŞ, Ornek T, Gündüz G, Filiz A, Ozdemir L, Okumuş G. General Characteristics and Prognostic Factors of Pneumonia Cases Developed During Pandemic (H1N1) Influenza-A Virus Infection in Turkey. Balkan Med J 2013; 30:68-73. [PMID: 25207072 DOI: 10.5152/balkanmedj.2012.089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 09/17/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Unlike seasonal influenza, seen in previous years, the strain identified in the 2009 influenza-A pandemic involved high mortality. In this study, prognostic factors and general characteristics of pneumonia cases developed in Turkey during the H1N1 pandemic between October 2009 and January 2010 were analyzed. STUDY DESIGN Multicenter retrospective study. MATERIAL AND METHODS This multicentric retrospective study was conducted between August and October 2010 and patients' data were collected by means of standard forms. RESULTS The study included 264 pneumonia cases, collected from 14 different centers. Mean age was 47.5±18.6 years. Nineteen patients (7.2%) were pregnant or had a new birth and comorbid diseases were detected in 52.3% of all patients. On admission, 35 (13.8%) cases had altered mental status. Overall, 32.6% were treated in intensive care units (ICU) and invasive/non-invasive mechanical ventilation was performed in 29.7%. The mean duration of ICU stay was 2.9±6.2 and total hospital stay was 12.0±9.4 days. Mortality rate was 16.8% (43-cases). The length of ICU treatment, total hospital stay, and mortality were significantly higher in H1N1-confirmed patients. Mortality was significantly higher in patients with dyspnea, cyanosis, and those who had altered mental status on admission. Patients who died had significantly higher rate of peripheral blood neutrophils, lower platelet counts, higher BUN, and lower SaO2 levels. CONCLUSION This study showed that pneumonia developed during H1N1 pandemic in our country had resulted in a high mortality. Mortality was especially high among patients with cyanosis, altered mental state and those with lower SaO2.
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Affiliation(s)
- Tevfik Ozlu
- Department of Chest Diseases, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Yılmaz Bülbül
- Department of Chest Diseases, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Sezai Taşbakan
- Department of Chest Diseases, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Hatice Kılıç
- Clinic of Chest Diseases, Atatürk Education and Research Hospital, Ankara, Turkey
| | - Tülin Kuyucu
- Clinic of Chest Diseases, Süreyyapaşa Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
| | - Tekin Yıldız
- Department of Chest Diseases, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Tarkan Ozdemir
- Clinic of Chest Diseases, Chest Diseases Hospital, Çorum, Turkey
| | - Serap Duru
- Clinic of Chest Diseases, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Funda Oztuna
- Department of Chest Diseases, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Nalan Adıgüzel
- Clinic of Chest Diseases, Süreyyapaşa Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
| | - Leyla Sağlam
- Department of Chest Diseases, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Ayşin Şakar Coşkun
- Department of Chest Diseases, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Tacettin Ornek
- Department of Chest Diseases, Faculty of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey
| | - Gazi Gündüz
- Clinic of Chest Diseases, Dr. Suat Seren Chest Diseases and Thoracic Surgery Education and Research Hospital, İzmir, Turkey
| | - Ayten Filiz
- Department of Chest Diseases, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Levent Ozdemir
- Clinic of Chest Diseases, Dörtyol State Hospital, Hatay, Turkey
| | - Gülfer Okumuş
- Department of Chest Diseases, Faculty of Medicine, Istanbul University, İstanbul, Turkey
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Abstract
PURPOSE OF REVIEW Shortly after the advent of severe acute respiratory syndrome and the avian influenza, the emergence of the influenza A(H1N1)2009 pandemic caused significant vibrations to the public health authorities and stressed the health systems worldwide. We sought to investigate whether this experience has altered our knowledge and our current and future practice on the management of severe acute respiratory infections (SARI) and community-acquired pneumonia. RECENT FINDINGS A changing epidemiology was demonstrated, with obesity and pregnancy beyond established risk groups for influenza A, other clinical syndromes beyond primary viral pneumonia, possible coinfections by other viral beyond bacterial pathogens and a disappointing performance of all available severity assessment tools. On the treatment topic, accumulating evidence suggesting worse outcomes argues against the use of corticosteroids, but some noninvasive ventilating modalities require further assessment. SUMMARY The recent influenza A(H1N1)2009 pandemic has highlighted our weaknesses relating to the diagnosis and assessment of severity of SARI, compromising early treatment and ultimate outcomes; further research based on this experience will help to improve prognosis and boost our future preparedness. An important message is the necessity of international collaboration for the rapid dissemination of locally acquired knowledge.
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Kumar TCN, Shivakumar NS, Deepak TS, Krishnappa R, Goutam MS, Ganigar V. H1N1-infected Patients in ICU and Their Clinical Outcome. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 4:394-8. [PMID: 23050248 PMCID: PMC3456478 DOI: 10.4103/1947-2714.100984] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: The swine flu (H1N1) with rapid spread and panic in population is truly global pandemic, affected mainly younger population. There is need to accumulate evidence regarding patient's intensive care parameters for effective management of newer strains of influenza viral infections. Hence an observed retrospective record analysis of confirmed H1N1 patients admitted to intensive care unit (ICU) of a tertiary care centre is done. Aims: The study was designed to study the profile and pattern of H1N1 patients admitted to ICU and to study the distribution and associated factors with treatment outcomes. Materials and Methods: The demographic, clinical, and laboratory data of 32 (RT-PCR confirmed) H1N1cases were collected and analyzed using Fischer's exact test/paired t test between survivors and nonsurvivors to know their significance. This data included criteria for admission to ICU, type of lung injury, mode of oxygenation, antiviral, and other drugs used. Results: There were 11 males and 21 female. Age ranged from 19 to 72 years. Age group of 15–45 years had most cases (78%) and mortality (60%). Most common symptoms were fever and breathlessness (100%). The mean duration of breathlessness was statistically significant (P = 0.037) between two groups. Most common signs were tachycardia and tachypnea. The 75% cases developed acute respiratory distress syndrome (ARDS), of this 16% survived. Among these fatal cases nine were positive for procalcitonin (PCT) (P = 0.006). The rest of 25% developed acute lung injury (ALI) and recovered completely (P = 0.0001). Conclusion: Fever and breathlessness were the main presenting complaints. Tachypnea and tachycardia as clinical signs predict development of respiratory complications. Arterial blood gas analysis (ABG) and PaO2/FiO2 were important in deciding severity of lung injury and mode of ventilation. ARDS was observed to be the main cause of mortality in this study. Serum PCT level estimation is useful in determining outcome.
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16
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A review on the clinical spectrum and natural history of human influenza. Int J Infect Dis 2012; 16:e714-23. [DOI: 10.1016/j.ijid.2012.05.1025] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 05/14/2012] [Indexed: 01/27/2023] Open
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Parnell GP, McLean AS, Booth DR, Armstrong NJ, Nalos M, Huang SJ, Manak J, Tang W, Tam OY, Chan S, Tang BM. A distinct influenza infection signature in the blood transcriptome of patients with severe community-acquired pneumonia. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R157. [PMID: 22898401 PMCID: PMC3580747 DOI: 10.1186/cc11477] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 08/15/2012] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Diagnosis of severe influenza pneumonia remains challenging because of a lack of correlation between the presence of influenza virus and clinical status. We conducted gene-expression profiling in the whole blood of critically ill patients to identify a gene signature that would allow clinicians to distinguish influenza infection from other causes of severe respiratory failure, such as bacterial pneumonia, and noninfective systemic inflammatory response syndrome. METHODS Whole-blood samples were collected from critically ill individuals and assayed on Illumina HT-12 gene-expression beadarrays. Differentially expressed genes were determined by linear mixed-model analysis and overrepresented biological pathways determined by using GeneGo MetaCore. RESULTS The gene-expression profile of H1N1 influenza A pneumonia was distinctly different from those of bacterial pneumonia and systemic inflammatory response syndrome. The influenza gene-expression profile is characterized by upregulation of genes from cell-cycle regulation, apoptosis, and DNA-damage-response pathways. In contrast, no distinctive gene-expression signature was found in patients with bacterial pneumonia or systemic inflammatory response syndrome. The gene-expression profile of influenza infection persisted through 5 days of follow-up. Furthermore, in patients with primary H1N1 influenza A infection in whom bacterial co-infection subsequently developed, the influenza gene-expression signature remained unaltered, despite the presence of a superimposed bacterial infection. CONCLUSIONS The whole-blood expression-profiling data indicate that the host response to influenza pneumonia is distinctly different from that caused by bacterial pathogens. This information may speed the identification of the cause of infection in patients presenting with severe respiratory failure, allowing appropriate patient care to be undertaken more rapidly.
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Myles P, Nguyen-Van-Tam JS, Semple MG, Brett SJ, Bannister B, Read RC, Taylor BL, McMenamin J, Enstone JE, Nicholson KG, Openshaw PJ, Lim WS. Differences between asthmatics and nonasthmatics hospitalised with influenza A infection. Eur Respir J 2012; 41:824-31. [PMID: 22903963 PMCID: PMC3612580 DOI: 10.1183/09031936.00015512] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Asthmatics hospitalised because of influenza A infection are less likely to
require intensive care or die compared with nonasthmatics. The reasons for this
are unknown. We performed a retrospective analysis of data on 1520 patients admitted to 75 UK
hospitals with confirmed influenza A/H1N1 2009 infection. A multivariable model
was used to investigate reasons for the association between asthma and severe
outcomes (intensive care unit support or death). Asthmatics were less likely than nonasthmatics to have severe outcome
(11.2% versus 19.8%, unadjusted OR 0.51,
95% CI 0.36–0.72) despite a greater proportion requiring
oxygen on admission (36.4% versus 26%,
unadjusted OR 1.63) and similar rates of pneumonia (17.1%
versus 16.6%, unadjusted OR 1.04). The results
of multivariable logistic regression suggest the association of asthma with
outcome (adjusted OR 0.62, 95% CI 0.36–1.05;
p=0.075) are explained by pre-admission inhaled corticosteroid use
(adjusted OR 0.34, 95% CI 0.18–0.66) and earlier
admission (≤4 days from symptom onset) (adjusted OR 0.60,
95% CI 0.38–0.94). In asthmatics, systemic corticosteroids
were associated with a decreased likelihood of severe outcomes (adjusted OR
0.36, 95% CI 0.18–0.72). Corticosteroid use and earlier hospital admission explained the association of
asthma with less severe outcomes in hospitalised patients.
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Mahony AA, Cheng AC, Olsen KL, Aboltins CA, Black JFP, Johnson PDR, Lindsay Grayson M, Torresi J. Diagnosing swine flu: the inaccuracy of case definitions during the 2009 pandemic, an attempt at refinement, and the implications for future planning. Influenza Other Respir Viruses 2012; 7:403-9. [PMID: 22712880 PMCID: PMC5779837 DOI: 10.1111/j.1750-2659.2012.00398.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background At the onset of the pandemic H1N1/09 influenza A outbreak in Australia, health authorities devised official clinical case definitions to guide testing and access to antiviral therapy. Objectives To assess the diagnostic accuracy of these case definitions and to attempt to improve on them using a scoring system based on clinical findings at presentation. Patients/Methods This study is a retrospective case–control study across three metropolitan Melbourne hospitals and one associated community‐based clinic during the influenza season, 2009. Patients presenting with influenza‐like illness who were tested for H1N1/09 influenza A were administered a standard questionnaire of symptomatology, comorbidities, and risk factors. Patients with a positive test were compared to those with a negative test. Logistic regression was performed to examine for correlation of clinical features with disease. A scoring system was devised and compared with case definitions used during the pandemic. The main outcome measures were the positive and negative predictive values of our scoring system, based on real‐life data, versus the mandated case definitions’. Results Both the devised scoring system and the case definitions gave similar positive predictive values (38–58% using ascending score groups, against 39–44% using the various case definitions). Negative predictive values were also closely matched (ranging from 94% to 73% in the respective score groups against 83–84% for the case definitions). Conclusions Accurate clinical diagnosis of H1N1/09 influenza A was difficult and not improved significantly by a structured scoring system. Investment in more widespread availability of rapid and sensitive diagnostic tests should be considered in future pandemic planning.
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Affiliation(s)
- Andrew A Mahony
- Infectious Diseases Department, Austin Health, Melbourne, Vic., Australia.
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Nicolini A, Claudio S, Rao F, Ferrera L, Isetta M, Bonfiglio M. Influenza A (H1N1)-associated pneumonia. J Bras Pneumol 2012; 37:621-7. [PMID: 22042394 DOI: 10.1590/s1806-37132011000500009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Accepted: 07/19/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the characteristics of patients with influenza A (H1N1)-associated pneumonia treated at two hospitals in the region of Liguria, Italy, as well as to describe their treatment and outcomes. METHODS This was a prospective observational study including all patients older than 16 years of age with a confirmed diagnosis of influenza A (H1N1) who were admitted to Villa Scassi Hospital, in the city of Genoa, Italy, or to the Sestri Levante General Hospital, in the city of Sestri Levante, Italy, between September of 2009 and January of 2010. The primary outcome measure was mortality within 60 days after diagnosis. Secondary outcome measures were the need for mechanical ventilation and the length of hospital stay. RESULTS Of the 40 patients with a confirmed diagnosis of influenza A (H1N1), 27 presented pneumonia during the study period. The mean age of the 27 patients was 42.8 ± 14.8 years, and the mean length of hospital stay was 11.6 ± 8.2 days. Of the 27 patients, 20 had respiratory failure, 4 underwent invasive mechanical ventilation, and 5 underwent noninvasive ventilation. One patient had comorbidities, developed multiple organ failure, and died. CONCLUSIONS During the influenza A (H1N1) pandemic, the associated mortality rate was lower in Italy than in other countries, and cases reported in the country typically had a milder course than did those reported elsewhere. Nevertheless, 9 of our cases (33%) rapidly evolved to respiratory failure, requiring mechanical ventilation.
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González-Candelas F, Astray J, Alonso J, Castro A, Cantón R, Galán JC, Garin O, Sáez M, Soldevila N, Baricot M, Castilla J, Godoy P, Delgado-Rodríguez M, Martín V, Mayoral JM, Pumarola T, Quintana JM, Tamames S, Domínguez A. Sociodemographic factors and clinical conditions associated to hospitalization in influenza A (H1N1) 2009 virus infected patients in Spain, 2009-2010. PLoS One 2012; 7:e33139. [PMID: 22412995 PMCID: PMC3296770 DOI: 10.1371/journal.pone.0033139] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 02/04/2012] [Indexed: 01/09/2023] Open
Abstract
The emergence and pandemic spread of a new strain of influenza A (H1N1) virus in 2009 resulted in a serious alarm in clinical and public health services all over the world. One distinguishing feature of this new influenza pandemic was the different profile of hospitalized patients compared to those from traditional seasonal influenza infections. Our goal was to analyze sociodemographic and clinical factors associated to hospitalization following infection by influenza A(H1N1) virus. We report the results of a Spanish nationwide study with laboratory confirmed infection by the new pandemic virus in a case-control design based on hospitalized patients. The main risk factors for hospitalization of influenza A (H1N1) 2009 were determined to be obesity (BMI≥40, with an odds-ratio [OR] 14.27), hematological neoplasia (OR 10.71), chronic heart disease, COPD (OR 5.16) and neurological disease, among the clinical conditions, whereas low education level and some ethnic backgrounds (Gypsies and Amerinds) were the sociodemographic variables found associated to hospitalization. The presence of any clinical condition of moderate risk almost triples the risk of hospitalization (OR 2.88) and high risk conditions raise this value markedly (OR 6.43). The risk of hospitalization increased proportionally when for two (OR 2.08) or for three or more (OR 4.86) risk factors were simultaneously present in the same patient. These findings should be considered when a new influenza virus appears in the human population.
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Singanayagam A, Singanayagam A, Wood V, Chalmers JD. Factors associated with severe illness in pandemic 2009 influenza a (H1N1) infection: implications for triage in primary and secondary care. J Infect 2011; 63:243-51. [PMID: 21839111 DOI: 10.1016/j.jinf.2011.07.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 07/29/2011] [Accepted: 07/29/2011] [Indexed: 10/17/2022]
Abstract
Pandemic (H1N1) 2009 influenza virus (pH1N1/09) infection spread rapidly around the globe, leading to a phase 6 pandemic level of alert declared in June 2009. The WHO declared the end of the pandemic in August 2010. Although for the majority of infected patients, it manifest as a mild, self-limiting illness, a proportion appeared to follow an adverse clinical course, requiring higher level care and aggressive management strategies. Experience with previous pandemics suggests that H1N1 will continue to circulate for many years. The aim of this review is to evaluate data from published case series reporting patients with pH1N1/09 influenza to identify clinical markers of severe disease. Comorbid illnesses including chronic lung disease, obesity and pregnancy have been shown to confer increased risk of severe infection. Admission vital signs, laboratory investigations and chest radiographic features can guide admitting clinicians to stratify patients' risk of severe disease, however, the currently available severity scoring tools have only a limited role in risk assessment. Knowledge of high risk parameters remains important for clinicians triaging patients with suspected pH1N1/09 influenza and to inform strategies for future pandemics.
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Affiliation(s)
- Anika Singanayagam
- Department of Respiratory Medicine, Barnet and Chase Farm Hospitals NHS Trust, London EN28JL, United Kingdom.
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Brett SJ, Myles P, Lim WS, Enstone JE, Bannister B, Semple MG, Read RC, Taylor BL, McMenamin J, Nicholson KG, Nguyen-Van-Tam JS, Openshaw PJM. Pre-admission statin use and in-hospital severity of 2009 pandemic influenza A(H1N1) disease. PLoS One 2011; 6:e18120. [PMID: 21541017 PMCID: PMC3081811 DOI: 10.1371/journal.pone.0018120] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 02/21/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Statins are drugs that are used to lower plasma cholesterol levels. Recently, contradictory claims have been made about possible additional effects of statins on progression of a variety of inflammatory disorders, including infections. We therefore examined the clinical course of patients admitted to hospital with 2009 pandemic influenza A(H1N1), who were or weren't taking statins at time of admission. METHODS A retrospective case-control study was performed using the United Kingdom Influenza Clinical Information Network (FLU-CIN) database, containing detailed information on 1,520 patients admitted to participating hospitals with confirmed 2009 pandemic influenza A(H1N1) infection between April 2009 and January 2010. We confined our analysis to those aged over 34 years. Univariate analysis was used to calculate unadjusted odds ratios (OR) and 95 percent confidence intervals (95%CI) for factors affecting progression to severe outcome (high dependency or intensive care unit level support) or death (cases); two multivariable logistic regression models were then established for age and sex, and for age, sex, obesity and "indication for statin" (e.g., heart disease or hypercholesterolaemia). RESULTS We found no statistically significant association between pre-admission statin use and severity of outcome after adjustment for age and sex [adjusted OR: 0.81 (95% CI: 0.46-1.38); n = 571]. After adjustment for age, sex, obesity and indication for statin, the association between pre-admission statin use and severe outcome was not statistically significant; point estimates are compatible with a small but clinically significant protective effect of statin use [adjusted OR: 0.72 (95% CI: 0.38-1.33)]. CONCLUSIONS In this group of patients hospitalized with pandemic influenza, a significant beneficial effect of pre-admission statin use on the in-hospital course of illness was not identified. Although the database from which these observations are derived represents the largest available suitable UK hospital cohort, a larger study would be needed to confirm whether there is any benefit in this setting.
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Affiliation(s)
- Stephen J Brett
- Centre for Peri-operative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, London, United Kingdom.
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