1
|
Minodier L, Charrel RN, Ceccaldi PE, van der Werf S, Blanchon T, Hanslik T, Falchi A. Prevalence of gastrointestinal symptoms in patients with influenza, clinical significance, and pathophysiology of human influenza viruses in faecal samples: what do we know? Virol J 2015; 12:215. [PMID: 26651485 PMCID: PMC4676820 DOI: 10.1186/s12985-015-0448-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/04/2015] [Indexed: 12/14/2022] Open
Abstract
This review provides for the first time an assessment of the current understanding about the occurrence and the clinical significance of gastrointestinal (GI) symptoms in influenza patients, and their correlation with the presence of human influenza viruses in stools of patients with confirmed influenza virus infection. Studies exploring how human influenza viruses spread to the patient’s GI tract after a primary respiratory infection have been summarized. We conducted a systematic search of published peer-reviewed literature up to June 2015 with regard to the above-mentioned aspects, focusing on human influenza viruses (A(H1N1), A(H1N1)pdm09, A(H3N2), and B). Forty-four studies were included in this systematic review and meta-analysis. The pooled prevalence of any digestive symptoms ranged from 30.9 % (95 % CI, 9.8 to 57.5; I2 = 97.5 %) for A(H1N1)pdm09 to 2.8 % (95 % CI, 0.6 to 6.5; I2 = 75.4 %) for A(H1N1). The pooled prevalence of influenza viruses in stool was 20.6 % (95 % CI, 8.9 to 35.5; I2 = 96.8 %), but their correlation with GI symptoms has rarely been explored. The presence of viral RNA in stools because of haematogenous dissemination to organs via infected lymphocytes is likely, but the potential to cause direct intestinal infection and faecal–oral transmission warrants further investigation. This review highlights the gaps in our knowledge, and the high degree of uncertainty about the prevalence and significance of GI symptoms in patients with influenza and their correlation with viral RNA positivity in stool because of the high level of heterogeneity among studies.
Collapse
Affiliation(s)
- Laetitia Minodier
- EA 7310, laboratory of virology, University of Corsica-Inserm, 20250, Corte, France.
| | - Remi N Charrel
- Aix Marseille Université, IRD French Institute of Research for Development, INSERM U1207, EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales", & IHU Méditerranée Infection, APHM Public Hospitals of Marseille, Marseille, France.
| | - Pierre-Emmanuel Ceccaldi
- Unité EPVO, Institut Pasteur, Paris-UMR CNRS 3569-Université Paris Diderot, Paris Sorbonne Cité, Cellule Pasteur, Paris, France.
| | - Sylvie van der Werf
- Unit of Molecular Genetics of RNA viruses, Institut Pasteur-UMR CNRS 3569-Université Paris Diderot-Sorbonne Paris Cité, Paris, France. .,Coordinating Center of the National Reference Center for influenza viruses, National Influenza Center (Northern-France), Institut Pasteur, Paris, France.
| | - Thierry Blanchon
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Paris, France. .,INSERM, UMR_S 1136, Paris, France.
| | - Thomas Hanslik
- INSERM, UMR_S 1136, Paris, France. .,Université Versailles Saint Quentin en Yvelines, UFR de Médecine Paris-Ile-de-France-Ouest, 9 boulevard d'Alembert, 78280, Guyancourt, France. .,Service de médecine interne, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, 92100, Boulogne Billancourt, France.
| | - Alessandra Falchi
- EA 7310, laboratory of virology, University of Corsica-Inserm, 20250, Corte, France.
| |
Collapse
|
2
|
Plataras C, Tsangouri S, Bourikas D, Christianakis E. Acute appendicitis in a child with swine influenza (H1N1). BMJ Case Rep 2015; 2015:bcr-2014-208219. [PMID: 25814027 DOI: 10.1136/bcr-2014-208219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Swine flu is a multisystemic disease and can affect the gastrointestinal system. There are only three published reports of swine flu cases with acute appendicitis; two of them in children under 16 years of age. We present an unusual case of acute appendicitis in a child already diagnosed with swine flu infection. A 9½-year-old girl presented with febrile illness and mild abdominal pain. PCR (+) was positive for H1N1. 3 days after hospital admission she developed acute appendicitis and was operated on. On the fourth postoperative day she developed right upper lobe atelectasis; she was started on antiviral treatment to which she responded very well. She was discharged on day 7 without further consequences in her postoperative course. Children with swine flu may be susceptible to rapidly deteriorating and complicated acute appendicitis. This calls for more caution especially in periods of epidemics.
Collapse
Affiliation(s)
- Christos Plataras
- Department of Paediatric Surgery, General Children's Hospital of Penteli, Athens, Attiki, Greece
| | - Sotiria Tsangouri
- Department of Paediatric Surgery, General Children's Hospital of Penteli, Athens, Attiki, Greece
| | - Dimitrios Bourikas
- Department of Paediatric Surgery, General Children's Hospital of Penteli, Athens, Attiki, Greece
| | - Efstratios Christianakis
- Department of Paediatric Surgery, General Children's Hospital of Penteli, Athens, Attiki, Greece
| |
Collapse
|
3
|
Vivar KL, Uyeki TM. Influenza virus infection mimicking an acute abdomen in a female adolescent. Influenza Other Respir Viruses 2014; 8:140-1. [PMID: 24373432 PMCID: PMC4186460 DOI: 10.1111/irv.12222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2013] [Indexed: 12/20/2022] Open
Abstract
We report an adolescent with respiratory symptoms admitted for clinical signs of an acute abdomen. The only diagnostic finding was influenza A viral RNA detected in an upper respiratory tract specimen. Influenza should be considered in the differential diagnosis of children with respiratory illness and abdominal pain during influenza season.
Collapse
Affiliation(s)
- Karina L Vivar
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | | |
Collapse
|