Clinical differences of influenza subspecies among hospitalized children

Abstract

Aim: Clinical findings, mortality, and morbidity rates differ among influenza subspecies. Awareness of these differences will lead physicians to choose the proper diagnostic and therapeutic strategies and to foresee possible complications. The aim of this study was to evaluate the clinical differences of influenza subspecies among hospitalized children. Material and Methods:Hospitalized children with proven influenza infection by polymerase chain reaction on nasopharyngeal swab specimens in our clinic, between December 2013 and March 2016, were enrolled. These children were divided into 3 groups as Influenza A/H1N1 (n=42), Influenza A/H3N2 (n=23), and Influenza B (n=35). Results:The median age of the children was 51.5 months (range, 3-204 months). The most common presenting symptoms were fever (n=83), cough (n=58), and difficulty in breathing (n=25). The most common non-respiratory findings were lymphadenopathy (n=18) and gastrointestinal system involvement (n=17). Sixty-two percent of the patients (n=62) had chronic diseases. H1N1 and H3N2 were significantly more common among patients with chronic neurologic disorders and renal failure, respectively. Leukopenia (n=32) and thrombocytopenia (n=22) were the most common pathologic laboratory findings. Neutropenia, elevated CRP levels, and antibiotic use were significantly more common among patients with H1N1 infection. Seven patients were transferred to the intensive care unit with diagnoses of acute respiratory distress syndrome (n=4), encephalitis (n=2), and bronchiolitis (n=1). Two patients with chronic diseases and H1N1 infection died secondary to acute respiratory distress syndrome.Conclusions: Influenza A/H1N1 infection represented more severe clinical disease. (Turk Pediatri Ars 2017; 52: 15-22)

Epidemiological and clinical characteristics of children hospitalized due to influenza A and B in the south of Europe, 2010–2016

“…Of these, more than three-quarters were infected with the influenza A virus, with the H1N1 pdm09 subtype being found in more than half the cases. The higher frequency of type A and, specifically, the H1N1 subtype, among cases admitted to the ICU, is in line with other published studies 1,21–23 . This suggests disease severity is associated with influenza A infection, as in our study, in which the three deaths were caused by influenza A, and two by subtype H1N1 pdm09.…”

“…1 who found that children with cancer were more susceptible to influenza B, and the study by Acar et al . 21 which found influenza B infection is more frequent in children with pulmonary, cardiac or immune system disorders.…”

Laboratory abnormalities in children with mild and severe coronavirus disease 2019 (COVID-19): A pooled analysis and review

“…Of interest, CRP was not found to be as frequently elevated in mild COVID-19 cases as would be expected, yielding a PPE of only 18%. In children hospitalized with influenza, the rate of elevated CRP ranges from 37 to 67%) [33]. In contrast, we found an elevation in PCT level of 26% PPE, suggesting the possibility of a secondary bacterial infection in children hospitalized with COVID-19 pneumonia.…”

“…In contrast, we found an elevation in PCT level of 26% PPE, suggesting the possibility of a secondary bacterial infection in children hospitalized with COVID-19 pneumonia. This is higher than that noted in children hospitalized with influenza, in which PCT elevations were noted in 6%-12% [33]. Importantly, bacterial and viral coinfections at the time of admission have been reported as being common in children with COVID-19 [24].…”

“…In influenza, leukopenia is common occurring in~1/3rd of hospitalized children. However, when compared to COVID-19, a similar rate of leukocytosis (3-10%) and neutropenia (14-26%) are observed in influenza [33].…”