Pneumonia associada a influenza A (H1N1)

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.

Pulmonary function in patients with pandemic H1N1

“…In and international study with 27 patients, 55.55% presented comorbidities, being the most frequent lung diseases, diabetes and dementia (19). The present study found that 54.54% of the patients had associated comorbidities, the most present being systemic arterial hypertension and diabetes.…”

“…The group evaluated through this research did not present direct relations between Spirometry and associated comorbidities, had a BMI of >40kg/m². On the other hand, Nicolini et al (19) found only 2 overweight patients out of the 27 evaluated.…”

“…Permanence in hospital raises the risk of complications, studies like those of Nicolini et al (19) and Luyt et al (26) present the pro ile of patients who remained in ICU under mechanical ventilation. Our patients remained on average 12.27 (± 9.05) days hospitalized in different units, only 3 of which in ICU, however all needed extra oxygen supply.…”

Influenza A (H1N1) pneumonia: HRCT findings

“…Gastrointestinal symptoms, such as nausea, vomiting, and diarrhea, have also been reported. ( 4 - 6 ) In most cases, the symptoms are mild and run a self-limiting course; however, a small proportion of individuals develop a severe course, which can result in respiratory failure and death. ( 4 , 7 - 10 ) …”

“…The most common laboratory test findings include increased serum lactate dehydrogenase levels (which can exceed 1,000 IU/L), bearing in mind that elevated lactate dehydrogenase levels are significantly associated with disease severity and ICU admission ( 6 , 11 ) ; increased C-reactive protein levels; increased serum creatine kinase levels; lymphopenia; and thrombocytopenia. Elevated transaminase and D-dimer levels can occur in some patients.…”