Severe Pneumonia Caused by a Novel Influenza A (H1N1) Virus in an Asymptomatic Emphysematous Smoker

Ozawa, Hideki; Asai, Satoshi; Gui-lan, Jin; Hasunuma, Yuya; Tanaka, Chiharu; Ikeda, Takayuki; Kimura, Moritsugu; Ueda, Akihiro; Yamashita, Tomohiro; Miyachi, Hayato

doi:10.2169/internalmedicine.49.3293

Cited by 2 publications

(1 citation statement)

References 15 publications

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“…Therefore, the malnutrition observed in the present study might have caused immune-deficient conditions in combination with lymphocytopenia, which is associated with respiratory bacterial and viral infection and the subsequent development of COPD exacerbation. 11,28,29 The mean BMI that we reported in the present study (22 kg/m 2 ) was lower than that reported in Western patients with COPD (27 kg/m 2 ) 15,16 and consistent with the values reported in Japan (22-23 kg/m 2 ). 17,18 Furthermore, the proportion of patients with low BMI (<20 kg/m 2 ) in the present study (27.2%) was higher than that among Western patients with COPD (9.5%).…”

Section: Discussionsupporting

confidence: 91%

<p>Malnutrition, Airflow Limitation and Severe Emphysema are Risks for Exacerbation of Chronic Obstructive Pulmonary Disease in Japanese Subjects: A Retrospective Single-Center Study</p>

Yamaya¹,

Usami²,

Nakayama³

et al. 2020

COPD

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Background: Different characteristics of patients with chronic obstructive pulmonary disease (COPD) between Western and Japanese populations have been reported. Risk factors for COPD exacerbation have been reported in Western countries but have not been studied in Japan. Patients and Methods: We retrospectively examined risk factors for COPD exacerbation. A total of 156 Japanese patients were enrolled, and the records of 136 patients were analyzed. Results: In the exacerbation group (n=60), body mass index, forced vital capacity (FVC), forced expiratory volume in one second (FEV 1), the FEV 1 /FVC ratio (FEV 1 /FVC), the percent predicted values of FEV 1 (%FEV 1), and serum total protein (TP) and albumin concentrations were lower, and age, mortality rate, frequency of common cold and pneumonia, COPD severity rankings, modified Medical Research Council (mMRC) dyspnea score, and proportions of patients with severe emphysema (>50% of low attenuation area) and receiving long-term oxygen therapy were higher than those in the nonexacerbation group (n=76). However, the proportion of patients with a greater number of eosinophils (≥200/μL and/or ≥2%) and the exhaled nitric oxide concentration did not differ between the two groups. In the univariate analysis, the risk factors for exacerbation were age; long-term oxygen therapy; low FVC, FEV 1 , FEV 1 /FVC and %FEV 1 ; high COPD severity ranking and mMRC score; severe emphysema; hypoproteinemia (<6.5 g/ dL); hypoalbuminemia (<3.5 g/dL); leukocytosis; lymphocytopenia; and anemia. In the multivariate analysis, the risk factors were hypoalbuminemia, hypoproteinemia and low FEV 1. Additionally, in patients in the exacerbation-induced mortality subgroup, age, exacerbation frequency, mMRC score and the proportion of patients with lymphocytopenia were higher, and FVC, %FVC, FEV 1 , serum TP concentration and the lymphocyte number were lower than those in the exacerbation survival subgroup. Conclusion: Malnutrition, airflow limitation and severe emphysema were risks for exacerbation and mortality associated with infection in Japanese patients with COPD.

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Section: Discussionsupporting

confidence: 91%

<p>Malnutrition, Airflow Limitation and Severe Emphysema are Risks for Exacerbation of Chronic Obstructive Pulmonary Disease in Japanese Subjects: A Retrospective Single-Center Study</p>

Yamaya¹,

Usami²,

Nakayama³

et al. 2020

COPD

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A Case of Severe Influenza (H1N1) 2009 Virus Pneumonia Identified by Virus Culture Instead of PCR

et al. 2011

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A 70-year-old man was being treated for asthma and chronic obstructive pulmonary disease, which had been well controlled. He was seen at our emergency outpatient department on October 24, 2009, for respiratory distress and mild fever. Point-of-care testing for influenza, general bacteria, and acid-fast bacilli in the sputum, were negative. With antibiotics ineffective, his respiratory status worsened, requiring him to be intubated and ventilated mechanically. Steroid pulse therapy temporarily improved his condition, as confirmed by imaging studies, but he died on hospital day 38. Polymerase chain reaction (PCR) analysis of tracheal secretion and bronchial washings collected on hospital day 14 and 21 were negative for influenza (H1N1) 2009 virus, which was identified in a subsequent culture. Negative results for reverse transcriptase-PCR analysis leave (H1N1) 2009 virus unable to be diagnosed clinically. Culture tests and repeated PCR analysis have been done in cases of strongly suspected clinical infection to confirm results. Our case, in which the virus was identified by culture, suggests that the viral load may have been too low or the time of culture inappropriate.

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Severe Pneumonia Caused by a Novel Influenza A (H1N1) Virus in an Asymptomatic Emphysematous Smoker

Cited by 2 publications

References 15 publications

<p>Malnutrition, Airflow Limitation and Severe Emphysema are Risks for Exacerbation of Chronic Obstructive Pulmonary Disease in Japanese Subjects: A Retrospective Single-Center Study</p>

<p>Malnutrition, Airflow Limitation and Severe Emphysema are Risks for Exacerbation of Chronic Obstructive Pulmonary Disease in Japanese Subjects: A Retrospective Single-Center Study</p>

A Case of Severe Influenza (H1N1) 2009 Virus Pneumonia Identified by Virus Culture Instead of PCR

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