Virus-associated hemophagocytic syndrome as a major contributor to death in patients with 2009 influenza A (H1N1) infection

Beutel, Gernot; Wiesner, Olaf; Eder, Matthias; Hafer, Carsten; Schneider, Andrea; Kielstein, Jan T.; Kühn, Christian; Heim, Albert; Ganzenmüller, Tina; Kreipe, Hans-Heinrich; Haverich, Axel; Tecklenburg, A.; Ganser, Arnold; Welte, Tobias; Hoeper, Marius M.

doi:10.1186/cc10073

Cited by 93 publications

(85 citation statements)

References 32 publications

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“…This is thought to be related with cell migration from the circulation to the infected respiratory mucosa during infection (25). It has been reported that hemaphagocytosis, which develops during influenza infection, causes reduction in bone marrow cell series (26). In our study, the most commonly observed abnormal laboratory findings included leukopenia and thrombocytopenia, in accordance with the literature.…”

Section: Discussionsupporting

confidence: 79%

Clinical differences of influenza subspecies among hospitalized children

Acar¹,

Sütçü²,

Aktürk³

et al. 2017

Turk Pediatri Ars

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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)

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Section: Discussionsupporting

confidence: 79%

Clinical differences of influenza subspecies among hospitalized children

Acar¹,

Sütçü²,

Aktürk³

et al. 2017

Turk Pediatri Ars

View full text Add to dashboard Cite

show abstract

“…In the only prospective observational study that has been done in patients with VAHS secondary to influenza A H1N1 infection [14], 9 out of 25 critically ill patients with influenza infection presented hemophagocytic syndrome. The median age of these 9 patients was 53 years (39 to 56), 7 were male, and 5 patients (56%) had an underlying comorbid condition associated with a severe course of illness.…”

Section: Resultsmentioning

confidence: 99%

“…Only English language papers were reviewed. This search revealed 15 other cases of adults with influenza A associated HPS [5][6][7][8][9][10][11][12][13] and a prospective observational study carried out in 25 critically ill patients with VAHS secondary to influenza H1N1 which was not included in the analysis because of incomplete individual patient data [14].…”

Section: Methodsmentioning

confidence: 99%

“…Unfortunately, treatment was never started in many cases because of delayed diagnosis. In the study by Beutel et al [14], the median time from the onset of symptoms to the diagnosis of VAHS was 23 days (interquartile range [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. This could explain, at least in part, the poor prognosis of HPS secondary to influenza A infection.…”

Section: Comorbidities/ Co-morbid Infectionsmentioning

confidence: 99%

“…In the case of avian influenza and influenza H1N1 associated hemophagocytic syndrome, the mortality is around 50%-89% [1,14,21]. Because of the high mortality observed in HPS secondary to influenza A infection, we believe it is crucial to make an early diagnosis and start antiviral and immunomodulatory treatment as soon as possible.…”

Section: Comorbidities/ Co-morbid Infectionsmentioning

confidence: 99%

See 2 more Smart Citations

Influenza-Associated Hemophagocytic Syndrome in Adults: Case Report and Review

Trujillo¹,

Lalueza²,

Blanco³

et al. 2018

J Antivir Antiretrovir

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ATO (Arsenic Trioxide) Effects on Promyelocytic Leukemia Nuclear Bodies Reveals Antiviral Intervention Capacity

et al. 2020

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Human adenoviruses (HAdV) are associated with clinical symptoms such as gastroenteritis, keratoconjunctivitis, pneumonia, hepatitis, and encephalitis. In the absence of protective immunity, as in allogeneic bone marrow transplant patients, HAdV infections can become lethal. Alarmingly, various outbreaks of highly pathogenic, pneumotropic HAdV types have been recently reported, causing severe and lethal respiratory diseases. Effective drugs for treatment of HAdV infections are still lacking. The repurposing of drugs approved for other indications is a valuable alternative for the development of new antiviral therapies and is less risky and costly than de novo development. Arsenic trioxide (ATO) is approved for treatment of acute promyelocytic leukemia. Here, it is shown that ATO is a potent inhibitor of HAdV. ATO treatment blocks virus expression and replication by reducing the number and integrity of promyelocytic leukemia (PML) nuclear bodies, important subnuclear structures for HAdV replication. Modification of HAdV proteins with small ubiquitin‐like modifiers (SUMO) is also key to HAdV replication. ATO reduces levels of viral SUMO‐E2A protein, while increasing SUMO‐PML, suggesting that ATO interferes with SUMOylation of proteins crucial for HAdV replication. It is concluded that ATO targets cellular processes key to HAdV replication and is relevant for the development of antiviral intervention strategies.

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Virus-associated hemophagocytic syndrome as a major contributor to death in patients with 2009 influenza A (H1N1) infection

Cited by 93 publications

References 32 publications

Clinical differences of influenza subspecies among hospitalized children

Clinical differences of influenza subspecies among hospitalized children

Influenza-Associated Hemophagocytic Syndrome in Adults: Case Report and Review

ATO (Arsenic Trioxide) Effects on Promyelocytic Leukemia Nuclear Bodies Reveals Antiviral Intervention Capacity

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