Are there any differences in clinical and laboratory findings on admission between H1N1 positive and negative patients with flu-like symptoms?
Tóm tắt
The World Health Organization alert for the H1N1 influenza pandemic led to the implementation of certain measures regarding admission of patients with flu-like symptoms. All these instructions were adopted by the Greek National Health System. The aim of this study was to retrospectively examine the characteristics of all subjects admitted to the Unit of Infectious Diseases with symptoms indicating H1N1 infection, and to identify any differences between H1N1 positive or negative patients. Patients from the ED (emergency department) with flu-like symptoms (sore throat, cough, rhinorhea, or nasal congestion) and fever >37.5°C were admitted in the Unit of Infectious diseases and gave pharyngeal or nasopharyngeal swabs. Swabs were tested with real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR). Patients were divided into two groups. Group A comprised 33 H1N1 positive patients and Group B (control group) comprised of 27 H1N1 negative patients. The two groups did not differ in terms of patient age, co-morbidities, length of hospitalization, temperature elevation, hypoxemia, as well as renal and liver function. There were also no significant differences in severity on admission. C-reactive protein (CRP) (mean 12.8 vs. 5.74) and white blood count (WBC) (mean 10.528 vs. 7.114) were significantly higher in group B than in group A upon admission. Obesity was noted in 8 patients of Group A (mean 31.67) and 14 patients of Group B (mean 37.78). Body mass index (BMI) was lower in H1N1 positive than in H1N1 negative patients (mean 31.67 vs. 37.78, respectively; p = 0.009). The majority of patients in both groups were young male adults. CRP, WBC and BMI were higher among H1N1 negative patients. Finally, clinical course of patients in both groups was mild and uneventful.
Tài liệu tham khảo
Naffakh N, van der Werf SV: April 2009: an outbreak of swine-origin influenza A (H1N1) virus with evidence for human-to-human transmission. Microbes Infect. 2009, 11: 725-728. 10.1016/j.micinf.2009.05.002.
Influenza A (H1N1) -- update 14. 2009, Geneva: World Health Organization, Accessed November 30, 2009, [http://www.who.int/csr/don/2009_05_04a/en/index.html]
Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team, Dawood FS, Jain S, Finelli L, Shaw MW, Lindstrom S, Garten RJ, Gubareva LV, Xu X, Bridges CB, Uyeki TM: Novel Swine-Origin Influenza A (H1N1)Virus Investigation Team. Emergence of a novel swine-origin influenza A (H1N1)virus in humans. N Engl J Med. 2009, 360: 2605-15. 10.1056/NEJMoa0903810.
World Health Organization. Pandemic (H1N1) 2009--update 69. 2009, [http://www.who.int/csr/don/2009_10_09/en/]
Centers for Disease Control and Prevention (CDC): Update: infections with a swine-origin influenza A (H1N1) virus-United States and other countries, April 28, 2009. MMWR Morb Mortal Wkly Rep. 2009, 58: 431-433.
Cao B, Li XW, Mao Y, Wang J, Lu HZ, Chen YS, Liang ZA, Liang L, Zhang SJ, Zhang B, Gu L, Lu LH, Wang DY, Wang C, National Influenza A Pandemic (H1N1) 2009 Clinical Investigation Group of China: Clinical Features of the Initial Cases of 2009 Pandemic Influenza A (H1N1) Virus Infection in China. N Engl J Med. 2009, 361: 2507-2517. 10.1056/NEJMoa0906612.
Louria DB, Blumenfeld HL, Ellis JT, Kilbourne ED, Rogers DE: Studies on influenza in the pandemic of 1957-1958. II. Pulmonary complications of influenza. J Clin Invest. 1959, 38: 213-265. 10.1172/JCI103791.
Ng WF, To KF, Lam WW, Ng TK, Lee KC: The comparative pathology of severe acute respiratory syndrome and avian influenza A subtype H5N1--a review. Hum Pathol. 2006, 37: 381-390. 10.1016/j.humpath.2006.01.015.
Sprenger MJ, Mulder PG, Beyer WE, Van Strik R, Masurel N: Impact of influenza on mortality in relation to age and underlying disease, 1967-1989. Int J Epidemiol. 1993, 22: 334-340. 10.1093/ije/22.2.334.
Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R: The American-European consensus conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994, 149: 818-824.
CDC protocol of realtime RTPCR for swine influenza A (H1N1). 2009, Geneva: World Health Organization, Accessed November 30th, 2009, [http://www.who.int/csr/resources/publications/swineflu/CDCrealtimeRTPCRprotocol-20090428.pdf]
Newman AP, Reisdorf E, Beinemann J, Uyeki TM, Balish A, Shu B, Lindstrom S, Achenbach J, Smith C, Davis JP: Human case of swine influenza (H1N1) triple reassortant virus infection, Wisconsin. Emerg Infect Dis. 2008, 14: 1470-1472. 10.3201/eid1409.080305.
Taubenberger JK, Reid AH, Lourens RM, Wang R, Jin G, Fanning TG: Characterization of the 1918 influenza virus polymerase genes. Nature. 2005, 437: 889-893. 10.1038/nature04230.
United States Centers for Disease Control and Prevention: Interim Recommendations for Clinical Use of Influenza Diagnostic Tests During the 2009-10 Influenza Season. [http://www.cdc.gov/h1n1flu/guidance/diagnostic_tests.htm]
WHO Guidelines on the Use of Vaccines and Antivirals During Influenza Pandemics. 2004, Geneva, World Health Organization, Accessed: November 17, 2005, [http://www.who.int/csr/resources/publications/influenza/11_29_01_A.pdf]
Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, Coley CM, Marrie TJ, Kapoor WN: A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997, 336: 243-250. 10.1056/NEJM199701233360402.
Myers KP, Olsen CW, Gray GC: Cases of swine influenza in humans: a review of the literature. Clin Infect Dis. 2007, 44: 1084-1088. 10.1086/512813.
Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, Hernandez M, Quiñones-Falconi F, Bautista E, Ramirez-Venegas A, Rojas-Serrano J, Ormsby CE, Corrales A, Higuera A, Mondragon E, Cordova-Villalobos JA: Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med. 2009, 361: 680-689. 10.1056/NEJMoa0904252.
Flood RG, Badik J, Aronoff SC: The Utility of Serum C-Reactive Protein in Differentiating Bacterial from Nonbacterial Pneumonia in Children: A Meta-Analysis of 1230 Children. Infect Dis J. 2008, 27: 95-99.
George EL, Panos A: Does a high WBC count signal infection?. Nursing. 2005, 35 (1): 20-2.
Pablo Ortega-Deballon, Radais Francois, Facy Olivier, Philipped` Athis, Masson David, Charles Pierre E, Cheynel Nicolas, Favre Jean-Pierre, Patrick Rat: C-Reactive protein is an early predictor of septic complications after elective colorectal surgery. World Journal of Surgery. 2010, 34 (4): 808-14. 10.1007/s00268-009-0367-x.
Riquelme R, Riquelme M, Rioseco ML, Inzunza C, Gomez Y, Contreras C, Riquelme J, Peyrani P, Wiemken T, Ramirez J: Characteristics of hospitalised patients with 2009 H1N1 influenza in Chile. Eur Respir J. 2010, 36: 864-869. 10.1183/09031936.00180409.
Lee Warren, Slutsky Arthur, Mason MD: Murray & Nadel's Textbook of Respiratory Medicine. Copyright© 2005 Saunders, An Imprint of Elsevier, 4
WHO Global Database on Body mass Index. [http://apps.who.int/bmi/index.jsp?introPage=intro_3.html]
Simonsen L, Clarke MJ, Williamson GD, Stroup DF, Arden NH, Schonberger LB: The impact of influenza epidemics on mortality: introducing a severity index. Am J Public Health. 1997, 87: 1944-1950. 10.2105/AJPH.87.12.1944.
Morens DM, Taubenberger JK, Fauci AS: Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness. J Infect Dis. 2008, 198: 962-970. 10.1086/591708.
World Health Organization: Transcript of statement by Margaret Chan, Director General of the World Health Organization. pdf Date last accessed: August 3, 2010. Date last updated: June 11, 2009, [http://www.who.int/mediacentre/influenzaAH1N1_presstranscript_20090611]
World Health Organization. Pandemic (H1N1) 2009. Date last accessed: August 3, 2010. Date last updated: July 31, 2009, [http://www.who.int/csr/don/2009_08_04/en/index.html]
Jain S, Kamimoto L, Bramley AM: Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. N Engl J Med. 2009, 361: 1935-1944. 10.1056/NEJMoa0906695.
Centers for Disease Control and Prevention: Intensive-care patients with severe novel influenza A (H1N1) virus infection--Michigan, June 2009. MMWR Morb Mortal Wkly Rep. 2009, 58: 749-752.
Mangtani P, Cumberland P, Hodgson CR, Roberts JA, Cutts FT, Hall AJ: A cohort study of the effectiveness of influenza vaccine in older people performed using the United Kingdom General Practice Research Database. J Infect Dis. 2004, 190: 1-10. 10.1086/421274.
Uhnoo I, Linde A, Pauksens K, Lindberg A, Eriksson M, Norrby R: Treatment and prevention of influenza: Swedish recommendations. Scand J Infect Dis. 2003, 35: 3-11. 10.1080/0036554021000026999.
Influenza Bautista E, Chotpitayasunondh T, Gao Z, Harper SA, Shaw M, Uyeki TM, Zaki SR, Hayden FG, Hui DS, Kettner JD, Kumar A, Lim M, Shindo N, Penn C, Nicholson KG, Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009: Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection. N Engl J Med. 2010, 362 (21): 2039-
Kaiser Laurent, Wat Cynthia, Mills Tracy, Mahoney Paul, Ward Penelope, Hayden Frederick: Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations. Arch Intern Med. 2003, 163: 1667-1672. 10.1001/archinte.163.14.1667.
Hak E, Verheij TJ, Grobbee DE, Nichol KL, Hoes AW: Confounding by indication in nonexperimental evaluation of vaccine effectiveness: the example of prevention of influenza complications. J Epidemiol Community Health. 2002, 56: 951-955. 10.1136/jech.56.12.951.