Clinical and laboratory features distinguishing pandemic H1N1 influenza-related pneumonia from interpandemic community-acquired pneumonia in adults

Bewick, Thomas; Myles, Puja; Greenwood, Sonia; Nguyen‐Van‐Tam, Jonathan S; Brett, Stephen; Semple, Malcolm G; Openshaw, Peter; Bannister, Barbara; Read, Robert C.; Taylor, Bruce L.; McMenamin, Jim; Enstone, Joanne; Nicholson, Karl G.; Lim, Wei Shen

doi:10.1136/thx.2010.151522

Cited by 30 publications

(31 citation statements)

References 49 publications

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“…In addition, 10-30% of hospitalized patients required admission to ICUs and mechanical ventilation. (3,6,7) Radiographic findings were similar to those seen in cases of severe pneumonia. (4,8) Viral specimens from the lower respiratory tract (BAL fluid samples) are more reliable than are those of samples from the upper airway.…”

Section: Introductionsupporting

confidence: 66%

“…(12,13) Higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, lower PaO 2 /FiO 2 ratio, shock, hemodialysis, and Streptococcus pneumoniae infection are independent factors predicting death. (6,7,10,14) From the beginning of the epidemic, influenza A (H1N1) infection seemed to have a more severe course and worse outcomes than did infection with seasonal influenza A. In addition, the demographic profile of influenza A (H1N1) infection was younger, and it affected individuals with fewer comorbidities.…”

Section: Introductionmentioning

confidence: 99%

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Pneumonia associada a influenza A (H1N1)

et al. 2011

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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.

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Section: Introductionsupporting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Pneumonia associada a influenza A (H1N1)

et al. 2011

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“…and Franquet,21, 22 unless a formal radiograph report also stated ‘no pneumonia’.Chest radiograph report not provided, but specific mention in the clinical case notes that a radiograph had been formally reported as showing pneumonia. …”

Section: Methodsmentioning

confidence: 99%

Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09‐related pneumonia: an individual participant data meta‐analysis

Muthuri¹,

Venkatesan²,

Myles³

et al. 2016

Influenza Resp Viruses

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BackgroundThe impact of neuraminidase inhibitors (NAIs) on influenza‐related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection.MethodsA worldwide meta‐analysis of individual participant data from 20 634 hospitalised patients with laboratory‐confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) ‘pandemic influenza’. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids.ResultsOf 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95% CI 0·64–1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44–1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71–1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55–0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54–0·85; P = 0·001)].ConclusionsEarly NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support.

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“…Unlike seasonal influenza, seen in previous years, thrombocytopenia have been experienced in pandemic (H 1 N 1 ) influenza-A in some studies from Turkey and internationally (3,12,(16)(17)(18)(19). Leukopenia and lymphopenia, which is an indicator of viral infection, is a common finding in pandemic (H 1 N 1 ) influenza-A pneumonia (3,15). Cunha et al (20) have shown that lymphopenia, and thrombocytopenia may play a key role in the diagnosis of pandemic (H 1 N 1 ) influenza-A pneumonia in hospitalized cases.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, mortality rate may differ in ICU patients and was reported to vary between 15% and 62.5% according to the centers (4,23,24). However, in some studies, the mortality rate of pandemic (H 1 N 1 ) influenza-A pneumonia cases not requiring ICU support did not differ from that of CAP with no H 1 N 1 infection (3,15).…”

Section: H1n1mentioning

confidence: 99%