Rhabdomyolysis Associated With 2009 Influenza A(H1N1)

Abstract

Zhou et al state that "recent evidence-based recommendations for the management of patients with herpes zoster recommend using antiviral therapy to decrease the incidence of PHN," citing an article for which I am a coauthor. 4 This article stated that antiviral therapy should be used to treat patients with herpes zoster and that it had an impact on acute neuritis. Although the guidelines concluded that the use of antiviral therapy may have an effect on "chronic pain," this therapy was not sufficient to uniformly prevent PHN. As noted here, the FDA reached a similar conclusion.The goal of management of herpes zoster is to accelerate healing, prevent complications, and decrease pain-both acute pain and PHN. With the evidence available from existing antiviral studies, these end points have been achieved with the exception of prevention of PHN. The management of PHN is of critical importance for individuals who have herpes zoster. Consideration of combination therapy at the onset of disease, particularly in patients with severe acute pain, needs to be further evaluated. 4 Future treatment strategies may prevent or provide more significant relief for this potentially devastating complication.

Clinical Analysis in Influenza A (H1N1) Virus Patients

“…A striking feature observed in this cohort of patients was the high frequency of systemic involvement with laboratory evidence of myositis/rhabdomyolysis, elevated acute-phase reactants. Myositis (with or without rhabdomyolysis) has previously been associated with influenza infections [10]. Elevation of LDH, CPK levels has been reported for patients with seasonal influenza but may not be considered a specific marker of severity.…”

Acute Kidney Injury due to Rhabdomyolysis in H1N1 Influenza Infection

“…5 In contrast to elevation of CPK levels in the course of H1N1 infection, only eight cases of rhabdomyolysis were reported since 2009 by Medline research. 1,[6][7][8][9][10][11][12][13] Three of these cases were reported from pediatric population and all cases of AKI were improved with supportive treatment. The ages of the other cases were between 17 and 57 years.…”

2009 Influenza A Infection and Acute Kidney Injury: Incidence, Risk Factors, and Complications

“…Acute kidney injury (AKI) requiring renal replacement therapy (RRT) has also been independently associated with poor outcome in these patients [8,9,11,13,14,15]. Several mechanisms for renal injury have been implicated in subjects with influenza A infection, including pigment injury due to elevations in creatine kinase (CK), hemodynamic effects, and/or direct effect of the H1N1 virus on the kidney [14,16,17,18,19,20]. The confluence of these risk factors may result in higher incidence of AKI in these patients; however, the true incidence of renal impairment and other metabolic abnormalities have not been examined, and previous reports were limited to critically ill patients.…”