Clinical features of pneumonia caused by 2009 influenza A(H1N1) virus in Beijing, China - PubMed (original) (raw)

. 2011 May;139(5):1156-1164.

doi: 10.1378/chest.10-1036. Epub 2010 Sep 23.

Li Gu 1, Bin Cao 2, Xiao-Li Zhai 3, Min Lu 4, Yong Lu 5, Li-Rong Liang 5, Lei Zhang 3, Zi-Fen Gao 4, Ke-Wu Huang 5, Ying-Mei Liu 1, Shu-Fan Song 1, Lin Wu 1, Yu-Dong Yin 1, Chen Wang 6

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Clinical features of pneumonia caused by 2009 influenza A(H1N1) virus in Beijing, China

Lu Bai et al. Chest. 2011 May.

Abstract

Background: Data on symptoms and radiographic changes in patients with pandemic 2009 influenza A(H1N1) (A[H1N1]) pneumonia during convalescence have not been reported.

Methods: During October 26, 2009, and January 23, 2010, adult patients with pneumonia with laboratory-confirmed or clinically suspected A(H1N1) infections were observed for clinical characteristics, high-resolution chest CT scan, and lung function test changes during acute and 3-month convalescent phases.

Results: Of the 65 case subjects, the median age was 41 (interquartile range [IQR], 28-57) years, 60.0% were men, and 55.4% had at least one underlying medical condition. Sixty-two patients started oseltamivir therapy within a median of 5 (IQR, 4-6) days from the onset of illness, and 31 received IV corticosteroids. ARDS developed in 33 patients, and 24 were treated initially with noninvasive positive pressure ventilation (NPPV). In this group, NPPV was successful in 13 patients (54.2%). Nine patients died at a median of 16 (IQR, 10-24) days after onset of illness. Multivariate Cox regression identified two independent risk factors for death: progressive dyspnea after resolution of fever (relative risk, 5.852; 95% CI, 1.395-24.541; P = .016) and a higher APACHE (Acute Physiology and Chronic Health Evaluation) II score on presentation (relative risk for each point, 1.312; 95% CI, 1.140-1.511; P < .001). At 3-month follow-up of survivors with A(H1N1), ground-glass opacities were still present, although diminished, in 85.7%, and diffusing capacity for carbon monoxide was mildly reduced in 61.5%.

Conclusions: Ground-glass opacities and decreased diffusing capacity were the main abnormalities observed at 3-month follow-up of survivors of A(H1N1).

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Figures

Figure 1

Figure 1

Radiologic findings during follow-up of a 49-year-old male discharged patient with 2009 influenza A(H1N1) (A[H1N1]) (patient No. 5 in Table 4), who was treated successfully with oseltamivir and noninvasive positive pressure ventilation. A, Initial high-resolution CT (HRCT) scan obtained 12 days after onset of illness shows bilateral extensive ground-glass opacities (GGOs) and multifocal consolidation that had a predominant subpleural distribution. B, HRCT scan obtained 29 days after onset of illness shows GGOs, interlobular septal thickening, and reticular nodules pattern (arrows). C, On day 54, only GGOs are seen. D, At a 3-month visit, GGOs are still present but are much improved. E and F, The same scan as A shows centrilobular nodules in the left upper lobe (arrows in E) and a very small amount of right pleural effusion (arrow in F).

Figure 2

Figure 2

Histopathologic changes of lung tissue sample of one fatal case. A, Gross findings of right lung. B-E, Microscopic findings of the specimen (hematoxylin and eosin, original magnification × 100 [B, D] or original magnification × 400 [C, E]) show diffuse alveolar damage, formation of hyaline membrane, thickening of alveolar septa, and inflammatory cell infiltration with fibrinous exudates. F, The right lower lobe abscess shows Aspergillus spp hyphae microscopically (hematoxylin and eosin, original magnification × 100).

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