【Abstract】 Objective To analyze the lung pathological features of type A H1N1 influenza and respiratory failure. Methods The data of imaging and aspiration lung biopsy of five patients with type A H1N1 influenza and respiratory filure since October 2009 were retrospectively analyzed. Results Common clinical manifestations of patients with type A H1N1 influenza and respiratory failure were rapid progress of illness after common cold-like symptoms with high fever, dyspnea, severe hypoxemia, large amounts of bloody sputum, wet rales over both lungs, and with other organs involved or even septic shock. Early lung pathological features were inflammatory exudate in alveoli and lung interstitium, infiltration of inflammatory cells, and extensive hemorrhage. Middle and late pathological features were hyperplasia of alveolar epithelial,disconnection of alveolar septa, replaced of alveolar spaces by fibrosis. Conclusions The pathology of patients with type A H1N1 influenza and respiratory failure is similiar with ARDS. Development of treatment strategies targeted to pathological characteristics of ARDS caused by type A H1N1 influenza is of greatsignificance for effective and timely treatment.
Objective To investigate the clinical characteristics of patients with sever H1N1 influenza in Xinjiang region, and analyze risk factors related to patients’prognosis. Methods 63 patients with severe H1N1 influenza from September 2009 to December 2009, who came from five general hospitals and contagious disease hospitals were retrospectively studied. Data of baseline characteristics, treatment, and outcomes were collected. Results Among the 63 cases of severe H1N1 influenza patients, 46 patients survived, in which 30 cases were complicated with pneumonia( 63. 8% ) , 10 cases with MODS ( 43. 48% ) ;26 were male,20 were female; the median age was ( 28. 48 ±19. 59) years old.17 patients died, in which 11 were male, 6 were female; the median age was ( 39. 47 ±21. 23) years old. There were no significantdifferences in white blood cells, neutrophils, granulocytes, lymphocytes, Hb, platelets, CK-MB, HB, DH, UN,APTT, INR, K+ , Na+ , Cl - , PaO2 , SaO2 between the survival patients and the died patients ( P gt; 0. 05) .However there were significant differences in AST, ALT, CK, LDH, AL, CR, and pH ( P lt; 0. 05) .Conclusions Most of the patients with sever H1N1 influenza are young. The typical clinical manifestations are fever, cough, and expectoration. The patients usually are complicated with pneumonia. The patients complicated with MODS have a higher risk of death. Early administration of effective antiviral agents, low dose corticosteroids, and reasonable mechanical ventilation may improve the prognosis.
Objective To investigate the clinical characteristics and treatment of severe H1N1 influenza during pregnancy and postpartum.Methods Clinical data of 7 pregnant women and 2 postpartum women with severe H1N1 influenza admitted from October to December 2009 were reviewed. Results Three pregnant women underwent caesarean section during hospitalization. The main symptoms included fever ( in9 cases, and fever lasted more than 3 days in 7 cases) , cough and sputum ( in 9 cases) , and dyspnea ( in 7 cases) . Asthenia and muscular soreness were not serious, and there were no accompanying symptoms of digestive tract. Moist rales were heard in 5 cases. White blood cell count decreased in 3 cases, neutrophils increased in 6 cases, and lymphocytes reduced in 7 cases. Hepatic enzymes were abnormal in 4 cases, and myocardial enzymes were abnormal in5 cases. 8 patients had hypoxemia, with PaO2 less than 40 mmHg in5 cases. Chest X-ray films and CT showed double pneumonia in 9 patients. 9 patients were given oseltamivir antiviral treatment. 8 cases were given antibiotic therapy. 5 patients with bilateral severe pneumonia and respiratory failure were given corticosteriod therapy. 5 severe patients were treated with non-invasive ventilation. One case switched to invasive ventilation and eventually died. Conclusions Pregnant and postpartum women with influenzaH1N1 are likely to develop into severe condition which is commonly rapidlyprogressive and even life-threatening. The main causes of death are pneumonia and acute respiratory distress syndrome.
Objective To explore the clinical characteristics of patients with severe pandemic H1N1 Influenza in Sichuan and risk factors related to patients’ prognosis. Methods We observed 135 severe patients who came to hospitals for pandemic H1N1 Influenza from 12 cities in Sichuan, China,between September 12, 2009 to December 14, 2009, and described their baseline characteristics, treatment,and outcomes. A stepwise multiple Logistic-regression analysis was used to evaluate the independentpredictors of death. Results Of the 135 patients we studied, 86 patients were male. The average age was ( 28. 2 ±19. 3) years old, while patients between 19 to 45 years of age accounted for 47. 4% . 96 patients ( 71. 1% ) presented with fever. 51 patients( 37. 8% ) had comorbid conditions. The most frequent organdysfunction was seen in lung ( 71. 1% ) , liver( 27. 4% ) and cardia( 24. 4%) ; 130 patients( 96. 3% ) had received oseltamivir, 26 patients ( 19. 3% ) required mechanical ventilation. 12 of the 135 patients died.Compared with the survivors, patients who died were more likely to have a higher age, lower average bloodpressure when admitted, more organ dysfunction, and more likely to have cardia or nervous system dysfunction. The nonsurvivors also seemed to have less opportunity to be exposed to neuraminidase inhibitors, and have more demand for mechanical ventilation. The P value were all under 0. 05. The multipleLogistic-regression analysis showed the independent predictors of death were the average blood pressure when admitted and the demand for mechanical ventilation . The P value were both under 0. 05. The OR value was 0. 86(95% CI 0. 002-0. 936) and 13. 86( 95% CI 1. 146-16. 583) , respectively. Conclusions For these severe patients with pandemic H1N1 Influenza we study, the male patients are more than female. Most patients are between 19 to 45 years of age. The most frequent organ dysfunction is seen in lung, liver and cardia. The mortality of these patients is 8. 9% . Compared with the survivors, patients who died were morelikely to have a higher age, lower average blood pressure when admitted, more organ dysfunction, and more likely to have cardia ornervous systemdysfunction. The nonsurvivors also seemed to have less opportunity to be exposed to neuraminidase inhibitors, and more demand for mechanical ventilation. The multiple Logisticregression analysis showed the independent predictors of death are the average blood pressure and the demand for mechanical ventilation. The OR value is 0. 86 ( 95% CI 0. 002-0. 936) and 13. 86 ( 95% CI1. 146-16. 583) respectively.
ObjectiveTo analyze the clinical features, laboratory examination, imaging findings, treatment and outcome of influenza A H1N1 virus infection in China, so as to improve the clinicians' understanding of the disease.MethodsOne patient with influenza A H1N1 pneumonia was reported in this hospital. The databases of CNKI, VIP network and Wanfang data were systematically consulted. After removing the duplicate and deleting the incomplete literature published between January 1989 and August 2019, 62 literatures were included, involving 880 patients. Hence, 881 patients in total were included. The clinical manifestations, laboratory examination, imaging manifestations, treatment and prognosis were analyzed.ResultsThere were 477 males and 404 females, aged from 50 days to 86 years old, with an average age of (20.4 ±10.0) years. The most common clinical symptoms were fever (99.4%, 876/881), followed by cough (85.0%, 749/881), expectoration (38.1%, 336/881), sore throat (37.0%, 326/881) and dyspnea (33.7%, 297/881), asthenia and general pain (33.5%, 295/881) and so on. Laboratory examination in the leukocyte decreased in 249 patients (28.3%), neutrophil increased in 143 patients (16.2%) and leukocyte increased in 141 patients (16.0%). Myocardial injury was found in 370 patients (42.0%), liver injury in 303 patients (34.4%) and renal insufficiency in 84 patients (9.5%). The main imaging manifestations were spotted, patchy or flaky shadows (41.8%, 362/866) in varying degrees, with consolidation shadows (19.3%, 167/866), thickening of lung texture (11.3%, 98/866), ground glass shadows (4.5%, 39/866), and pleural effusion (5.5%, 48/866). The most common treatments were anti-virus, anti-infection, anti-inflammation, mechanical ventilation and symptomatic support. Comprehensive treatment resulted good effects. There were 37 deaths and the mortality rate was 4.2%. The main cause of death was respiratory failure.ConclusionsInfluenza A H1N1 virus infection is a preventable, controllable and treatable infectious disease, which is similar to the general influenza virus. After active comprehensive treatment, most of the influenza A (H1N1) can be cured and the prognosis is benign.
ObjectiveTo analyze risk factors, clinical features and outcome factors of invasive pulmonary aspergillosis (IPA) in severe H1N1 patients so as to achieve early diagnosis and improve prognosis.MethodsFifty severe H1N1 influenza patients with IPA admitted to West China Hospital and 64 severe H1N1 influenza patients in the same period matched by age and gender were collected. Patient characteristics, laboratory examinations, radiological imaging, microbiology data and prognostic indicators were involved into analysis.ResultsThe mortality of severe H1N1 influenza patients with IPA was significantly higher than those without IPA (51.6% vs. 32.0%, P=0.036). However, the incidence of IPA in severe H1N1 influenza patients was not related with the patient's age, gender, underlying disease, glucocorticoid use and CD4+ T cell count. Serum C-reactive protein level [(125.0±88.8) vs. (86.1±80.1) mg/L, P=0.038] and interleukin-6 level [(148.7±154.2) vs. (81.7±110.2) μg/L, P=0.039] of severe H1N1 influenza patients with IPA were significantly higher than those without IPA. Besides, more patients presented with fever (81.3% vs. 64.0%, P=0.038) and dyspnea (51.6% vs. 24.0%, P=0.003) in severe H1N1 patients with IPA. The radiological imaging of severe H1N1 patients with IPA were mostly characterized by combining with nodular changes on the basis of ground-glass opacity.ConclusionThe occurrence of IPA in severe H1N1 influenza patients may be related with pulmonary excessive inflammatory response secondary to viral invasion rather than basic condition of the patient.
Objective To analyze the clinical characteristics and the treatment of 20 confirmed A/H1N1 flu cases of serious conditions. Methods The 20 confirmed A/H1N1 flu cases of serious conditions were collected and we analyzed their Clinical characteristics, treatment and prognosis. Results The 20 cases of serious conditions were given Oseltamivir, endotrachealintubation, ventilator ventilator assistant, high dose intravenous injection of Gamma-globulin/ albuminum/plasam of A/H1N1 flu rehabilitation, appropriate liquid recovery and hypothermic treatment, etc. A total of 19 of 20 confirmed A/H1N1 flu cases of serious conditions were cured and 1 case died. Conclusion The intent observation, early detection and early intervention are very helpful for A/H1N1 flu cases of serious conditions.
Objective To analyze the clinical features and treatment of severe H1N1 influenza.Methods The clinical data of 34 patients with severe H1N1 influenza admitted to intensive care unit from October to December 2009 were reviewed. Results The patients aged 3 months to 60 years with an average of ( 13. 9 ±4. 5) years, of which 24 patients were younger than 7 years old. Fever( 30 cases) , cough( 32 cases) , progressive shortness of breath( 19 cases) were the main symptoms. White blood cell count was normal in 21 cases, increased in 6 cases, and decreased in 7 cases. Lymphocyte count was normal in 16 cases, increased in 12 cases, and decreased in6 cases. Chest X-ray films showed bilateral or unilateral patchy pulmonary fuzzy shadows in28 cases. Chest CT showed diffuse interstitial lesion in1 case, pleural effusion in 2 cases, and bronchiectasis in 1 case. The hepatic and myocardial enzymogramparameters were all abnormal.30 cases were treated by oseltamivir and ribavirin, 4 cases by methyllprednisolone, and 6 cases by gamma globulin. 8 cases underwent routine intubation and mechanical ventilation, and 5 cases received non-invasive mechanical ventilation. All 34 patients were cured. Conclusions Lung, heart, and liver are the major target organs in severe H1N1 influenza. Mechanical ventilatory support is an important treatment for severe H1N1influenza.
