Clinical, laboratory and radiologic characteristics of 2009 pandemic influenza A/H1N1 pneumonia: primary influenza pneumonia versus concomitant/secondary bacterial pneumonia
- Authors
- Song, Joon Y.; Cheong, Hee J.; Heo, Jung Y.; Noh, Ji Y.; Yong, Hwan S.; Kim, Yoon K.; Kang, Eun Y.; Choi, Won S.; Jo, Yu Mi; Kim, Woo Joo
- Issue Date
- Nov-2011
- Publisher
- Blackwell Publishing Inc.
- Keywords
- 2009 H1N1; C-reactive protein; influenza; pneumonia; procalcitonin
- Citation
- Influenza and other Respiratory Viruses, v.5, no.6, pp R535 - R543
- Indexed
- SCIE
SCOPUS
- Journal Title
- Influenza and other Respiratory Viruses
- Volume
- 5
- Number
- 6
- Start Page
- R535
- End Page
- R543
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/13041
- DOI
- 10.1111/j.1750-2659.2011.00269.x
- ISSN
- 1750-2640
1750-2659
- Abstract
- Background
Although influenza virus usually involves the upper respiratory tract, pneumonia was seen more frequently with the 2009 pandemic influenza A/H1N1 than with seasonal influenza.
Methods
From September 1, 2009, to January 31, 2010, a specialized clinic for patients (aged ≥15 years) with ILI was operated in Korea University Guro Hospital. RT-PCR assay was performed to diagnose 2009 pandemic influenza A/H1N1. A retrospective case–case–control study was performed to determine the predictive factors for influenza pneumonia and to discriminate concomitant/secondary bacterial pneumonia from primary influenza pneumonia during the 2009–2010 pandemic.
Results
During the study period, the proportions of fatal cases and pneumonia development were 0·12% and 1·59%, respectively. Patients with pneumonic influenza were less likely to have nasal symptoms and extra-pulmonary symptoms (myalgia, headache, and diarrhea) compared to patients with non-pneumonic influenza. Crackle was audible in just about half of the patients with pneumonic influenza (38·5% of patients with primary influenza pneumonia and 53·3% of patients with concomitant/secondary bacterial pneumonia). Procalcitonin, C-reactive protein (CRP), and lactate dehydrogenase were markedly increased in patients with influenza pneumonia. Furthermore, procalcitonin (cutoff value 0·35 ng/ml, sensitivity 81·8%, and specificity 66·7%) and CRP (cutoff value 86·5 mg/IU, sensitivity 81·8%, and specificity 59·3%) were discriminative between patients with concomitant/secondary bacterial pneumonia and patients with primary influenza pneumonia.
Conclusions
Considering the subtle manifestations of 2009 pandemic influenza A/H1N1 pneumonia in the early stage, high clinical suspicion is required to detect this condition. Both procalcitonin and CRP would be helpful to differentiate primary influenza pneumonia from concomitant/secondary bacterial pneumonia.
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Collections - 2. Clinical Science > Department of Radiology > 1. Journal Articles
- 2. Clinical Science > Department of Infectious Diseases > 1. Journal Articles
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