Characteristics and Outcome of Patients with Influenza A (H1N1 ...

Egyptian Journal of Medical Microbiology, January 2010 Vol. 19, No. 1H1N1 is susceptible to neuramidinase inhibitorsbut not to M2 inhibitors 6Swine influenza virus (SIV) can betransmitted through droplet and infected fomitis.The symptoms range from fever and anorexia tocoughing, rhinorhea, and gastrointestinal upset.Pneumonia, respiratory failure, and deaths havebeen reported with swine flu infection inhumans; and, as with seasonal influenzaoutbreaks, SIV in humans can worsenunderlying chronic conditions 6 .Warning signs should be watched inpatients with confirmed H1N1 or suspected tobe infected that predict progression to moresevere disease which include shortness ordifficulty of breath, turning blue, bloody orcolored sputum, chest pain, altered mentalstatus, high fever that persists after 3 days, lowblood pressure, recurrence of fever afterimprovement which may indicate secondarypneumonia. In children, danger signs includefast or difficult breathing, lack of alertness,difficulty in waking up and little or no desire toplay 7 .The aim of this work was to describebaseline characteristics, treatment, andprognosis in patients with influenza A (H1N1)admitted to a Saudi hospital and compare ourfindings with similar data published elsewhere.SUBJECTS & METHODSThis study was conducted over 4 months inthe period from September 2009 to January2010, from patients in Chest Department, PrinceAbd El Mohsen General Hospital , MadinahMonawarha .Ninety seven patients wereincluded in the study; (52) males and (45)females. Inclusion criteria consisted of: febrile(> 38°C) acute illness; respiratory symptomsconsistent with cough, sore throat, myalgia orinfluenza-like illness; acute respiratory failurerequiring intensive care unit (ICU) admission;plus microbiologic confirmation of novelinfluenza A (H1N1). Patients were admitted inisolation ward .- According to the regulation of Ministry ofHealth, Kingdom of Saudi Arabia; Anypatient suffered from flu symptoms morethan 3 days ; nasopharyngeal aspirates wereobtained , tested by RT-PCR for H1N1 andstarted ostelemivir treatment and alsocontacts . The continuity of treatment or notwas according to PCR results.- From all patients with flu symptoms; only'confirmed cases' were included in thecurrent study.84- Primary viral pneumonia was defined inpatients presenting during the acute phase ofinfluenza virus illness with acute respiratorydistress and unequivocal alveolaropacification involving two or more lobeswith negative respiratory and blood bacterialcultures.- The ICU admission criteria and treatmentdecisions for all patients were made by theattending physician.- All patients were subjected for:- Medical history taking and clinicalexamination including :1. Demographic data,2. Comorbidities,- Time of illness onset and hospital admission,- Time to first dose of antiviral treatment.- Nasopharyngeal swab specimens werecollected at admission and respiratorysecretions were also obtained in intubatedpatients and put on viral transport media .These specimens were sent to King FahdReferral Hospital for RT-PCR .- Specimens were cultured on Blood,MacConkey's, and Chocolate agars toexclude concomitant bacterial disease.- Blood samples were obtained and subjectedto blood cultures on Bactec 9240 automatedblood culture system to exclude other causesof fever.- Chest radiologic findings at ICU admission.- Intubation and mechanical ventilationrequirements.- Laboratory finding at ICU admission werealso recorded to determine the severity ofillness.- All patients were confirmed by RT-PCR forpandemic H1N1 virus using kits from RocheDiagnostics (Germany) which included:- RNA extraction: 200 ul of binding bufferwas added to 200 ul of samplesupplemented with 4 ul poly A and 50 ulof proteinase K , mixed thoroughly andincubated for 10 min at 72 o C then mixedwith 100 ul binding buffer, transferred tocombined filter and collection tubes ,centrifuged for 35 sec at 8000xg,flowthrough was discarded. 500 ul ofinhibitor removal buffer was added andcentrifuged again for 1 min at 8000xgwith discard of the flowthrough. 450 ul ofwash buffer was added and centrifugedagain 1 min at 8000xg, washed andcentrifuged again, followed by centrifuge10 sec at 13000xg with discard offlowthrough. To elute viral RNA 50 ul ofelution buffer was added and centrifuged