Aspects of pneumonia in patients with pandemic 2009 A H1N1 influenza

Abstract

During the spring of 2009 the WHO declared 2009 A (H1N1) influenza pandemic. The first case of pandemic influenza A(H1N1), in Republic of Moldova, was registered on July 27, 2009. As of this moment were reported around 29 850 cases of influenza. A part of them were confirmed by RT-PCR (2708 cases of 6500 examined samples). The most severe complication of influenza is pneumonia. From the beginning of the pandemic in Republic of Moldova, has been reported 21 382 cases of pneumonia. Retrospective analysis of medical records of 650 patients hospitalized for at least 24 hours for flu-like symptoms during the period November 2009 - January 2010 in 5 hospitals in Chisinau. Influenza A (H1N1) infection was confirmed by RT-PCR in 114/650 (17.5%) cases, and in 69/328 (21%) patients with pneumonia, in all other examined cases diagnosis of influenza was established on clinical and epidemiological grounds. Of the 650 patients who underwent chest radiography on admission, 316 had findings consistent with pneumonia. Radiological changes of alveolar infiltration, interstitial infiltration, or mixed images met the majority of patients. In 12 (3.6%) patients the diagnosis was established only clinically, chest X-Ray being normal. The average age of patients with pneumonia was 40.8 years, 28 (8.5%) patients were older than 65 years. 32 (10%) patients with pneumonia required hospitalization in an intensive care unit for a period varying from one day to 28 days, 6 patients died (1.8% of all patients with pneumonia). Comorbidities were present in 113/328 (34.4%) patients (COPD, diabetes, cardiovascular diseases, obesity, lymphogranulomatosis, drug addiction). In all patients with flu symptoms, antiviral treatment with oseltamivir was administered from the first day of hospitalization for a period of 5-10 days, radiological infirmation of pneumonia wasn't criterion for annulment of antiviral therapy. Pneumonia can develop both in apparently healthy young people and those with comorbidities and was diagnosed in around 50% of cases of patients who required hospitalization. Antiviral therapy in the first days of disease seems to be associated with a favorable evolution of the disease, with cure.