Clinical significance of early immunological paralysis in patients with severe H1N1 influenza A / 中华危重病急救医学

Objective To analysis the immunological characteristics of patients with severe H1N1 influenza A, and to provide theoretical basis for predicting the prognosis of the disease. Methods A retrospective analysis was conducted. The clinical data of 15 patients diagnosed with severe H1N1 influenza A and admitted to Shanghai General Hospital of Nanjing Medical University from October 2015 to December 2016 were collected. All the patients were divided into survival and death groups according to 28-day survival. Clinical characteristics, treatment algorithm, organ function, inflammatory reaction and immune cell status were compared, and Cox regression was used to decide the risk factors of 28-day death in patients with severe H1N1 infection A. Results All 15 patients with severe H1N1 infection A were enrolled, most of who presented with cough (93.3%), fever (86.7%), sputum production (80.0%), shortness of breath (73.3%), myalgia (40.0%) and fatigue (40.0%). All had been received anti-virus, antibiotics, mechanical ventilation and anti-coagulation therapy; some were treated with prone position, neuromuscular blocker and extracorporeal membrane oxygenation (ECMO). The incidences of acute myocardial and kidney injury were high, and the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score (14.1±6.1) and sequential organ failure assessment (SOFA) score (9.6±4.1) implicated the critical condition. Of 15 patients, 4 patients died in 28 days, while 11 were cured and discharged. Compared with survival group, the patients in death group had higher levels of APACHE Ⅱscore (22.7±3.8 vs. 11.8±3.8), troponin [cTn (μg/L): 0.52 (0.07, 2.02) vs. 0.15 (0.10, 0.45)] and blood urea nitrogen [BUN (mmol/L): 11.9 (6.7, 29.1) vs. 3.9 (2.7, 6.8)] and a lower level of blood platelets count [PLT (×109/L): 76±33 vs. 146±49, all P 0.05). B lymphocyte in death group was significantly higher than that of survival group (0.477±0.136 vs. 0.229±0.121, P < 0.01). Cox regression analysis revealed that APACHE Ⅱ score [risk ratio (RR) = 20.4, 95% confidence interval (95%CI) = 5.3-31.2, P = 0.017], CD4+ T cell (RR = 11.1, 95%CI = 5.1-20.0, P = 0.048) and CD8+ T cell (RR = 9.1, 95%CI = 4.3-16.7, P = 0.049) were independently risk factors of 28-day survival of patients with severe H1N1 influenza A. Conclusion Immunological paralysis and severe inflammatory response were early complicated with severe H1N1 influenza A, and these were significantly associated with prognosis.

Clinical Profile of the H1N1 Influenza.

The H1N1 influenza A infection initially pandemic started in Mexico in March 2009 and spread as per WHO phases of pandemic alert all over the world. It was in late march 2009 an outbreak of a respiratory illness and later to proved to be caused by novel swine origin influenza A (S-OIV) identified in Mexico. Aims & Objectives : The aim of the present study was to describe first clinical presentation, various organ damage, treatment outcome duration of hospital stay and mortality and impact on high risk group patients. This is retrospective study hospital based Bharati Vidyapeeth Deemed University Medical College and Hospital, Sangli. Material and Methods: During post-pandemic period in 2010 the patients were admitted in hospitals which were suspected cases of H1N1 influenza “A” infection. 118 cases were studied August 2010 to 31st January 2011. Results : One hundred eighteen (118) patients were admitted in hospital. Of the 118 patients 32 patients were H1N1 positive and 86 patients H1N1 negative. RT- PCR test was done for confirmation of infection. X- Ray chest in positive cases of H1N1 influenza “A” infection bilateral extensive Pneumonititis other organ damage suggestive ECG, STT were changes renal failure common symptoms cough, fever, breathlessness in 28 cases sex-wise and age-wise distribution is not significant. Hospital stay all admitted patients and hospital stay in expired patients p value < 0.00 and < 0.005 highly significant. Statistics – percentage, ratio Chi- square tests used. Conclusion : Mortality in risk (Comorbid condition) with and without risk (ventilator required) The Mortality was 18.50 % more during the winter season (Chilly and cold atmosphere August to October during this season feverable for viability of the virus) significantly mortality is seen in young age group. This infection can be prevented by vaccination. The tablet tamiflu 75 mg 1 BD for 10 days no other adverse effects observed in our study the drug is safe and no resistance was observed.

An epidemiological study of H1N1 influenza A / 中国免疫学杂志

H1N1 influenza A spread around the world in 2009.There were lots of patients in China too.We did this research to know the epidemiological feature and transmission route and strengthen the prevention and control measure of the influenza.Methods:We collected the nasopharyngeal swab and serum samples of 56 patients who had flu symptom from the infectious disease department of 1st hospital of Jilin University from October in 2009 to December in 2009.The specific antibody of the serum samples were detected by the blood clots suppression method and the H 1N1 RNA of the nasopharyngeal swab was detected by the Nest-RT-PCR assay.Results:The results of nucleic acid test showed that 21(37.5%) and 16(27.8%) samples were found NP and M of influenza A positive respectively and only 2 ( 3.6%) were found H1N1 of influenza A positive.The results of the blood clots suppression method showed that the serum samples of 27 patients (48.2%) could suppress the red blood cells blot of H 1N1 influenza A specifically and all the antibody titer was more than 1∶320.The antibody titer was more than 1∶5 120 in 8 of them.There′s significant difference of the serum antibody titer between the recovery phase and the acute phase.The specific H1N1 influenza A antibody of 27 (48.2%) serum samples in the recovery phase were positive and it was much higher than the result of nucleic acid test .Conclusion:The nucleic acid could be detected in the acute phase and the serum antibody detection could be done in the later stage .Using both the assays could increase the positive rate of H 1N1 influenza.

The Association of Lymphopenia with the Clinical Severity in the Korean Children Admitted to the Hospital with Pandemic (H1N1) 2009 Infection / 감염과화학요법

BACKGROUND: Critical illness due to pandemic (H1N1) 2009 is an emerging threat to global health. In this study, lymphopenia was focused on as a major risk factor for a critical clinical course of pandemic (H1N1) 2009 infection. We investigated the association of lymphopenia at the time of admission with the clinical severity of the admitted children with pandemic (H1N1) 2009 infection. Material and Methods: We performed a retrospective study on the patients who were younger than 15 years of age and who were admitted to Wonju Christian Hospital due to pandemic (H1N1) 2009 infection between August 20, 2009 and February 20, 2010. Pandemic (H1N1) 2009 infection was confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) in all patients. We divided the study period into two periods as August 20 - November 30 2009 (pre-vaccination period) and December 1 2009 - February 20 2010 (post-vaccination period). The clinical differences between two periods were analyzed. To define the role of lymphopenia, we examined the differences of clinical manifestations between the H1N1 patients with lymphopenia and those without lymphopenia. RESULTS: Among the 2,399 children who had H1N1 infection, 149 patients (6.2%) were admitted under the following diagnoses: pneumonia (67.1%), bronchiolitis/asthma (18.8%), croup (6%) and febrile convulsion (8.7%). The median age of the patients was significantly different between during the pre-vaccination period and the post-vaccination period (6 years of age [range: 0.25-14] vs. 3 years of age, [range: 0.1-14], P<0.05). The proportion of patients who had lymphopenia was significantly different between two periods (39.5% vs. 20%, P<0.05). When we compared the clinical severity between the patients with lymphopenia and those without lymphopenia, age (P<0.0001), the length of hospital stay (P<0.0001) and the serum levels of C-reactive protein (P<0.01) were significantly different. CONCLUSION: Our data support that lymphopenia may be a major determining factor that could cause a critical clinical course during pandemic period among children in the Republic of Korea.

A Case of Pandemic 2009 H1N1 Influenza A Manifestation as Apical Ballooning Syndrome

Critical ill patients with pandemic 2009 H1N1 influenza A are associated with mortality, including cardiovascular, respiratory and renal dysfunction. Understanding of risk factor and clinical manifestation that suggest a higher mortality can recognize high risk patients earlier. There are many reports for severe acute respiratory distress syndrome, multiple organ failure and renal failure with pandemic 2009 H1N1 influenza A. But cardiovascular disease with pandemic 2009 H1N1 influenza A remains unknown. This is the report of pandemic 2009 H1N1 influenza A association with apical balloning syndrome.

Encephalitis Induced by 2009 H1N1 Influenza A

The number of domestic cases of pandemic H1N1 influenza A was elevated in 2009. The common clinical symptoms associated with H1N1 influenza include respiratory symptoms such as cough, sore throat, rhinorrhea, fever, chills, myalgia, and fatigue. Gastrointestinal symptoms are relatively common. H1N1 influenza A infection brings about neurological symptoms in rare cases. However, there are few reports about H1N1 influenza A infection with neurological manifestations. We recently experienced an H1N1 influenza A patient who presented with disturbed mental status, seizures, and focal changes on brain magnetic resonance imaging, associated with infection.

DNA vaccines encoding hemagglutinin of novel H1N1 influenza A virus inducing neutralization antibody in mice / 中华微生物学和免疫学杂志

Objective To study the characteristics of neutralization antibody in mice induced by DNA vaccines of hemagglutinin(HA) of novel H1N1 influenza A virus(2009H1N1).Methods HA encoding plasmids of 2009H1N1 or 1918H1N1(2009HA or 1918HA)were constructed.25 μg or 200 μg dosage of 2009HA plasmids were used to immunize the mice,the total antibody of anti-20O9HA or cross-reactive antibody were assayed by ELISA using 2009HA or 1918HA protein as capture antigen,and the neutralizing antibody were assayed by two kinds of virus pseudo - particles(pp) of 2009H1N1 and 1918H1N1 .Results During of 4 to 16 weeks after boost immunization,in two groups of mice immunized with 25 μg or 200 μg dosage 2009HA plasmids,both total antibody of anti-2009HA and neutralizing antibody to 2009H1Nlpp reached the similar level(P ＞0.05),and there were cross-reactive antibody to 1918HA protein in two groups of mice serum,with similar titers of cross-neutralizing activity to 1918H1N1 pp(P ＞0.05),Conclusion A low dosage DNA vaccine encoding HA of 2009 H1 N1 virus is able to induce persistent and high level of neutralizing antibody,and may be potential valuable vaccine against the new emerging influenza virus.

Influenza / Influenza

La influenza es una infección viral aguda de las vías respiratorias, altamente contagiosa. Es causada por el virus de la influenza A, B y C. Puede afectar a todos los grupos etarios durante epidemias, aunque tiene mayor morbilidad en los extremos de la vida. La enfermedad frecuentemente requiere de atención médica y hospitalización, contribuyendo sustancialmente a pérdidas económicas, exceso en el número de días/cama-hospital y muertes. Considerando la epidemia reciente en México del virus de la influenza humana H1N1, y la presencia de brotes epidémicos estacionales, se presenta esta actualización, haciendo énfasis en los aspectos de prevención y tratamiento.

Influenza is a highly contagious acute viral infection of the respiratory tract. It is caused by influenza A, B and C virus. Infection occurs at all ages, but during epidemics the morbidity is higher at extremes of life. Sick patients demand medical care and hospitalization, consuming limited resources, increasing length of hospital-days and eventually death. Recently, in Mexico a novel influenza A virus (H1N1) caused an epidemic. With the new virus surveillance, infections due also to seasonal virus were documented. This update highlights recommendations for prevention and treatment of influenza.