ABSTRACT
PURPOSE: Neurological complications of influenza A(H1N1) have been reported in several patients since the onset of the pandemic in 2009. However, meningococcal disease complicating influenza A(H1N1) has not been reported. PATIENTS: Two patients were admitted to an intensive care unit (ICU) for altered mental status, fever, and rapidly spreading petechial purpura. They were diagnosed with meningococcal meningitis and/or meningococcemia and influenza A(H1N1) co-infection. CONCLUSIONS: Meningococcal disease presenting as meningitis and/or meningococcemia is among the potential complications of influenza A(H1N1) infection. Physicians should be aware of this co-infection, as it must be detected and treated promptly with antibiotics in addition to supportive care.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Antiviral Agents/therapeutic use , Coinfection/drug therapy , Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza, Human/drug therapy , Meningococcal Infections/drug therapy , Neisseria meningitidis/isolation & purification , Nervous System Diseases/drug therapy , Adolescent , Adult , Coinfection/complications , Coinfection/microbiology , Female , France , Humans , Influenza A Virus, H1N1 Subtype/drug effects , Influenza, Human/complications , Influenza, Human/diagnosis , Influenza, Human/microbiology , Male , Meningococcal Infections/complications , Meningococcal Infections/diagnosis , Meningococcal Infections/microbiology , Neisseria meningitidis/drug effects , Nervous System Diseases/complications , Nervous System Diseases/microbiology , Real-Time Polymerase Chain Reaction , Reverse Transcriptase Polymerase Chain Reaction , Treatment OutcomeABSTRACT
Intravenous urography, systematically performed in 50 consecutive acute pyelonephritis patients, revealed abnormalities in 17 of them: in 12 cases (24%), treatment and follow-up were modified; in the other 5 cases (10%), the anomalies were insignificant. The nephrogram was normal for 33 patients (66%). The frequency of significant abnormalities was higher in patients over 50 years of age (46.2%) than in those under 50 (16.2%) (p less than 0.05), and was also higher in patients remaining febrile for 3 days after the onset of an appropriate antibiotic therapy (66.6%) than in responsive patients (14.4%) (p less than 0.01). Among the significant lesions, 10 were detectable by echography and another by abdominal X-ray. Thus, a population of women under 50 years of age with acute pyelonephritis can be selected for urography, as shown by these results, however, they must be confirmed before changing the systematic practice of urography.
