Clinical, laboratory and radiologic characteristics of 2009 pandemic influenza A/H1N1 pneumonia: primary influenza pneumonia versus concomitant/secondary bacterial pneumonia.

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.

Correlation of coronary artery atherosclerosis with atherosclerosis of the intracranial cerebral artery and the extracranial carotid artery.

BACKGROUND: Investigating atherosclerosis of the coronary artery in ischemic stroke patients is clinically important because comorbidity is relatively common in such patients. We studied the relationship of atherosclerosis of the coronary artery to atherosclerosis of the intracranial cerebral artery and extracranial carotid artery. Further investigation was performed for determining the factors independently associated with coronary artery atherosclerosis in ischemic stroke patients. METHODS: We consecutively recruited ischemic stroke patients who had no history of coronary artery disease, and they underwent vascular examination. Patient-based vascular assessment was performed with magnetic resonance angiography of the cerebral arteries and computed tomography coronary angiography. The factors independently associated with coronary artery stenosis (> or =50%) were obtained from the conventional vascular risk factors and cerebral arterial stenosis using the logistic regression model. RESULTS: Coronary artery stenosis was observed in 25.4% of the patients and this was associated with age (OR: 1.16, 95% CI: 1.03-1.30) and the presence of stenosis of the extracranial carotid artery (OR: 11.37, 95% CI: 1.88-68.75) after logistic regression analysis. Intracranial arterial stenosis was not independently related to coronary stenosis. CONCLUSION: Careful concern about coronary artery disease is needed when treating ischemic stroke patients who have atherosclerosis of the extracranial carotid artery.