Impacto del virus de la gripe A (H1N1) 2009 en un servicio de urgencias de un hospital de tercer nivel / Impact of the 2009 influenza A (H1N1) virus pandemic on the emergency department of a tertiary hospital

Introducción: La pandemia por el virus de la gripe A (H1N1) 2009 ha supuesto un gran reto para el sistema sanitario a nivel mundial. Material y métodos: Se analizaron prospectivamente los pacientes con sospecha clínica de gripe A (H1N1) 2009 que cumplían criterios de estudio microbiológico de julio a diciembre de 2009 atendidos en un servicio de urgencias pediátricas. La confirmación microbiológica se realizó mediante reacción de la cadena de polimerasa en transcripción reversa. Se analizaron el número de consultas e ingresos desde urgencias. Se compararon los casos confirmados de gripe A (H1N1) 2009 con los negativos. Resultados: Se atendió a 1.144 pacientes con criterios de estudio microbiológico. Ingresaron 513 (44,8%) pacientes, 12 de ellos (1%) en UCIP y 3 fallecieron (0,3%). En 824 pacientes (72%) se detectaron factores de riesgo para complicaciones. 412 (36%) pacientes fueron positivos para gripe A (H1N1) 2009 y 732 (64%) fueron negativos. Al comparar ambos grupos, los pacientes positivos fueron de mayor edad (edad media: 7,4 vs 4,1 años, p < 0,001), tuvieron más factores de riesgo (OR: 2,21 [1,65-2,96]), menos neumonía (OR: 0,33 [0,23-0,49]) e ingresaron menos (OR: 0,19 [0,14-0,24]). Hubo un incremento del 12% de urgencias y del 5,7% de ingresos respecto al año 2008. Conclusiones: El virus de la gripe A (H1N1) 2009 ha presentado una elevada morbilidad con baja incidencia de casos graves y baja mortalidad incluso en población con factores de riesgo (AU)

Background: The 2009 H1N1 influenza A virus infection pandemic was an important challenge for public health systems worldwide. Material and methods: A prospective study including all patients with an influenza-like illness, with microbiological criteria for 2009 H1N1 virus, from July to December 2009 seen in the paediatric emergency department. Viral testing was performed using multiplex real-time reverse transcription polymerase chain reaction (RT-PCR). We analysed the number of visits to, and hospital admissions from, our emergency department. We compared patients with laboratoryconfirmed2009 H1N1 virus with non-confirmed ones. Results: A total of 1144 patients with microbiological criteria were identified. Of these, 513 (44.8%) were admitted to hospital, 12 of them (1%) to the PICU and 3 (0.3%) died. The majority of the patients (824; 72%) had some underlying medical condition. Of the 1144 patients, 412 (36%) had RT-PCR confirmed 2009 H1N1 infection, and 732 (64%) were not confirmed. The mean age of patients with 2009 H1N1 infection was higher than those not infected (median age: 7.4vs 4.1 years; p < .001). Laboratory-confirmed 2009 pandemic H1N1 influenza patients had more underlying high-risk conditions (OR: 2.21 [1.65-2.96]), suffered from pneumonia in less cases (OR: 0.33 [0.23-0.49]) and were admitted to hospital in less cases (OR: 0.19 [0.14-0.24]). In our emergency department, we identified an important increase in the number of visits (12%) and admissions (5.7%) compared to the previous year, 2008. Conclusions: The 2009 pandemic H1N1 influenza caused significant morbidity but the mortality was not significant. The majority of children with laboratory-confirmed 2009 H1N1 virus had uncomplicated illnesses despite the increased presence of high-risk conditions (AU)

[Impact of the 2009 influenza A (H1N1) virus pandemic on the emergency department of a tertiary hospital]. / Impacto del virus de la gripe A (H1N1) 2009 en un servicio de urgencias de un hospital de tercer nivel.

BACKGROUND: The 2009 H1N1 influenza A virus infection pandemic was an important challenge for public health systems worldwide. MATERIAL AND METHODS: A prospective study including all patients with an influenza-like illness, with microbiological criteria for 2009 H1N1 virus, from July to December 2009 seen in the paediatric emergency department. Viral testing was performed using multiplex real-time reverse transcription polymerase chain reaction (RT-PCR). We analysed the number of visits to, and hospital admissions from, our emergency department. We compared patients with laboratory-confirmed 2009 H1N1 virus with non-confirmed ones. RESULTS: A total of 1144 patients with microbiological criteria were identified. Of these, 513 (44.8%) were admitted to hospital, 12 of them (1%) to the PICU and 3 (0.3%) died. The majority of the patients (824; 72%) had some underlying medical condition. Of the 1144 patients, 412 (36%) had RT-PCR confirmed 2009 H1N1 infection, and 732 (64%) were not confirmed. The mean age of patients with 2009 H1N1 infection was higher than those not infected (median age: 7.4 vs 4.1 years; p<.001). Laboratory-confirmed 2009 pandemic H1N1 influenza patients had more underlying high-risk conditions (OR: 2.21 [1.65-2.96]), suffered from pneumonia in less cases (OR: 0.33 [0.23-0.49]) and were admitted to hospital in less cases (OR: 0.19 [0.14-0.24]). In our emergency department, we identified an important increase in the number of visits (12%) and admissions (5.7%) compared to the previous year, 2008. CONCLUSIONS: The 2009 pandemic H1N1 influenza caused significant morbidity but the mortality was not significant. The majority of children with laboratory-confirmed 2009 H1N1 virus had uncomplicated illnesses despite the increased presence of high-risk conditions.

[Invasive pneumococcal disease and hemolytic uremic syndrome]. / Enfermedad neumocócica invasiva y síndrome hemolítico urémico.

INTRODUCTION: Streptococcus pneumoniae is an infrequent casual agent of hemolytic uremic syndrome (HUS) with more severity than classic HUS. CASE REPORT: We present two patients with pneumococcal pneumonia and empyema who developed HUS. One patient the renal function returned to normal and the other needed a renal transplantation. CONCLUSION: Pneumococcal invasive disease may be a cause of severe HUS, so a high index of suspicion is mandatory to prompt appropriate diagnosis and management.

Enfermedad neumocócica invasiva y síndrome hemolítico urémico / Invasive pneumococcal disease and hemolytic uremic syndrome

Introducción: Streptococcus pneumoniae es un agente etiológico infrecuente del síndrome hemolítico urémico (SHU) con una mayor gravedad que el SHU clásico. Casos clínicos: Presentamos 2 pacientes con pleuroneumonía neumocócica que desarrollaron SHU. En un caso la evolución fue hacia la normalización de la función renal y en el otro, hacia la insuficiencia renal, que requirió trasplante renal. Conclusión: La enfermedad neumocócica invasiva puede ser causa de SHU grave. Un alto índice de sospecha es necesario para un diagnóstico precoz y un adecuado tratamiento (AU)

Introduction: Streptococcus pneumoniae is an infreqüent casual agent of hemolytic uremic syndrome (HUS) with more severity than classic HUS. Case report: We present two patients with pneumococcal pneumonia and empyema who developed HUS. One patient the renal function returned to normal and the other needed a renal transplantation. Conclusion: Pneumococcal invasive disease may be a cause of severe HUS, so a high index of suspicion is mandatory to prompt appropriate diagnosis and management (AU)