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Influenza pneumonia: a descriptive study.
Autor – Oliveira EC; Marik
PE; Colice G
Zeitschrift/Erscheinungsdatum –
Chest 2001 Jun;119(6):1717-23.
STUDY OBJECTIVES:
To describe the clinical features and complications of patients hospitalized
with influenza during the 1999-2000 influenza season. METHODS: We reviewed
all cases of patients with influenza admitted to a large metropolitan
referral hospital during the 1999-2000 season. RESULTS: Thirty-five adult
patients (15 men and 20 women) tested positive for influenza A by direct
enzyme immunoassay. A fourfold to sevenfold increase in the number of
influenza cases was observed over previous years. Most patients had serious
comorbid illnesses (88%), such as diabetes and chronic respiratory and
heart disease. Seventeen patients developed pneumonia; these patients
tended to be older (mean SD, 63 13 years vs 51 19 years, respectively;
p = 0.04) and had a higher incidence of chronic lung disease (41% vs 6%,
respectively; p = 0.02) than the patients without pneumonia. Shortness
of breath was the only symptom that distinguished patients with pneumonia
from those with an upper respiratory tract illness alone. Antiviral treatment
was begun 4 3 days from initiation of symptoms in patients with pneumonia
and consisted of oseltamivir (35.2%), rimantadine (5.8%), or a combination
of both (17.6%). Respiratory and/or blood culture results were positive
in five patients (29%), Staphylococcus aureus was isolated in five patients,
and Streptococcus pneumoniae was isolated in one patient. Ten of the patients
with pneumonia (58.8%) were admitted to the ICU, and 5 patients (29%)
died. The length of ICU stay and mechanical ventilation were 28 26 days
and 21.5 20.5 days, respectively. Death in most pneumonia patients was
attributed to respiratory failure. CONCLUSION: The recognized number of
hospital admissions for influenza increased fourfold to sevenfold over
previous years, most likely due to the implementation of rapid diagnostic
tests for influenza. Patients with signs and symptoms of influenza and
shortness of breath should undergo chest radiography. Hospitalization
of patients with influenza pneumonia occurred in both previously healthy
and immunocompromised patients and had a high mortality. S aureus was
the most common bacterial isolate in patients with influenza pneumonia.
Empiric antibiotics with staphylococcal activity should be used pending
culture results in patients with influenza pneumonia. The effectiveness
of oseltamivir and rimantadine in treating patients with influenza pneumonia
remains to be determined.
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