A case of pandemic 2009 influenza A (H1N1) in a patient with HIV infection

Little is known about pandemic 2009 influenza A (H1N1) among patients with human immunodeficiency virus (HIV) infection. We report a case of 2009 influenza A (H1N1) in a patient who was newly diagnosed as having HIV. His general condition was good, and he was successfully treated in an outpatient setting. The literature was reviewed for the diagnosis, treatment, prevention, and infection control of pandemic 2009 influenza A (H1N1) among those who have HIV infection.     

中国内地首例输入性甲型H1N1流感病例诊断处置流程分析

患者从美囝圣路易斯出发,经3d的飞机(美国圣保罗-东京-北京-成都)后抵达成都.由于感到不适,患者与接机的2名亲人从机场乘坐出租车到四川省人民医院急救中心就诊.流行病学调查显示,患者在美国一直居住于密苏里大学内,当地没有猪病死情况发生,附近没有活猪交易市场、农贸市场、饲养场、屠宰场;未曾与猪有接触史;发病前4d密切接触过有"感冒"症状的患者;患者发病前7d内未到过甲型HINI流感病毒学实验室.临床检验发现,患者发热(37.8-38.8 ℃),WBC:7.9×10-9 L-1:N:5.475×10-9 L-1;L:19.5%;胸部X线检查:双肺纹理较多,心影增大;咽拭子检查:结果均为阴性.四川省CDC第一次病毒核酸检测结果显示甲型H1N1流感病毒,可疑.四川省卫生厅组织防控甲型H1N1流感专家组会诊,根据流行病学调查、病员发病症状体征、实验室检查和省CDC病毒检测结果分析,诊断为国内首例"甲型H1N1流感疑似病例".中国卫生部宣布,四川省甲型H1N1流感疑似病例,经国家CDC和卫生部专家组认定为我国内地首例甲型H1N1流感确诊病例.     

中国内地首例输入性甲型H1N1流感诊治经过及文献复习

目的：探讨甲型H1N1流感的诊治。方法：对中国内地首例输入性新甲型H1N1流感病例诊治经过临床分析并文献复习。结果：通过流行病学史、临床表现、甲型H1N1流感病毒的核酸检测（real-time RT-PCR法）可明确诊断。经中西医积极治疗痊愈出院。结论：2009年中国内地首例输入性甲型H1N1流感病例临床表现较轻,病程短,无并发症;推测此次致病的甲型H1N1流感毒力小,病毒清除迅速,预后良好。     

Horizontal transmission of novel H1N1/09 influenza virus in a newborn: Myth or fact?

Horizontal transmission of H1N1/09 virus infection is very common however; transmission through this route has not been reported in newborns. To our knowledge, this is the first case report of newborn who acquired infection of novel H1N1/09 virus horizontally through asymptomatic family members or hospital staff during epidemic period in Kolkata, India. Baby recovered without antiviral therapy but received antibiotic for bacterial co-infection.     

浙江省德清县农村成人甲型流感各亚型病毒血清抗体检测及其关联探讨

目的 了解浙江省德清县农村社区成人禽流感病毒H7N9、H9、H5、甲型H1N1、季节性H1、H3的血清抗体水平,探索各亚型流感病毒之间的关联。方法 2013年4月德清县发现2例H7N9患者,分别在急性期和恢复期检测了患者及其家属的血清抗体;利用已有的生物样本库,检测病例发生之前收集的725份血清和病例发生之后收集的503份血清的H7N9、H9、H5的抗体水平,了解疫情前后人群血清抗体水平变化情况,在503份血清中抽取398份,检测甲型H1N1、季节性H1、H3的抗体情况,探索其与其他亚型流感病毒的关系;血清检测采用血凝抑制试验(HI),H7N9、H9、H5以HI抗体滴度1: 20为阳性,甲型H1N1和季节性H1、H3以1: 40为阳性,对于部分阳性和阴性样本进行复测;计算抗体阳性率和几何平均滴度,关联分析采用配对2检验并计算关联系数r。结果 H7N9的14名密切接触者中有2人抗体阳性,阳性率为14.3%;H7N9疫情出现之前,一般人群血清中未发现H7N9抗体(0/725),疫情出现之后发现1名隐性感染者,抗体阳性率为0.2%(1/503),H7N9疫情出现前后均未检出H5抗体,H9抗体阳性率没有明显变化,约为4.19%(22/503),标化率4.18%;甲型H1N1阳性率为4.77%(19/398),标化率5.73%;季节性H1为5.28%(21/398),标化率7.86%;季节性H3为11.31%(45/398),标化率6.28%;各个年龄组之间抗体阳性率差异无统计学意义;关联分析显示甲型H1N1血清抗体阳性者,H9血清抗体也趋于阳性(r=0.108, P 0.05);季节性流感病毒H1、H3抗体阳性者,甲型H1N1血清抗体也趋于阳性(r=0.504, P 0.05; r=0.111,P 0.05)。结论 德清县农村社区一般人群对H7N9和H5无免疫力,对H9、甲型H1N1和季节性H3、H1免疫保护水平有限,需要重点监测和保护。甲型H1N1和季节性流感病毒H9可能存在抗体交叉保护或共同暴露。     

48例儿童甲型H1N1流感病例临床分析

目的探讨儿童甲型H1N1流感患者的临床特征和治疗特点。方法回顾分析广东省人民医院2009年9月19日～12月30日收治的48例住院儿童甲型H1N1流感病例的临床资料,总结其临床特征及治疗经验。结果 14例为轻症患儿,30例为重症患儿,4例为危重症患儿。48例确诊病例均为本地发病者,其中10例有明确的甲型H1N1流感患者接触史。表现为发热（100%）,咳嗽（93.8%）,气促（35.4%）,喘息（25%）,呼吸困难（4.16%）,腹泻（12.5%）;50%患儿合并肺炎,2例并发心肌炎,5例患儿合并胸腔积液,其中2例出现呼吸衰竭;75%患儿白细胞正常或减低,45.8%患儿有肌酸激酶（CK）增高。按照卫生部《甲型H1N1流感诊疗方案（2009年第三版）》给予奥司他韦抗病毒、预防感染、吸氧、营养心肌及对症支持治疗,积极治疗基础疾病,必要时给予呼吸机支持、胸腔穿刺引流,所有患儿均痊愈。结论甲型H1N1流感患儿临床表现以呼吸系统症状为主,肺炎是常见并发症,少数患儿合并胸腔积液,甚至出现呼吸衰竭;接近半数患儿伴有不同程度心肌酶损害,少数并发心肌炎;尚未发现神经系统并发症;奥司他韦治疗敏感,采取综合治疗预后良好。     

甲型H1N1流感院前转运临床路径探讨

目的探讨甲型H1N1流感院前转运临床路径。方法对我国首例甲型H1N1流感院前转运情况进行临床分析。结果该例患者来自疫区美国密西根州,乘飞机从口岸回国。院前转运顺利,医护人员未出现头晕、呕吐等晕车症状。患者住院7天痊愈出院。无院内感染及第2代患者的发生。结论运用该临床路径转运甲型H1N1流感病例是适当的、有顺序的,为所有相关的工作人员提供了一个"全景图",以明确在整个院前转运中各自的作用,值得在呼吸道烈性传染病院前转运中推广。     

Treating Critical Illness Caused by the 2009 H1N1 Influenza A Virus

Background

The 2009 H1N1 influenza A pandemic has set the world spinning, unexpectedly producing significant morbidity and mortality in young, otherwise healthy patients.

Discussion

As the virus spreads across the Northern Hemisphere, emergency physicians are confronted with the challenging task of caring for the many that become critically ill from this pathogen. With the exception of a few observational studies and case reports, there is little information to guide the emergency physician in resuscitating and delivering critical care to a rapidly deteriorating patient. Many moribund patients with 2009 H1N1 influenza A infection require non-conventional critical care therapies.

Conclusion

In this article, we describe the case of a critically ill patient with confirmed 2009 H1N1 influenza A infection. After a brief review of the unique characteristics of this virus, we discuss the management of critically ill patients burdened by infection with 2009 H1N1 influenza A.     

收治我国首例甲型H1N1流感患者病区管理的应对措施

目的 探讨收治甲型H1N1流感患者的病区管理,为今后的护理工作提供借鉴和参考。方法在收治我国首例甲型H1N1流感患者的护理工作中,病区从环境、人员、物品管理等方面加强管理,严格执行消毒隔离制度。结果患者住院8d,康复出院,未发生与护理相关的并发症,医护人员无一例感染。结论面对突发疫情,病区制订并实施了有效的应对措施,对切断甲型H1N1流感在医院内的传播途径、确保医务人员、住院患者的安全,具有十分重要的意义。     

氧合指数对重症甲型H1N1流感患者预后的影响

目的 通过对重症甲型H1N1流感病例的分析,评价氧合指数(PaO_2/FiO_2)是否是影响患者转归的独立危险因素,并探寻ICU介入的时机.方法 将收集的病例分为死亡组与存活组,并将这两组病例的一般资料及入ICU时的病情评估进行比较.结果 重症甲型H1N1流感患者入院时氧合指数越差,则预后越差.结论 氧合指数可作为重症甲型H1N1流感患者预后的独立危险因素,应当在患者的氧合指数呈逐渐下降趋势且病情无好转的情况下,及时将患者收入ICU进行进一步治疗,而不能等到患者出现ARDS之后.     

Effect of oral gavage treatment with ZnAL42 and other metallo-ion formulations on influenza A H5N1 and H1N1 virus infections in mice

Avian influenza H5N1 infections can cause severe, lethal human infections. Whether influenza A virus treatments effectively ameliorate avian influenza H5N1 human infections is uncertain. The research objective was to evaluate the efficacy of novel zinc and other metallo-ion formulations in two influenza A mouse models. Mice infected with influenza A/Duck/MN/1525/81 (H5N1) virus were treated orally 48 h before virus exposure and then twice daily for 13 days with ZnAL42. The optimal dosing regimen for ZnAL42 was achieved at 17.28 mg/kg 48 h prior to virus exposure, twice daily for 7 days. The survival rate was 80% compared with 10% in the untreated control group and a 100% survival rate with ribavirin (75 mg/kg/day, twice a day for 5 days, beginning 4 h before virus exposure). ZnAL42 treatment significantly lessened the decline in arterial oxygen saturation (SaO2; P < 0.001). This regimen was also well tolerated by the mice. Manganese and selenium formulations were not inhibitory to virus replication when given therapeutically. Mice were also infected with influenza A/NWS/33 (H1N1) virus and were treated 48 h before virus exposure with three dosages of ZnAL42 (8.64, 1.46 or 0.24 mg/kg/day). Treatment was by oral gavage twice daily for 13 days. The highest dose of ZnAL42 was significantly inhibitory to the virus infection as seen by prevention of deaths and lessening of decline in SaO2. The data suggest that the prophylactic use of ZnAL42 is effective against avian influenza H5N1 or H1N1 virus infection in mice and should be further explored as an option for treating human influenza virus infections.     

儿童危重甲型H1N1流感合并急性呼吸窘迫综合征的临床特征与救治

目的 了解儿童危重甲型H1N1流感合并急性呼吸窘迫综合征(ARDS)的临床特点,探讨救治措施.方法 前瞻性观察上海交通大学附属儿童医院收治的3例危重甲型H1N1流感的临床表现、化验检查、诊断、治疗转归.结果 实时RCT-PCR检测3例患者均为甲型H1N1流感感染.以发热、咳嗽起病,全身性炎症反应相对轻.病程4～6 d病情突然恶化,出现口唇发绀,呼吸急促.X线片显示双肺多叶渗出或弥漫性炎症阴影.入院时已发展为ARDS.采用奥司他韦,小潮气量(6 mL/kg)、适当高PEEP通气策略和相对保守液体等治疗,3例患儿中存活2例,死亡1例.结论 儿童危重甲型H1N1流感患儿,突然咳嗽加重和呼吸急促时,应高度怀疑ARDS.及时氧疗及呼吸支持,保守液体管理,预防继发感染等可能是关键治疗措施.需要积累更多病例资料来明确危重甲型H1N1流感特征和评价救治手段.     

儿科门诊甲型H1N1流感流行期间的预防与控制对策

目的:探讨甲型H1N1流感流行期间儿科门诊的防控策略。方法:(1)制订并落实了甲型H1N1流感感染分诊预检流程、收治流程、上报流程、医院感染防控应急预案。(2)建章力制、应急物资储备、知识储备、人员培训。(3)现场督导,以保证制度措施落实。(4)做好关口筛查,防止遗漏甲型H1N1流感感染患者。(5)对确诊患者进行及时有效处理,防止疫情的传播和蔓延。结果:在收治中国内地首例甲型H1N1流感的诊疗过程中未发生院内感染,无1例二代甲型H1N1流感感染发生。结论:应急工作常态管理,及时制订应急预案,监督落实医院感染控制措施,是患者成功有序诊疗和院感控制的有力保证。     

广东省深圳市首例孕妇感染H9N2禽流感病例流行病学调查

目的通过对广东省深圳市龙岗区报告的首例孕妇感染H9N2禽流感病例的流行病学调查,探明可能的感染来源,为今后防控H9N2等亚型禽流感疫情积累经验。方法2017－2018年采用现场流行病学方法系统收集深圳市龙岗区报告病例的流行病学资料,采集病例、密切接触者和暴露环境等样本;应用抗原检测的方法检测A型流感病毒;应用荧光定量PCR的方法检测禽流感病毒,并进行分型。采用Excel 2019软件对检验结果进行分析。结果患者咽拭子H9N2禽流感病毒核酸阳性,确诊为深圳市首例孕妇感染H9N2禽流感病例;8名密切接触者在医学观察期内均未出现流感样症状,流感抗原及禽流感核酸检测均呈阴性;2017年日常监测结果外环境H9病毒亚型阳性率为14.49%,在A型通用阳性中占比达62.69%;本次疫情共采集外环境标本103份,其中A型通用阳性15份,H9亚型阳性9份。 结论该患者感染来源可能为青峰乳鸽农庄,但也不能排除日常接触禽类制品暴露。深圳禽类市场外环境禽流感病毒污染情况仍然存在,流行季节高危人群仍有暴露感染的可能,需要予以重视。     

儿童危重甲型H1N1流感合并急性呼吸窘迫综合征的临床特征与救治

目的 了解儿童危重甲型H1N1流感合并急性呼吸窘迫综合征(ARDS)的临床特点,探讨救治措施.方法 前瞻性观察上海交通大学附属儿童医院收治的3例危重甲型H1N1流感的临床表现、化验检查、诊断、治疗转归.结果 实时RCT-PCR检测3例患者均为甲型H1N1流感感染.以发热、咳嗽起病,全身性炎症反应相对轻.病程4～6 d病情突然恶化,出现口唇发绀,呼吸急促.X线片显示双肺多叶渗出或弥漫性炎症阴影.入院时已发展为ARDS.采用奥司他韦,小潮气量(6 mL/kg)、适当高PEEP通气策略和相对保守液体等治疗,3例患儿中存活2例,死亡1例.结论 儿童危重甲型H1N1流感患儿,突然咳嗽加重和呼吸急促时,应高度怀疑ARDS.及时氧疗及呼吸支持,保守液体管理,预防继发感染等可能是关键治疗措施.需要积累更多病例资料来明确危重甲型H1N1流感特征和评价救治手段.     

Influenza A(H1N1) infection and severe cardiac dysfunction in adults: A case series

BACKGROUND: While viral myocarditis and heart failure are recognized and feared complications of seasonal influenza A infection, only limited information is available for 2009 influenza A(H1N1)-induced heart failure. METHODS AND MAIN FINDINGS: This case series summarizes the disease course of four patients with 2009 influenza A(H1N1) infection who were treated at our institution from November 2009 until September 2010. All patients presented with severe cardiac dysfunction (acute heart failure, cardiogenic shock or cardiac arrest due to ventricular fibrillation) as the leading symptom of influenza A(H1N1) infection. Two patients most likely had pre-existent cardiac pathologies, and three required catecholamine therapy to maintain hemodynamic function. Except for one patient who died before influenza A(H1N1) infection had been diagnosed, all patients received antiviral therapy with oseltamivir and supportive critical care. Acute respiratory distress syndrome due to influenza A(H1N1) infection developed in one patient. Heart function normalized in two of the three surviving patients but remained impaired in the other one at hospital discharge. CONCLUSIONS: Influenza A(H1N1) infection may be associated with severe cardiac dysfunction which can even be the leading clinical symptom at presentation. During an influenza pandemic, a thorough history may reveal flu-like symptoms and should indicate testing for H1N1 infection also in critically ill patients with acute heart failure.     

Stroke as a complication of H1N1 influenza infection: a case study

In June 2010, the Centers for Disease Control and Prevention ended the US public health emergency for the H1N1 pandemic with estimates for total cases, hospitalizations, and deaths counted from April 2009 to April 2010. By the end of this period, the human H1N1 virus was estimated to have been responsible for 12,470 deaths in the United States. Most deaths associated with the seasonal flu or H1N1 infection are due to complications such as secondary infections. Experts are finding, however, that a small percentage of these deaths or comorbid conditions may be caused by disseminated intravascular coagulation, and stroke can be a sequela of disseminated intravascular coagulation. This case study describes the clinical course of a patient who had multiple strokes due to disseminated intravascular coagulation triggered by H1N1 infection. Useful clinical information about disseminated intra-vascular coagulation is detailed for nursing practice. Implications of the possible link between H1N1 infection (and influenza A and B) and stroke resulting from disseminated intravascular coagulation are discussed.     

Pandemic influenza A (H1N1) in pregnant women: impact of early diagnosis and antiviral treatment

Evaluation of: Siston AM, Rasmussen SA, Honein MA et al. Pandemic 2009 influenza A (H1N1) virus illness among pregnant women in the United States. JAMA 303(15), 1517–1525 (2010).

Pregnant women are at increased risk for severe illness from influenza infection, particularly pandemics, including the current flu pandemic. Early antiviral therapy using oseltamivir or zanamivir may be beneficial, but limited information is available regarding their safety and effectiveness during pregnancy. The article by Siston et al. assessed the findings of a recently published paper describing the severity of illness due to 2009 influenza A (H1N1) infection among 788 pregnant women reported to the CDC, stratified by timing of antiviral therapy and pregnancy trimester at symptom onset. The authors’ findings highlight the potential for severe illness and high risk of mortality due to influenza A (H1N1) infection among pregnant women and suggest the benefit of early antiviral treatment in reducing intensive care unit admissions and mortality rate. The WHO and CDC recommendations including 2009 influenza A (H1N1) vaccination and early antiviral therapy in case of influenza-like illness for all pregnant women are discussed regarding the key findings of this paper and other published data on influenza A (H1N1) infection in pregnant women.     

儿童危重甲型H1N1流感合并急性呼吸窘迫综合征的临床特征与救治

目的 了解儿童危重甲型H1N1流感合并急性呼吸窘迫综合征(ARDS)的临床特点,探讨救治措施.方法 前瞻性观察上海交通大学附属儿童医院收治的3例危重甲型H1N1流感的临床表现、化验检查、诊断、治疗转归.结果 实时RCT-PCR检测3例患者均为甲型H1N1流感感染.以发热、咳嗽起病,全身性炎症反应相对轻.病程4～6 d病情突然恶化,出现口唇发绀,呼吸急促.X线片显示双肺多叶渗出或弥漫性炎症阴影.入院时已发展为ARDS.采用奥司他韦,小潮气量(6 mL/kg)、适当高PEEP通气策略和相对保守液体等治疗,3例患儿中存活2例,死亡1例.结论 儿童危重甲型H1N1流感患儿,突然咳嗽加重和呼吸急促时,应高度怀疑ARDS.及时氧疗及呼吸支持,保守液体管理,预防继发感染等可能是关键治疗措施.需要积累更多病例资料来明确危重甲型H1N1流感特征和评价救治手段.     

一例人感染高致病性禽流感病毒(H5N1)的流行病学调查

目的通过对1例人感染高致病性禽流感病毒(H5N1)的调查分析,为制定人禽流感预防控制措施提供科学依据。方法采用流行病学调查、临床检查、血清学检查和 RT-PCR、 Real-time PCR 法进行分析和诊断。结果发现1例人感染高致病性禽流感病毒(H5N1),经救治无效因呼吸衰竭死亡。患者有明确的病、死禽接触史。采用隔离治疗、个人防护、医学观察、消毒等措施,疫情得到控制,未出现二代病例。结论需加强禽流感疫情监测,采取综合防控措施,预防疫情再次发生。