-

Abstract

Although influenza is an acute and uncomplicated disease, that limits itself in the healthy children, it may lead to death by rarely forming the sickness. The most common complication of influenza is pneumonia and it is a rare complication which is developed together with myocarditis by influenza A and B viruses. A 32 months-old male patient was admitted for rapidly developed respiratory distress and tachycardia after fever, cough, vomiting, malaise and runny nose. His general status was medium, he had conscious and had hepatomegaly, tachycardia, dyspnea, tachypnea, intercostal-subcostal retractions and bilateral rhonchus. Cardiac enzyme levels and other laboratory parameters were found normal. Myocarditis and ejection fraction was determined as 42% in echocardiography. However, hospitalization hours between 24 and 48, the patient, whose significant respiratory compromise developed, was intubated and fastened to a mechanical ventilator. H1N1 is produce in nasopharyngeal swab culture at the sixth day of follow-up. Because we think H1N1 virus was responsible from current myocarditis, oseltamivir treatment was initiated. In the fourth day of the treatment the patient’s fever returned to normal, in the ninth day a dramatic recovery was observed. In tracking echocardiography, a significant improvement was observed in the ejection fraction and myocarditis picture compared with admission time. This case was presented in order to remind that in a patients, who present with influenza findings but have respiratory distress and tachycardia in addition to lower respiratory tract infection, myocarditis should also be considered in the differential diagnosis and to remind that promising results could be obtained with the early diagnosis and treatment

Keywords

• Child, H1N1, influenza virus, myocarditis, oseltamivir

İnfluenza virüsü (H1N1)’ne sekonder gelişen miyokardit olgusu

Abstract

İnfluenza, sağlıklı çocuklarda genellikle kendi kendini sınırlayan, akut ve komplikasyonsuz bir hastalık olsa da nadiren ciddi hastalık tablosu oluşturup ölüme neden olabilir. Enfeksiyonun en sık komplikasyonu pnömoni olup, miyokardit influenza A ve B virüsüne bağlı olarak gelişebilen nadir bir komplikasyondur. 32 aylık erkek hasta ateş, öksürük, kusma, halsizlik, burun akıntısı, sonrasında hızlı gelişen solunum sıkıntısı ve taşikardi şikâyetleri ile kabul edildi. Genel durumu orta, bilinci açık, hepatomegali, taşikardi, dispne, takipne, interkostal-subkostal çekilme ve bilateral ronküs mevcuttu. Kardiak enzim düzeyleri ve diğer laboratuvar parametreler normaldi. Ekokardiyografide miyokardit ve ejeksiyon fraksiyonu %42 olarak bulundu. Ancak takiplerinin 24-48. saatinde belirgin solunum sıkıntısı gelişen hasta entübe edilip mekanik ventilatöre bağlandı. Hastanın nazofarinks sürüntü kültüründe takiplerinin altıncı gününde H1N1 üredi. Mevcut myokardit tablosunun H1N1virüsüne bağlı olabileceği düşünülerek Oseltamivir tedavisi başlandı. Tedavinin dördüncü gününde ateşi normale dönen hastanın dokuzuncu gününde kliniğinde dramatik bir iyileşme görüldü. Ekokardiyografi takiplerinde ise ejeksiyon fraksiyonu ve myokardit tablosunda başvuru anına göre belirgin düzelme gözlendi. Gribal enfeksiyon bulgularıyla başvurup solunum sıkıntısı ve taşikardi gelişen hastalarda, alt solunum yolu enfeksiyonu yanında miyokarditin de ayırıcı tanıda düşünülmesi ve erken tanı ve tedavi ile yüz güldürücü sonuçların alınabileceğini hatırlatmak amacıyla sunuldu.

Anahtar Kelimeler: Çocuk, H1N1, influenza virüsü, myokardit, oseltamivir

Keywords

• Çocuk, H1N1, influenza virüsü, myokardit, oseltamivir

References

1. Jain R, Goldman RD. Novel influenza A (H1N1): clinical presentation, diagnosis, and management. Pediatr Emerg Care 2009;25:791-796.
2. Park MK. Pediatric cardiology for practitioners. 5th ed. Philadelphia: Mosby Elsevier, 2008: 360-367.
3. Centers for Disease Control and Prevention (CDC). H1N1 flu. Updated interim recommendations for the use of antiviral medications in the treatment and prevention of influenza for the 2009-2010 season. Atlanta, GA: Centers for Disease Control and Prevention; 2009. Accessed date: 26.04.2015. Available from: http://www.cdc.gov/H1N1flu/recommendations.htm
4. Sullivan SJ, Jacobson RM, Dowdle WR, Poland GA. 2009 H1N1 influenza. Mayo Clin Proc 2010;85:64-76.
5. Harper SA, Bradley JS, Englund JA, et al. Seasonal influenza in adults and children--diagnosis, treatment, chemoprophylaxis, and institutional outbreak management: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 2009;48:1003-1032.
6. Libster R, Bugna J, Coviello S, et al. Pediatric hospitalizations
7. associated with 2009 pandemic influenza A (H1N1) in Argentina. N Engl J Med 2010;362:45-55.
8. Jain S, Kamimoto L, Bramley AM, et al. Hospitalized patients with 2009 H1N1 influenza in the United States, AprilJune 2009. N Engl J Med 2009;361:1935-1944.