Evaluation of Patients with PCR-Positive Influenza Virus on Nasopharyngeal Specimens for Complications and Hospitalization

Abstract

Objective: Influenza is usually an acute self-limiting disease, though it can cause serious complications in high-risk patients. In this study the patients diagnosed as influenza infection during the year 2014 were investigated, and evaluation of the differences between patients followed up on an outpatient basis, and those requiring hospitalization.Material and Method: Forty- eight patients diagnosed as influenza based on PCR- positive nasopharyngeal smears obtained from patients followed up as an inpatient or on an ambulatory basis according to their clinical status and hospitalized patients in Istanbul University, Faculty of Medicine, Department of Children’s Health and Diseases between January2014-December 2014 were included in the study. Patients’ medical records and laboratory analysis were retrospectively analyzed.Results: Median age of the patients female, n=16, 33.3% was 54 months 4-204 months . The median age of hospitalized patients [n=22, 45.8%, median 43.5 months, 4-204 months ] was statistically smaller than the median age of ambulatory patients [n=26, 54.2%, median 92.5 months, 4-204 months ] p=0.002 . Fever was the most common presenting symptom n=38, 79,2% . Twenty-five patients 52.1% had chronic diseases with the most common one being asthma n=5, 10,4% . Only one patient 2.1% had influenza vaccination. Influenza types were H1N1 43,8% , H3N2 27,1% and Influenza B n=14, 29,2% . Neutropenia was the most common pathologic laboratory finding n=8, 16,7% . Median hemoglobin value of the hospitalized cases [median 11,7 gr/dL 7,4-1,3 gr/dL ] was significantly lower than that of the patients followed up on an ambulatory basis [median 12,4 gr/dL, 9,9-14,6 gr/dL ] p=0,02 . In total, median duration of the disease was 10 days 7-21 days . A patient 2,1% with the diagnosis of chronic liver disease died secondary to acute respiratory distress syndrome.Conclusion: In order to decrease complications and hospitalization rates related to influenza, small children and the patients with chronic disorders should be vaccinated

Keywords

• Influenza,child,complication

Nazofarengeal Sürüntü Örneklerinde PCR ile İnfluenza Virüsü Saptanan Vakaların Hastane Yatışı ve Komplikasyon Gelişimi Açısından Değerlendirilmesi

Abstract

Amaç: İnfluenza; sıklıkla akut, kendini sınırlayan bir hastalık olmakla birlikte, özellikle risk grubundaki hastalarda komplikasyonlarla seyredebilmektedir. Çalışmamızda 2014 yılı boyunca influenza tanısı alan vakalar incelenmiş ve ayaktan izlenen hastalar ile hastane yatışı gerektiren vakalar arasındaki farkların değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Çalışmaya, İstanbul Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Kliniği’nde Ocak-Aralık 2014 tarihlerinde, nazofarengeal sürüntü örneklerinde PCR inceleme ile influenza tanısı alan ve klinik durumuna göre ayaktan ya da yatarak izlenen 48 çocuk vaka dahil edildi. Hasta dosyaları, laboratuvar tetkikleri ve epikrizleri retrospektif olarak incelendi.Bulgular: İnfluenza tanılı 48 hastanın kız, n=16, %33.3 yaş ortalaması 54 ay 4-204 ay idi. Hastaneye yatırılan hastaların n=22, %45.8 ortalama yaşı [ortanca 43.5 ay, 4-204 ay ], ayaktan izlenen hastaların n=26, %54.2 ortalama yaşından [ortanca 92.5 ay, 4-204 ay ] anlamlı olarak küçük bulundu p=0.002 . En sık kliniğe başvuru yakınması ateşti n=38, %79.2 . Hastaların %52.1’inde n=25 , başta astım n=5, %10.4 olmak üzere eşlik eden kronik hastalık mevcuttu. Yalnızca 1 hasta %2.1 aşılanmıştı. Yirmi bir hastada %43.8 H1N1, 13 hastada %27.1 H3N2 ve 14 hastada %29.2 İnfluenza B virüsü tespit edildi. En sık laboratuvar bulgusu nötropeni n=8, %16.7 idi. Hastaneye yatırılan vakaların ortalama hemoglobin düzeyi [ortanca 11.7 gr/dL 7.4-13 gr/dL ] ayaktan izlenen hastalara göre [ortanca 12.4 gr/dL, 9.9-14.6 g/dL ] anlamlı ölçüde düşük bulundu p=0.02 . Tüm hastalarda ortalama hastalık süresi 10 gün 7-21 gün idi. Kronik karaciğer hastalığı olan bir vaka %2.1 ARDS nedeniyle kaybedildi.Sonuç: İnfluenzaya bağlı komplikasyonların ve hastane yatış oranlarının azaltılabilmesi için küçük yaştaki çocuklar ile kronik hastalığı olan vakalar aşılanmalıdır

Keywords

• İnfluenza,çocuk,komplikasyon

References

1. Xu J, Kochanek KD, Murphy Sl et al. Division of Vital Statistics. Deaths: Final Data for 2007. National Vital Statistics Reports. National Center for Health Statistics. Available at http://www.cdc.gov/NCHS/data/nvsr/nvsr58/nvsr58_19.pdf.
2. centers for Disease control and Prevention (cDc). Prevention and control of seasonal influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices-United States, 2013-2014. MMWR Recomm Rep 2013;62:1.
3. Poehling KA, edwards KM, Weinberg GA et al. The under- recognized burden of influenza in young children. N Engl J Med 2006;355:31. http://dx.doi.org/10.1056/NEJMoa054869
4. Goenka A, Michael BD, ledger e et al. Neurological mani- festations of influenza infection in children and adults: results of a National British Surveillance Study. Clin Infect Dis 2014;58:775. http://dx.doi.org/10.1093/cid/cit922
5. ekstrand JJ. Neurologic complications of influenza. Semin Pediatr Neurol 2012;19:96-100. http://dx.doi.org/10.1016/j.spen.2012.02.004
6. Mamas MA, Fraser D, neyses l. Cardiovascular manifesta- tions associated with influenza virus infection. Int J Cardiol 2008;130:304-9. http://dx.doi.org/10.1016/j.ijcard.2008.04.044
7. Wilking An, elliot e, Garcia Mn, et al. Central nervous system manifestations in pediatric patients with influenza A H1N1 infection during the 2009 pandemic. Pediatr Neurol 2014;51:370-6. http://dx.doi.org/10.1016/j.pediatrneurol.2014.04.026
8. cao B, li XW, Mao Y et al. Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China. N Engl J Med 2009;361:2507-17. http://dx.doi.org/10.1056/NEJMoa0906612

9. lewis De, Gilbert Be, Knight V. Influenza virus infection induces functional alterations in peripheral blood lymphocy- tes. J Immunol 1986;137:3777-81.
10. chaves SS, Perez A, Farley MM et al. The burden of influ- enza hospitalizations in infants from 2003 to 2012, United States. Pediatr Infect Dis J 2014;33:912. http://dx.doi.org/10.1097/INF.0000000000000321
11. Dawood FS, Fiore A, Kamimoto l et al. Burden of seasonal influenza hospitalization in children, United States, 2003 to 2008. J Pediatr 2010;157:808. http://dx.doi.org/10.1016/j.jpeds.2010.05.012
12. Bender JM, Ampofo K, Gesteland P et al. Influenza virus infection in infants less than three months of age. Pediatr Infect Dis J 2010;29:6. http://dx.doi.org/10.1097/INF.0b013e3181b4b950
13. Dagan r, Hall cB. Influenza A virus infection imitating bacterial sepsis in early infancy. Pediatr Infect Dis 1984;3:218. http://dx.doi.org/10.1097/00006454-198405000-00007
14. Influenza Division, national center for Immunization and respiratory Diseases, cDc. Prevention and control of seaso- nal influenza with vaccines. MMWR Recomm Rep 2013;62:1.
15. centers for Disease control and Prevention (cDc). Estimates of deaths associated with seasonal influenza -United States, 1976-2007. MMWR Morb Mortal Wkly Rep 2010;59:1057.
16. Wong KK, Jain S, Blanton l et al. Influenza-associated pediatric deaths in the United States, 2004-2012. Pediatrics 2013;132:796. http://dx.doi.org/10.1542/peds.2013-1493
17. centers for Disease control and Prevention (cDc). Prevention and control of seasonal influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices--United States, 2013-2014. MMWR Recomm Rep 2013;62:1.
18. Wong KK, Jain S, Blanton l et al. Influenza-associated pediatric deaths in the United States, 2004-2012. Pediatrics 2013;132:796. http://dx.doi.org/10.1542/peds.2013-1493
19. Bhat n, Wright JG, Broder Kr et al. Influenza-associated deaths among children in the United States, 2003-2004. N Engl J Med 2005;353:2559. http://dx.doi.org/10.1056/NEJMoa051721
20. to KK, Hung IF, li IW et al. Delayed clearance of viral load and marked cytokine activation in severe cases of pandemic H1N1 2009 influenza virus infection. Clin Infect Dis 2010;50:850-9. http://dx.doi.org/10.1086/650581