İNFLUENZA A (H1N1) PNÖMONİSİ, DİFFÜZ ALVEOLAR HEMORAJİ: OLGU SUNUMU

Öz

Yirmi yedi yaşında bayan hasta ateş, öksürük, boğaz ağrısı, halsizlik ve nefes darlığı şikâyetleriyle hastanemize başvurdu. Yüksek çözünürlüklü bilgisayarlı akciğer tomografisinde her iki akciğerde diffüz mikronodüler infiltrasyonlar, alveolar patern ve buzlu cam opasiteleri izlendi. Hastan ın takibi esnasında trombosit sayısı, hemoglobin ve hematokrit seviyeleri düştü. Nazal sürünt üden yapılan PCR testi sonucunda influenza A (H1N1) pozitif saptandı. Hasta bu bulgularla influenza A (H1N1) pnömonisi, diffüz alveolar hemoraji tanısı aldı ve oseltamivir, metilprednizolon, tedavisi uygulandı. Medikal tedavi ile semptomlarda ve akciğer grafisindeki infiltrasyonlarda belirgin düzelme gözlendi. Özet olarak influenza A (H1N1) virusu pnömoni, diffüz alveolar hemoraji ve solunum yetmezliğine neden olabilir. Erken tanı ve uygun tedavi ile bu komplikasyonlar düzelebilir.

Anahtar Kelimeler

• İnfluenza A, pnömoni, diffüz alveolar hemoraji

INFLUENZA A (H1N1) PNEUMONIA, DIFFUSE ALVEOLAR HEMORRHAGE: CASE REPORT

Abstract

A 27-year-old woman presented to our hospital with fever, cough, sore throat, fatigue and shortness of breath. High resolution chest CT at admission showed diffuse micronodular infiltrations, alveolar pattern and ground-glass opacifications in both of the lungs. Platelet count, hemoglobin and hematocrit levels decreased during the follow-up of the patient. PCR test revealed positive result for novel influenza A (H1N1) in nasal and swab. According to these findings, she was diagnosed to have novel influenza A (H1N1) pneumonia and diffuse alveolar hemorrhage, and treated with oseltamivir and metilprednisolone. After the medical treatment, the symptoms and infiltrations on chest radiograph improved. To sum up, influenza A (H1N1) virus can cause pneumonia, diffuse alveolar hemorrhage and respiratory failure. Early diagnosis and appropriate therapy can treat these complications.

Keywords

• Influenza A, pneumonia, diffuse alveolar hemorrhage

Kaynakça

1. 1. Center for Disea se Control and Prevention. 2009 H1N1 Flu ("Swine Flu") and You http:// www.cdc.gov/h1n1flu/qa.htm#f. Accesed Jan 20, 2010.
2. 2. World Health Organisation. Pandemic (H1N1)2009 - update 99. http:// www. who. int/csr/don/2010_05_07/en/index.html. Accesed May 13, 2010.
3. 3. Donaldson LJ, Rutter PD, Ellis B, et al. Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study. BMJ 2009; 339: b5213.
4. 4. Kuiken T, Taubenberger JK. Pathology of human influenza revised. Vaccine 2008; 26: 59-66.
5. 5. Chowell G, Bertozzi SM, Colchero MA, et al. Severe Respiratory disease concurrent with the Circulation of H1N1 Influenza. N Eng J Med 2009; 361: 674-9.
6. 6. Otero IG, Talavera JO, Santos FS, et al. Critical analysis of Deaths Due to atypical Pneumonia during the Onset of the Influenza A (H1N1) Virus. Arcmed. In pres 2009.
7. 7. Padilla RG, Zamboni DR, Leon SP, et al. Pneumonia and Respiratory Failure from Swine-Origin Influenza A (H1N1) in Mexico. N Eng J Med 2009; 361: 680-9.
8. 8. Vencata C, Sampathkumar P, Afessa B. Hospitalized patients with 2009 H1N1influenza infection: the Mayo Clinic experience. Mayo Clin Proc. 2010; 85: 798- 805.

9. 9. Cunha BA. Swine inflenza (H1N1) pneumonia during the ‘herald wave of the pandemic: no increase in bacterial pneumonia without empirical antibiotics. International journal of Antimicrobial agents 2010; 35: 2000-9.
10. 10. Louie JK, Acosta M, Winter K, et al. Factors associated with death or hospitalization due to pandemic 2009 influenza (H1N1) infection in California. JAMA 2009; 302: 1896-902.
11. 11. Gürgün A, Köflker P, Susur A, at al. Diffüz Alveoler Hemoraji Sendromlar›nda Mortaliteyi etkileyen Faktörler. Türkiye Klinikleri Akci¤er Arflivi 2009; 10: 39-44.
12. 12. Gilbert CR, Vipul K, Baram M. Novel H1N1 influenza A viral infection complicated by alveolar hemorrhage. Respir Care. 2010; 55: 623-5.