A CLINICAL ACCOUNT OF ICU CASES WITH SEVERE H1N1 (2009 PANDEMIC INFLUENZA A) INFECTION

Abstract

Objective: To determine clinical characteristics in adults with confirmed severe 2009 pandemic influenza A (H1N1) infection.
Study Design: A descriptive case series
Place and Duration of Study: The study was carried out at the department of Pulmonology and Critical Care, Military Hospital Rawalpindi, from 1st December 2009 to 30th May 2010.
Methodology: Fifteen in-hospital adults with severe H1N1 infection confirmed by reverse transciptase polymerase chain reaction (RT-PCR) were studied. A pre-designed patient data collection form was used to record clinical features, laboratory and radiological investigations and management data.
Results: Mean age for severe H1N1 cases was 41.56 ± 15.08 years and about 75% cases were from 20-40 yrs age group. Seventy five percent of our cases had at least one risk factor for complications with 2009 H1N1 infection; namely obesity – 33.3%, smokers – 26.7%, pregnancy, COAD and diabetes mellitus – 20% each. Fever (100%), cough (100%), and shortness of breath (93.3%) were the commonest symptoms. Radiographic abnormalities were bilateral patchy consolidations (60%), interstitial/reticular infiltrates (20%), and reticular shadows with areas of consolidation (20%). PaO2/FiO2 ratio was less than 200 in 60% cases on presentation. 73.3% cases had 1000-2000 (U/L) lactate dehydrogenase (LDH) levels while creatinine kinase (CK) levels were 400-1000 (U/L) in 66.7% cases. Six (40%) ICU cases with severe H1N1 infection died during hospital stay.
Conclusion: Severe H1N1 virus infection cases most commonly presented with fever, cough and shortness of breath. The severe H1N1 cases presenting with abnormal chest radiograph and hypoxemia require ICU care with high mortality.