Article information
Abstract
Influenza A(H1N1)pdm09 virus infection was associated with significant morbidity, mainly among children and young adults. The majority of patients had self-limited mild-to-moderate uncomplicated disease. However, some patients developed severe illness and some died. In addition to respiratory complications, several complications due to direct and indirect effects on other body systems were associated with influenza A(H1N1)pdm09 virus infection. The main complications reported in hospitalized adults with influenza A(H1N1)pdm09 were pneumonia (primary influenza pneumonia and concomitant/secondary bacterial pneumonia), exacerbations of chronic pulmonary diseases (mainly chronic obstructive pulmonary disease and asthma), the need for intensive unit care admission (including mechanical ventilation, acute respiratory distress syndrome and septic shock), nosocomial infections and acute cardiac events. In experimentally infected animals, the level of pulmonary replication of the influenza A(H1N1)pdm09 virus was higher than that of seasonal influenza viruses. Pathological studies in autopsy specimens indicated that the influenza A(H1N1)pdm09 virus mainly targeted the lower respiratory tract, resulting in diffuse alveolar damage (edema, hyaline membranes, inflammation, and fibrosis), manifested clinically by severe acute respiratory distress syndrome with refractory hypoxemia. Influenza A(H1N1)pdm09-related pneumonia and other complications were associated with increased morbidity and mortality among hospitalized patients.
Keywords:
Influenza A(H1N1)pdm09 virus
Complication
Pneumonia
Intensive care unit
Mortality
Resumen
Si bien la mayoría de los pacientes infectados por el virus de la gripe A(H1N1)pdm09 tuvieron enfermedad no complicada, autolimitada, leve a moderada, la infección se caracterizó por una morbilidad significativa, especialmente entre niños y adultos jóvenes, de forma que algunos pacientes desarrollaron una enfermedad grave y algunos murieron. La infección por virus de la gripe A(H1N1)pdm09 se asoció no sólo con complicaciones respiratorias, sino también con complicaciones debidas a los efectos directos e indirectos sobre otros sistemas del organismo. En los pacientes adultos hospitalizados las complicaciones principales fueron neumonía (neumonía primaria por gripe y neumonía bacteriana concomitante/secundaria), exacerbaciones de enfermedades pulmonares crónicas (principalmente enfermedad pulmonar obstructiva crónica y asma), necesidad para la admisión en unidad de cuidados intensivos (incluso ventilación mecánica, síndrome de dolor respiratorio agudo y shock séptico), infecciones nosocomiales y acontecimientos cardíacos agudos. En los animales de experimentación infectados con virus de la gripe A(H1N1)pdm09 el nivel de replicación del virus a nivel pulmonar era más alto que el de los virus de la gripe estacional. Los estudios anatomopatológicos de muestras de autopsia mostraron que el virus de la gripe A(H1N1)pdm09 actúa principalmente sobre el tracto respiratorio inferior, provocando lesión difusa del alveolo (edema, membranas hialinas, inflamación y fibrosis), lo que se traduce clínicamente en un síndrome de distrés respiratorio agudo grave con hipoxemia refractaria. La neumonía y otras complicaciones relacionadas con la gripe por virus A(H1N1)pdm09 se asociaron a una mayor morbilidad y mortalidad en los pacientes hospitalizados.
Palabras clave:
Virus de la gripe A (H1N1)pdm09
Complicaciones
Neumonía
Unidad de cuidados intensivos
Mortalidad
Full text is only aviable in PDF
References
[1.]
R. Pérez-Padilla, D. De la Rosa-Zamboni, S. Ponce de León, M. Hernández, F. Quiñones-Falconi, E. Bautista, INER Working Group on Influenza, et al.
Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico.
N Engl J Med, 361 (2009), pp. 680-689
[2.]
Surveillance Group for New Influenza A(H1N1) Virus Investigation and Control in Spain.
New influenza A(H1N1) virus infections in Spain, April-May 2009.
Euro Surveill, 14 (2009), pp. 19209
[3.]
D. Viasus, E. Cordero, J. Rodríguez-Baño, J.A. Oteo, A. Fernández-Navarro, L. Ortega, Novel Influenza A (H1N1) Study Group of the Spanish Network for Research in Infectious Diseases (REIPI), et al.
Changes in epidemiology, clinical features and severity of influenza A (H1N1) 2009 pneumonia in the first post-pandemic influenza season.
Clin Microbiol Infect, 18 (2012), pp. E55-E62
[4.]
M. Athanasiou, A. Baka, A. Andreopoulou, G. Spala, K. Karageorgou, L. Kostopoulos, et al.
Influenza surveillance during the post-pandemic influenza 2010/11 season in Greece, 04 October 2010 to 22 May 2011.
Euro Surveill, 16 (2011), pp. 20004
[5.]
E. Bautista, T. Chotpitayasunondh, Z. Gao, S.A. Harper, Shaw M., T.M. Uyeki, S.R. Zaki, Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza.
Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection.
N Engl J Med, 362 (2010), pp. 1708-1719
[6.]
M.B. Rothberg, S.D. Haessler, R.B. Brown.
Complications of viral influenza.
Am J Med, 121 (2008), pp. 258-264
[7.]
Y. Itoh, K. Shinya, M. Kiso, T. Watanabe, Y. Sakoda, M. Hatta, et al.
In vitro and in vivo characterization of new swine-origin H1N1 influenza viruses.
Nature, 460 (2009), pp. 1021-1025
[8.]
D. Viasus, J.R. Paño-Pardo, J. Pachón, M. Riera, F. López-Medrano, A. Payeras, Novel Influenza A(H1N1) Study Group of the Spanish Network for Research in Infectious Diseases (REIPI), et al.
Pneumonia complicating pandemic (H1N1) 2009: risk factors, clinical features, and outcomes.
Medicine (Baltimore), 90 (2011), pp. 328-336
[9.]
S. Jain, S.R. Benoit, J. Skarbinski, A.M. Bramley, L. Finelli.
for the 2009 Pandemic Influenza A (H1N1) Virus Hospitalizations Investigation Team. Influenza-Associated Pneumonia Among Hospitalized Patients With 2009 Pandemic Influenza A (H1N1) Virus—United States, 2009.
Clin Infect Dis., 54 (2012), pp. 1221-1229
[10.]
G. Cullen, J. Martin, J. O’Donnell, M. Boland, M. Canny, E. Keane, et al.
Surveillance of the first 205 confirmed hospitalised cases of pandemic H1N1 influenza in Ireland, 28 April - 3 October 2009.
Euro Surveill, 14 (2009), pp. 19389
[11.]
S. Jain, L. Kamimoto, A.M. Bramley, A.M. Schmitz, S.R. Benoit, J. Louie, et al.
2009 Pandemic Influenza A (H1N1) Virus Hospitalizations Investigation Team. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009.
N Engl J Med, 361 (2009), pp. 1935-1944
[12.]
J.K. Louie, M. Acosta, K. Winter, C. Jean, S. Gavali, R. Schechter, California Pandemic (H1N1) Working Group, et al.
Factors associated with death or hospitalization due to pandemic 2009 influenza A(H1N1) infection in California.
JAMA, 302 (2009), pp. 1896-1902
[13.]
W.J. Shieh, D.M. Blau, A.M. Denison, M. Deleon-Carnes, P. Adem, J. Bhatnagar, et al.
2009 pandemic influenza A (H1N1): pathology and pathogenesis of 100 fatal cases in the United States.
Am J Pathol, 177 (2010), pp. 166-175
[14.]
N. Nin, C. Sánchez-Rodríguez, L.S. Ver, P. Cardinal, A. Ferruelo, L. Soto, et al.
Lung histopathological findings in fatal pandemic influenza A (H1N1).
Med Intensiva, 36 (2012), pp. 24-31
[15.]
ANZIC Influenza Investigators.
Critical care services and. 2009 H1N1 influenza in Australia and New Zealand.
N Engl J Med, 361 (2009), pp. 1925-1934
[16.]
A. Kumar, R. Zarychanski, R. Pinto, D.J. Cook, J. Marshall, J. Lacroix, Canadian Critical Care Trials Group H1N1 Collaborative, et al.
Critically ill patients with 2009 influenza A(H1N1) infection in Canada.
JAMA, 302 (2009), pp. 1872-1879
[17.]
J. Rello, A. Rodríguez, P. Ibáñez, L. Socias, J. Cebrián, A. Marques, J. Guerrero, H1N1 SEMICYUC Working Group, et al.
Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)v in Spain.
Crit Care, 13 (2009), pp. R148
[18.]
E. Díaz, I. Martín-Loeches, L. Canadell, L. Vidaur, D. Suárez, L. Socias, H1N1 SEMICYUC-CIBERES-REIPI Working Group (GETGAG), et al.
Corticosteroid therapy in patients with primary viral pneumonia due to pandemic (H1N1) 2009 influenza.
J Infect, 64 (2012), pp. 311-318
[19.]
K.P. Klugman, Y.W. Chien, S.A. Madhi.
Pneumococcal pneumonia and influenza: a deadly combination.
Vaccine, 27 (2009), pp. C9-C14
[20.]
D.B. Louria, H.L. Blumenfeld, J.T. Ellis, E.D. Kilbourne, D.E. Rogers.
Studies on influenza in the pandemic of 1957–1958. II. Pulmonary complications of influenza.
J Clin Invest, 38 (1959), pp. 213-265
[21.]
N.C. Oswald, R.A. Shooter, M.P. Curwen.
Pneumonia complicating Asian influenza.
Br Med J, 2 (1958), pp. 1305-1311
[22.]
S. Echevarría-Zuno, J.M. Mejía-Aranguré, A.J. Mar-Obeso, C. Grajales-Muñiz, E. Robles-Pérez, M. González-León, et al.
Infection and death from influenza A H1N1 virus in Mexico: a retrospective analysis.
Lancet, 374 (2009), pp. 2072-2079
[23.]
E. Estenssoro, F.G. Ríos, C. Apezteguía, R. Reina, J. Neira, D.H. Ceraso, et al.
Pandemic 2009 influenza A in Argentina: a study of 337 patients on mechanical ventilation.
Am J Respir Crit Care Med, 182 (2010), pp. 41-48
[24.]
G. Palacios, M. Hornig, D. Cisterna, N. Savji, A.V. Bussetti, V. Kapoor, et al.
Streptococcus pneumoniae coinfection is correlated with the severity of H1N1 pandemic influenza.
PLoS One, 4 (2009), pp. e8540
[25.]
R.J. Murray, J.O. Robinson, J.N. White, F. Hughes, G.W. Coombs, J.C. Pearson, et al.
Community-acquired pneumonia due to pandemic A(H1N1)2009 influenzavirus and methicillin resistant Staphylococcus aureus co-infection.
PLoS One, 5 (2010), pp. e8705
[26.]
C. Garcia-Vidal, P. Barba, M. Arnan, A. Moreno, I. Ruiz-Camps, C. Gudiol, et al.
Invasive aspergillosis complicating pandemic influenza A (H1N1) infection in severely immunocompromised patients.
Clin Infect Dis, 53 (2011), pp. e16-e19
[27.]
C. Jean, J.K. Louie, C.A. Glaser, K. Harriman, J.K. Hacker, F. Aranki, et al.
Invasive group A streptococcal infection concurrent with 2009 H1N1 influenza.
Clin Infect Dis, 50 (2010), pp. e59-e62
[28.]
A. Dhanoa, N.C. Fang, S.S. Hassan, P. Kaniappan, G. Rajasekaram.
Epidemiology and clinical characteristics of hospitalized patients with pandemic influenza A (H1N1) 2009 infections: the effects of bacterial coinfection.
Virol J, 8 (2011), pp. 501
[29.]
C. Guervilly, Y. Coisel, E. Botelho-Nevers, S. Dizier, M. Castanier, R. Lepaul-Ercole, et al.
Significance of high levels of procalcitonin in patients with influenza A (H1N1) pneumonia.
J Infect, 61 (2010), pp. 355-358
[30.]
S. Ahn, W.Y. Kim, S.H. Kim, S. Hong, C.M. Lim, Y. Koh, et al.
Role of procalcitonin and C-reactive protein in differentiation of mixed bacterial infection from 2009 H1N1 viral pneumonia.
Influenza Other Respi Viruses, 5 (2011), pp. 398-403
[31.]
I. Martín-Loeches, A. Sánchez-Corral, E. Díaz, R.M. Granada, R. Zaragoza, C. Villavicencio, H1N1 SEMICYUC Working Group, et al.
Community-acquired respiratory coinfection in critically ill patients with pandemic 2009 influenza A(H1N1) virus.
Chest, 139 (2011), pp. 555-562
[32.]
L. Abbo, A. Quartin, M.I. Morris, G. Saigal, E. Ariza-Heredia, P. Mariani, et al.
Pulmonary imaging of pandemic influenza H1N1 infection: relationship between clinical presentation and disease burden on chest radiography and CT.
Br J Radiol, 83 (2010), pp. 645-651
[33.]
B. Cunha, U. Syed, S. Strollo.
During the “herald wave” of the pandemic bacterial pneumonia relatively rare with fatal swine influenza (H1N1) pneumonia: if chest films have no focal segmental/lobar infiltrates, antibiotic therapy is unnecessary.
J Chemother, 21 (2009), pp. 584-589
[34.]
F.W. Ko, M. Ip, P.K. Chan, J.P. Fok, M.C. Chan, J.C. Ngai, et al.
A 1-year prospective study of the infectious etiology in patients hospitalized with acute exacerbations of COPD.
Chest, 131 (2007), pp. 44-52
[35.]
G. Rohde, A. Wiethege, I. Borg, M. Kauth, T.T. Bauer, A. Gillissen, et al.
Respiratory viruses in exacerbations of chronic obstructive pulmonary disease requiring hospitalisation: a case-control study.
Thorax, 58 (2003), pp. 37-42
[36.]
F.S. Dawood, L. Kamimoto, T.A. D’Mello, A. Reingold, K. Gershman, J. Meek, et al.
Children with asthma hospitalized with seasonal or pandemic influenza, 2003–2009.
Pediatrics, 128 (2011), pp. e27-e32
[37.]
R.R. Miller 3rd, B.A. Markewitz, R.T. Rolfs, S.M. Brown, K.K. Dascomb, C.K. Grissom, et al.
Clinical findings and demographic factors associated with intensive care unit admission in Utah due to 2009 novel influenza A (H1N1) infection.
Chest, 137 (2010), pp. 752-758
[38.]
A. Verrall, K. Norton, S. Rooker, S. Dee, L. Olsen, C.E. Tan, et al.
Hospitalizations for pandemic (H1N1) 2009 among Maori and Pacific Islanders, New Zealand.
Emerg Infect Dis, 16 (2010), pp. 100-102
[39.]
G. Cullen, J. Martin, J. O’Donnell, M. Boland, M. Canny, E. Keane, et al.
Surveillance of the first 205 confirmed hospitalised cases of pandemic H1N1 influenza in Ireland, 28 April - 3 October 2009.
Euro Surveill, 14 (2009), pp. 19389
[40.]
D. Viasus, J.R. Paño-Pardo, J. Pachón, A. Campins, F. López-Medrano, A. Villoslada, et al.
Factors associated with severe disease in hospitalized adults with pandemic (H1N1) 2009 in Spain.
Clin Microbiol Infect, 17 (2011), pp. 738-746
[41.]
J.R. Paño-Pardo, J. Rodríguez-Baño, N. Martínez-Sánchez, D. Viasus, M.C. Fariñas, M. Leyes, et al.
Prognosis of 2009 A(H1N1) influenza in hospitalized pregnant women in a context of early diagnosis and antiviral therapy.
Antivir Ther, (2011),
[42.]
M. Riera, A. Payeras, M.A. Marcos, D. Viasus, M.C. Fariñas, F. Segura, et al.
Clinical presentation and prognosis of the 2009 H1N1 influenza A infection in HIV-1-infected patients: a Spanish multicenter study.
AIDS, 24 (2010), pp. 2461-2467
[43.]
K. Han, H. Ma, X. An, Y. Su, J. Chen, Z. Lian, et al.
Early use of glucocorticoids was a risk factor for critical disease and death from pH1N1 infection.
Clin Infect Dis, 53 (2011), pp. 326-333
[44.]
M.D. Van Kerkhove, K.A. Vandemaele, V. Shinde, G. Jaramillo-Gutierrez, A. Koukounari, C.A. Donnelly, et al.
Risk factors for severe outcomes following 2009 influenza A (H1N1) infection: a global pooled analysis.
PLoS Med, 8 (2011), pp. e1001053
[45.]
R. Gilca, G. De Serres, N. Boulianne, N. Ouhoummane, J. Papenburg, M. Douville-Fradet, et al.
Risk factors for hospitalization and severe outcomes of 2009 pandemic H1N1 influenza in Quebec, Canada.
Influenza Other Respi Viruses, 5 (2011), pp. 247-255
[46.]
D. Viasus, J.R. Paño-Pardo, J. Pachón, M. Riera, F. López-Medrano, A. Payeras, et al.
Timing of oseltamivir administration and outcomes in hospitalized adults with pandemic 2009 influenza A(H1N1) virus infection.
Chest, 140 (2011), pp. 1025-1032
[47.]
R.A. Brandão-Neto, A.C. Goulart, A.N. Santana, H.S. Martins, S.C. Ribeiro, L.Y. Ho, et al.
The role of pneumonia scores in the emergency room in patients infected by 2009 H1N1 infection.
Eur J Emerg Med, 19 (2012), pp. 200-202
[48.]
J.M. Pereira, R.P. Moreno, R. Matos, A. Rhodes, I. Martin-Loeches, M. Cecconi, et al.
Severity assessment tools in ICU patients with 2009 Influenza A (H1N1) pneumonia.
Clin Microbiol Infect, 18 (2012), pp. 1040-1048
[49.]
C. Warren-Gash, L. Smeeth, A.C. Hayward.
Influenza as a trigger for acute myocardial infarction or death from cardiovascular disease: a systematic review.
Lancet Infect Dis, 9 (2009), pp. 601-610
[50.]
I. Erden, E.C. Erden, H. Ozhan, C. Basar.
Acute myocarditis mimicking acute myocardial infarction associated with pandemic 2009 (H1N1) influenza A virus.
Cardiol J, 18 (2011), pp. 552-555
[51.]
B. Chacko, J.V. Peter, K. Pichamuthu, K. Ramakrishna, M. Moorthy, R. Karthik, et al.
Cardiac manifestations in patients with pandemic (H1N1) 2009 virus infection needing intensive care.
J Crit Care, 27 (2012), pp. 106.e1-106.e6
[52.]
N. Akritidis, M. Mastora, G. Baxevanos, G. Dimos, G. Pappas.
Electrocardiographic abnormalities in patients with novel H1N1 influenza virus infection.
Am J Cardiol, 106 (2010), pp. 1517-1519
[53.]
S. Kedia, B. Stroud, J. Parsons, T. Schreiner, D.J. Curtis, D. Bagdure, et al.
Pediatric neurological complications of 2009 pandemic influenza A (H1N1).
Arch Neurol, 68 (2011), pp. 455-462
[54.]
C. Glaser, K. Winter, K. Dubray, K. Harriman, T.M. Uyeki, J. Sejvar, et al.
A Population- Based Study of Neurologic Manifestations of Severe Influenza A(H1N1)pdm09 in California.
Clin Infect Dis, 55 (2012), pp. 514-520
[55.]
D.E. Lewis, B.E. Gilbert, V. Knight.
Influenza virus infection induces functional alterations in peripheral blood lymphocytes.
J Immunol, 137 (1986), pp. 3777-3781
[56.]
D. Viasus, J.R. Paño-Pardo, E. Cordero, A. Campins, F. López-Medrano, A. Villoslada, et al.
Effect of immunomodulatory therapies in patients with pandemic influenza A (H1N1) 2009 complicated by pneumonia.
J Infect, 62 (2011), pp. 193-199
[57.]
T. Fujii, T. Nakamura, A. Iwamoto.
Current concepts in SARS treatment.
J Infect Chemother, 10 (2004), pp. 1-7
[58.]
S.G. Demirjian, R. Raina, A. Bhimraj, S.D. Navaneethan, S.M. Gordon, M.J. Schreiber Jr., et al.
2009 influenza A infection and acute kidney injury: incidence, risk factors, and complications.
Am J Nephrol, 34 (2011), pp. 1-8
Copyright © 2012. Elsevier España, S.L.. All rights reserved
