metricas
covid
Buscar en
Enfermedades Infecciosas y Microbiología Clínica
Toda la web
Inicio Enfermedades Infecciosas y Microbiología Clínica The impact of influenza A(H1N1)pdm09 infection on immunosuppressed patients
Información de la revista
Vol. 30. Núm. S4.
The first influenza pandemic of the 21st century. The REIPI/SEIMC experience
Páginas 38-42 (octubre 2012)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 30. Núm. S4.
The first influenza pandemic of the 21st century. The REIPI/SEIMC experience
Páginas 38-42 (octubre 2012)
Acceso a texto completo
The impact of influenza A(H1N1)pdm09 infection on immunosuppressed patients
Impacto de la infección por gripe A(H1N1)pdm09 en los pacientes inmunodeprimidos
Visitas
2957
Elisa Corderoa,
Autor para correspondencia
, Julián de la Torre-Cisnerosb, Asunción Morenoc, Pilar Pérez-Romeroa, Melchor Rierad
a Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Sevilla, Spain
b Hospital Reina Sofía-IMIBIC, Córdoba, Spain
c Hospital Clínic, Barcelona, Spain
d Hospital Universitario Son Dureta, Palma de Mallorca, Spain
Este artículo ha recibido
Información del artículo
Abstract

Before the advent of the influenza A(H1N1)pdm virus in 2009, the information available about the clinical manifestations and prognosis of influenza in immunosuppressed patients was scarce. With the 2009 pandemic, knowledge of the behavior, severity and importance of antiviral therapy for influenza A infection in immunocompromised hosts has increased considerably. The aim of the present manuscript is to review the main challenges of influenza in the most representative immunosuppressed populations such as solid organ transplant recipients, hematopoietic stem cell transplant recipients, patients with solid and hematological cancer and human immunodeficiency virus infected patients.

Keywords:
Immunosuppressed patients
Influenza
Outcome
Transplant
Cancer patients
Human immunodeficiency virus
Resumen

Antes de 2009, momento en que se produjo la aparición de la gripe A(H1N1)pdm, no existía mucha información sobre las manifestaciones clínicas y el pronóstico de la gripe en los pacientes inmunodeprimidos. Sin embargo, desde la pandemia de 2009, el conocimiento de la conducta, la gravedad y la importancia del tratamiento antiviral para la infección por gripe A en huéspedes inmunodeprimidos han aumentado considerablemente. En este artículo se describen cuáles son los principales desafíos de la gripe en las poblaciones inmunodeprimidas más representativas como son los pacientes infectados por el virus de la inmunodeficiencia humana, pacientes con cáncer sólido o hematológico y los receptores de trasplante de órganos o de células madre hematopoyéticas.

Palabras clave:
Pacientes inmunodeprimidos
Gripe
Pronóstico
Trasplante
Pacientes con cáncer
Virus de la inmunodeficiencia humana
El Texto completo está disponible en PDF
References
[1.]
P. Ljungman, J. Andersson, J. Aschan, L. Barkholt, A. Ehrnst, M. Johansson, et al.
Influenza A in immunocompromised patients.
Clin Infect Dis, 17 (1993), pp. 244-247
[2.]
R. Martino, E. Ramila, N. Rabella, J.M. Muñoz, M. Peyret, J.M. Portos, et al.
Respiratory virus infections in adults with hematologic malignancies: a prospective study.
Clin Infect Dis, 36 (2003), pp. 1-8
[3.]
D. Schnell, J. Mayaux, C. De Bazelaire, J. Legoff, S. Feuillet, C. Scieux, et al.
Risk factors for pneumonia in immunocompromised patients with influenza.
Respir Med, 104 (2010), pp. 1050-1056
[4.]
B.D. Fox, Y. Raviv, D. Rozengarten, V. Rusanov, I. Bakal, M.R. Kramer.
Pandemic influenza (H1N1): impact on lung transplant recipients and candidates.
J Heart Lung Transplant, 29 (2010), pp. 1034-1038
[5.]
C.Y. Low, T. Kee, K.P. Chan, L.L. Oon, C.K. Tan, N.W. Tee, et al.
Pandemic (H1N1) 2009 Infection in Adult Solid Organ Transplant Recipients in Singapore.
Transplantation, 90 (2010), pp. 1016-1021
[6.]
B.J. Ng, A.R. Glanville, G. Snell, M. Musk, M. Holmes, D.C. Chambers, et al.
The impact of pandemic influenza A H1N1 2009 on Australian lung transplant recipients.
Am J Transplant, 11 (2011), pp. 568-574
[7.]
T.V. Freitas, G. Ono, L. Correa, P.S. Gomes, N.Z. Galante, H. Tedesco-Silva, et al.
Clinical manifestations and evolution of infection by influenza A (H1N1) in kidney transplant recipients.
J Bras Nefrol, 33 (2011), pp. 136-141
[8.]
E. Cordero, P. Pérez-Romero, A. Moreno, O. Len, M. Montejo, E. Vidal, et al.
Novel influenza A(H1N1) Study Group of Spanish Network for Research in Infectious Diseases (REIPI). Pandemic influenza A(H1N1) virus infection in solid organ transplant recipients: impact of viral and non-viral co-infection.
Clin Microbiol Infect, 18 (2012), pp. 67-73
[9.]
C. Troppmann, S. Cohen, A. De Mattos, R. Perez.
Rapidly progressive lethal infection with novel influenza A (H1N1) 2009 virus in a kidney recipient: a cautionary tale.
Transplantation, 89 (2010), pp. 369-370
[10.]
S.P. Watcharananan, T. Suwatanapongched, P. Wacharawanichkul, W. Chantratitaya, V. Mavichak, S.B. Mossad.
Influenza A/H1N1 2009 pneumonia in kidney transplant recipients: characteristics and outcomes following high-dose oseltamivir exposure.
Transpl Infect Dis, 12 (2010), pp. 127-131
[11.]
R. Zapata, M. Uribe, W. Martinez, A. Andrade, J.L. Leal, F. Gomez.
Severe novel H1N1 influenza A infection in the immediate postoperative period of a liver transplant patient.
Liver Transpl, 16 (2010), pp. 447-452
[12.]
D.P. Mason, S.C. Murthy, J.J. Yun, M. Machuzak, R. Shrestha, R.K. Avery, et al.
Lung transplantation in a recipient with novel 2009 H1N1 influenza: lessons learned.
Thorac Cardiovasc Surg, 59 (2011), pp. 126-127
[13.]
F. Crockett, H. Mal, K. Amazzough, M. Stern, E. Rivaud, C. Cerf, et al.
[H1N1 (2009) influenza A infection in transplant recipient patients: a comparative study versus non-transplanted patients].
Rev Pneumol Clin, 67 (2011), pp. 199-208
[14.]
D. Kumar, M.G. Michaels, M.I. Morris, M. Green, R.K. Avery, C. Liu, et al.
Outcomes from pandemic influenza A H1N1 infection in recipients of solid-organ transplants: a multicentre cohort study.
Lancet Infect Dis, 10 (2010), pp. 521-526
[15.]
M.T. Seville, J.E. Blair, H.R. Vikram, S. Kusne.
2009 H1N1 Influenza in Hospitalized Transplant Recipients.
Transplantation, 90 (2010), pp. 571-574
[16.]
A. Smud, C.B. Nagel, E. Madsen, M.C. Rial, L.A. Barcán, A.A. Gomez, et al.
Pandemic influenza A/H1N1 virus infection in solid organ transplant recipients: a multicenter study.
Transplantation, 90 (2010), pp. 1458-1462
[17.]
N. Lee, C.S. Cockram, P.K. Chan, D.S. Hui, K.W. Choi, J.J. Sung.
Antiviral treatment for patients hospitalized with severe influenza infection may affect clinical outcomes.
Clin Infect Dis, 46 (2008), pp. 1323-1324
[18.]
B. Cao, X.W. Li, Y. Mao, J. Wang, H.Z. Lu, Y.S. Chen, et al.
Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China.
N Engl J Med, 361 (2009), pp. 2507-2517
[19.]
A. Kumar, R. Zarychanski, D.J. Cook, J. Marshall, J. Lacroix, T. Stelfox, et al.
Critically ill patients with 2009 influenza A(H1N1) infection in Canada.
JAMA, 302 (2009), pp. 1872-1879
[20.]
D. Viasus, J.R. Paño-Pardo, J. Pachón, A. Campins, F. López-Medrano, A. Villoslada, et al.
Novel Influenza A (H1N1) Study Group of the Spanish Network for Research in Infectious Diseases (REIPI). Factors associated with severe disease in hospitalized adults with pandemic (H1N1) 2009 in Spain.
Clin Microbiol Infect, 17 (2011), pp. 738-746
[21.]
S. Jain, L. Kamimoto, A.M. Bramley, A.M. Schmitz, S.R. Benoit, J. Louie, et al.
Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009.
N Engl J Med, 361 (2009), pp. 1935-1944
[22.]
E. Cordero, T. Aydillo, M.C. Fariñas, J.R. Paño-Pardo, J. Pachón, D. Viasus, et al.
Immunosuppressed patients with pandemic influenza A 2009 (H1N1) virus infection.
Eur J Clin Microbiol Infect Dis, 31 (2012), pp. 547-556
[23.]
N. Lee, K.W. Choi, P.K. Chan, D.S. Hui, G.C. Lui, B.C. Wong, et al.
Outcomes of adults hospitalised with severe influenza.
Thorax, 65 (2010), pp. 510-515
[24.]
Centers for Disease Control and Prevention (CDC).
Patients hospitalized with 2009 pandemic influenza A (H1N1) - New York City, May 2009.
MMWR Morb Mortal Wkly Rep, 58 (2010), pp. 1436-1440
[25.]
R. Perez-Padilla, D. De la Rosa-Zamboni, S. Ponce de Leon, M. Hernandez, 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
[26.]
I.I. Bogoch, J.R. Andrews, E.L. Hohmann, C.N. Kotton, F.M. Marty.
Pandemic H1N1 influenza infection in adult transplant recipients.
Transplantation, 91 (2011), pp. e80-e81
[27.]
B.J. Minnema, M. Patel, C. Rotstein, T. Mazzulli, S. Hota, E.H. Cole, et al.
Comparison of hospitalized solid organ transplant recipients and nonimmunocompromised patients with pandemic H1N1 infection: a retrospective cohort study.
Transplantation, 92 (2011), pp. 230-234
[28.]
N. Ridao-Cano, A.I. Sanchez-Fructuoso, A. Rodriguez-Moreno, A. Barrientos.
H1N1 2009 influenza in kidney transplant patients.
Transplantation, 90 (2010), pp. 224-225
[29.]
A. Campbell, R. Rodin, R. Kropp, Y. Mao, Z. Hong, J. Vachon, et al.
Risk of severe outcomes among patients admitted to hospital with pandemic (H1N1) influenza.
CMAJ, 182 (2010), pp. 349-355
[30.]
R.A. Vilchez, K. McCurry, J. Dauber, A. Lacono, B. Griffith, J. Fung, et al.
Influenza virus infection in adult solid organ transplant recipients.
Am J Transplant, 2 (2002), pp. 287-291
[31.]
R. Vilchez, K. McCurry, J. Dauber, A. Iacono, R. Keenan, B. Griffith, et al.
Influenza and parainfluenza respiratory viral infection requiring admission in adult lung transplant recipients.
Transplantation, 73 (2002), pp. 1075-1078
[32.]
S. Garantziotis, D.N. Howell, H.P. McAdams, R.D. Davis, N.G. Henshaw, S.M. Palmer.
Influenza pneumonia in lung transplant recipients: clinical features and association with bronchiolitis obliterans syndrome.
Chest, 119 (2001), pp. 1277-1280
[33.]
R.S. Stucchi, I.F. Boin, R.N. Angerami, V. Sinckoc, F.C. Sa, T. Seva-Pereira, et al.
Correlations between A/H1N1 influenza and acute cellular rejection in liver transplantation patients.
Transplant Proc, 42 (2010), pp. 4184-4186
[34.]
F. Vistoli, D. Focosi, M. De Donno, S. Giannecchini, M.L. Mariotti, M. Occhipinti, et al.
Pancreas rejection after pandemic influenzavirus A(H1N1) vaccination or infection: a report of two cases.
Transpl Int, 24 (2011), pp. e28-e29
[35.]
J.F. Bermejo-Martin, R. Ortiz de Lejarazu, T. Pumarola, J. Rello, R. Almansa, P. Ramírez, et al.
Th1 and Th17 hypercytokinemia as early host response signature in severe pandemic influenza.
Crit Care, 13 (2009), pp. R201
[36.]
K.K. To, I.F. Hung, I.W. Li, K.L. Lee, C.K. Koo, W.W. Yan, et al.
Delayed Clearance of Viral Load and Marked Cytokine Activation in Severe Cases of Pandemic H1N1 2009 Influenza Virus Infection.
Clin Infect Dis, 50 (2010), pp. 850-859
[37.]
A.J. Cockbain, M. Jacob, C. Ecuyer, L. Hostert, N. Ahmad.
Transplantation of solid organs procured from influenza A H1N1 infected donors.
Transpl Int, 24 (2011), pp. e107-e110
[38.]
N. Halliday, S. Wilmore, P.D. Griffiths, J. Neuberger, D. Thorburn.
Risk of transmission of H1N1 influenza by solid organ transplantation in the United Kingdom.
Transplantation, 93 (2012), pp. 551-554
[39.]
R. Lattes, N. Jacob, F.J. de la, G. Fragale, P. Massari.
Pandemic influenza A/H1N1 and organ donation.
Transpl Infect Dis, 12 (2010), pp. 169-172
[40.]
R.F. Chemaly, S. Ghosh, G.P. Bodey, N. Rohatgi, A. Safdar, M.J. Keating, et al.
Respiratory viral infections in adults with hematologic malignancies and human stem cell transplantation recipients: a retrospective study at a major cancer center.
Medicine (Baltimore), 85 (2006), pp. 278-287
[41.]
F.S. Dawood, S. Jain, L. Finelli, M.W. Shaw, S. Lindstrom, R.J. Garten, et al.
Emergence of a novel swine-origin influenza A (H1N1) virus in humans.
N Engl J Med, 360 (2009), pp. 2605-2615
[42.]
P. Ljungman, R. De la Camara, L. Perez-Bercoff, M. Abecasis, J.B. Nieto Campuzano, M.J. Cannata-Ortiz, et al.
Outcome of pandemic H1N1 infections in hematopoietic stem cell transplant recipients.
Haematologica, 96 (2011), pp. 1231-1235
[43.]
T.R. Cate, R.B. Couch, J.A. Kasel, H.R. Six.
Clinical trials of monovalent influenza A/New Jersey/76 virus vaccines in adults: reactogenicity, antibody response, and antibody persistence.
J Infect Dis, 136 (1977), pp. S450-S455
[44.]
R. Dolin, T.G. Wise, M.H. Mazur, C.U. Tuazon, F.A. Ennis.
Immunogenicity and reactogenicity of influenza A/New Jersey/76 virus vaccines in normal adults.
J Infect Dis, 136 (1977), pp. S435-S442
[45.]
G. Redelman-Sidi, K.A. Sepkowitz, C.K. Huang, S. Park, J. Stiles, J. Eagan, et al.
2009 H1n1 Influenza Infection In Cancer Patients And Hematopoietic Stem Cell Transplant Recipients.
J Infect, 60 (2010), pp. 257-263
[46.]
A.R. Tramontana, B. George, A.C. Hurt, J.S. Doyle, K. Langan, A.B. Reid, et al.
Oseltamivir resistance in adult oncology and hematology patients infected with pandemic (H1N1) 2009 virus, Australia.
Emerg Infect Dis, 16 (2010), pp. 1068-1075
[47.]
T.M. Souza, J.I. Salluh, F.A. Bozza, M. Mesquita, M. Soares, F.C. Motta, et al.
H1N1pdm influenza infection in hospitalized cancer patients: clinical evolution and viral analysis.
PLoS One, 5 (2010), pp. e14158
[48.]
D.P. Shah, K.K. El Taoum, J.N. Shah, K.J. Vigil, J.A. Adachi, B.P. Granwehr, et al.
Characteristics and outcomes of pandemic 2009/H1N1 versus seasonal influenza in children with cancer.
Pediatr Infect Dis J, 31 (2012), pp. 373-378
[49.]
W.G. Nichols, K.A. Guthrie, L. Corey, M. Boeckh.
Influenza infections after hematopoietic stem cell transplantation: risk factors, mortality, and the effect of antiviral therapy.
Clin Infect Dis, 39 (2004), pp. 1300-1306
[50.]
M. Ditschkowski, A.H. Elmaagacli, D.W. Beelen.
H1N1 in allogeneic stem cell recipients: courses of infection and influence of vaccination on graft-versus-hostdisease (GVHD).
Ann Hematol, 90 (2011), pp. 117-118
[51.]
B. George, P. Ferguson, I. Kerridge, N. Gilroy, D. Gottlieb, M. Hertzberg.
The Clinical Impact of Infection with Swine Flu (H1N109) Strain of Influenza Virus in Hematopoietic Stem Cell Transplant Recipients.
Biol Blood Marrow Transplant, 17 (2011), pp. 147-153
[52.]
A.J. Peck, J.A. Englund, J. Kuypers, K.A. Guthrie, L. Corey, R. Morrow, et al.
Respiratory virus infection among hematopoietic cell transplant recipients: evidence for asymptomatic parainfluenza virus infection.
Blood, 110 (2007), pp. 1681-1688
[53.]
E. Tekgunduz, M.K. Yuksel, C. Erbay, B. Aribas, C. Ozdilekcan, H. Arslan, et al.
Pandemic 2009 H1N1 influenza in patients with hematopoietic stem cell transplantation and hematologic malignancy: single center experience.
Oncology, 79 (2010), pp. 409-414
[54.]
Y.J. Kim, M. Boeckh, J.A. Englund.
Community respiratory virus infections in immunocompromised patients: hematopoietic stem cell and solid organ transplant recipients, and individuals with human immunodeficiency virus infection.
Semin Respir Crit Care Med, 28 (2007), pp. 222-242
[55.]
P. Ljungman.
Respiratory virus infections in stem cell transplant patients: the European experience.
Biol Blood Marrow Transplant, 7Suppl (2001), pp. 5S-7S
[56.]
S.M. Choi, A.A. Boudreault, H. Xie, J.A. Englund, L. Corey, M. Boeckh.
Differences in clinical outcomes after 2009 influenza A/H1N1 and seasonal influenza among hematopoietic cell transplant recipients.
Blood, 11 (2011), pp. 5050-5056
[57.]
E. Suyani, Z. Aki, O. Guzel, S. Altindal, E. Senol, G. Sucak.
H1N1 infection in a cohort of hematopoietic stem cell transplant recipients: prompt antiviral therapy might be life saving.
Transpl Infect Dis, 13 (2011), pp. 208-212
[58.]
C. Lalayanni, A. Sirigou, M. Iskas, C. Smias, I. Sakellari, A. Anagnostopoulos.
Outbreak of novel influenza A (H1N1) in an adult haematology department and haematopoietic cell transplantation unit: clinical presentation and outcome.
J Infect, 61 (2010), pp. 270-272
[59.]
C. Cost, E. Brock, B. ms-Huet, J.D. Siegel, M.I. Ardura.
2009 pandemic influenza A (H1N1) virus infection in pediatric oncology and hematopoietic stem cell transplantation patients.
Pediatr Blood Cancer, 56 (2011), pp. 127-133
[60.]
F.W. Cheng, C.H. Li, M.K. Shing, D.K. Cheuk, J.P. Yau, A.S. Ling, et al.
Pandemic influenza A (2009-H1N1) infection in paediatric oncology patients in Hong Kong.
Br J Haematol, 151 (2010), pp. 202-206
[61.]
L.F. Chen, N.J. Dailey, A.K. Rao, A.T. Fleischauer, I. Greenwald, V.M. Deyde, et al.
Cluster of oseltamivir-resistant 2009 pandemic influenza A (H1N1) virus infections on a hospital ward among immunocompromised patients—North Carolina, 2009.
J Infect Dis, 203 (2011), pp. 838-846
[62.]
N. Amayiri, F. Madanat.
Retrospective analysis of pediatric cancer patients diagnosed with the pandemic H1N1 influenza infection.
Pediatr Blood Cancer, 56 (2011), pp. 86-89
[63.]
C. Garcia-Vidal, A. Upton, K.A. Kirby, K.A. Marr.
Epidemiology of invasive mold infections in allogeneic stem cell transplant recipients: biological risk factors for infection according to time after transplantation.
Clin Infect Dis, 47 (2008), pp. 1041-1050
[64.]
Oseltamivir-resistant novel influenza A (H1N1) virus infection in two immunosuppressed patients - Seattle, Washington, 2009.
MMWR Morb Mortal Wkly Rep, 58 (2009), pp. 893-896
[65.]
H. Harvala, R. Gunson, P. Simmonds, A. Hardie, S. Bennett, F. Scott, et al.
The emergence of oseltamivir-resistant pandemic influenza A (H1N1) 2009 virus amongst hospitalised immunocompromised patients in Scotland, November-December, 2009.
Euro Surveill, 15 (2010), pp. 19536
[66.]
T. Mehta, E. McGrath, S. Bheemreddy, H. Salimnia, N. Abdel-Haq, J.Y. Ang, et al.
Detection of oseltamivir resistance during treatment of 2009 H1N1 influenza virus infection in immunocompromised patients: utility of cycle threshold values of qualitative real-time reverse transcriptase PCR.
J Clin Microbiol, 48 (2010), pp. 4326-4328
[67.]
C. Wolfe, I. Greenwald, L. Chen.
Pandemic (H1N1) 2009 and oseltamivir resistance in hematology/oncology patients.
Emerg Infect Dis, 16 (2010), pp. 1809-1811
[68.]
M.B. Klein, Y. Lu, L. DelBalso, S. Cote, G. Boivin.
Influenzavirus infection is a primary cause of febrile respiratory illness in HIV-infected adults, despite vaccination.
Clin Infect Dis, 45 (2007), pp. 234-240
[69.]
K.M. Neuzil, C.S. Coffey, E.F. Mitchel Jr., M.R. Griffin.
Cardiopulmonary hospitalizations during influenza season in adults and adolescents with advanced HIV infection.
J Acquir Immune Defic Syndr, 34 (2003), pp. 304-307
[70.]
K.M. Neuzil, G.W. Reed, E.F. Mitchel Jr., M.R. Griffin.
Influenza-associated morbidity and mortality in young and middle-aged women.
JAMA, 281 (1999), pp. 901-907
[71.]
J.C. Lin, K.L. Nichol.
Excess mortality due to pneumonia or influenza during influenza seasons among persons with acquired immunodeficiency syndrome.
Arch Intern Med, 161 (2001), pp. 441-446
[72.]
A.N. Sheth, K.N. Althoff, J.T. Brooks.
Influenza susceptibility, severity, and shedding in HIV-infected adults: a review of the literature.
Clin Infect Dis, 52 (2011), pp. 219-227
[73.]
J. Kok, K. Tudo, C.C. Blyth, H. Foo, L. Hueston, D.E. Dwyer.
Pandemic (H1N1) 2009 influenza virus seroconversion rates in HIV-infected individuals.
J Acquir Immune Defic Syndr, 56 (2011), pp. 91-94
[74.]
Althoff KN, Gange SJ, Sahrp GB, Eichelberger, Gao J, Glesby M, et al. Elevated 2009 H1N1 antibody titers and serologic evidence of infection in HIV-infected and uninfected women: a sero-study conducted March1-September 3, 2009. 17th Conference of Retroviruses and Opportunistic Infections, San Francisco 2010. Available at: http://www.retroconference.org/2010/PDFs/807LB.pdf.
[75.]
E. Martínez, M.A. Marcos, I. Hoyo-Ulloa, A. Antón, M. Sánchez, A. Vilella, et al.
Influenza A H1N1 in HIV-infected adults.
[76.]
M.P. Golden, Z. Sajjad, L. Elgart.
Influenza and human immunodeficiency virus infection: absence of HIV progression after acute influenza infection.
Clin Infect Dis, 32 (2001), pp. 1366-1370
[77.]
M. Riera, A. Payeras, M.A. Marcos, D. Viasus, M.C. Farinas, F. Segura, et al.
Clinical presentation and prognosis of the 2009 H1N1 influenza A infection in HIV-1- infected patients: a Spanish multicenter study.
[78.]
C.E. Ormsby, D. De la Rosa-Zamboni, J. Vázquez-Pérez, Y. Ablanedo-Terrazas, R. Vega- Barrientos, M. Gómez-Palacio, et al.
Severe 2009 pandemic influenza A (H1N1) infection and increased mortality in patients with late and advanced HIV disease.
Copyright © 2012. Elsevier España, S.L.. All rights reserved
Descargar PDF
Opciones de artículo
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos