Objective To analyze the clinical features and treatment of severe H1N1 influenza.Methods The clinical data of 34 patients with severe H1N1 influenza admitted to intensive care unit from October to December 2009 were reviewed. Results The patients aged 3 months to 60 years with an average of ( 13. 9 ±4. 5) years, of which 24 patients were younger than 7 years old. Fever( 30 cases) , cough( 32 cases) , progressive shortness of breath( 19 cases) were the main symptoms. White blood cell count was normal in 21 cases, increased in 6 cases, and decreased in 7 cases. Lymphocyte count was normal in 16 cases, increased in 12 cases, and decreased in6 cases. Chest X-ray films showed bilateral or unilateral patchy pulmonary fuzzy shadows in28 cases. Chest CT showed diffuse interstitial lesion in1 case, pleural effusion in 2 cases, and bronchiectasis in 1 case. The hepatic and myocardial enzymogramparameters were all abnormal.30 cases were treated by oseltamivir and ribavirin, 4 cases by methyllprednisolone, and 6 cases by gamma globulin. 8 cases underwent routine intubation and mechanical ventilation, and 5 cases received non-invasive mechanical ventilation. All 34 patients were cured. Conclusions Lung, heart, and liver are the major target organs in severe H1N1 influenza. Mechanical ventilatory support is an important treatment for severe H1N1influenza.
Objective Since the first case of avian influenza A (H7N9) virus infection in humans identified in Suining, Sichuan province on January 25th, 2017, there were other five severely ill patients confirmed in the following 3 weeks. It is urgent to find out the common clinical characters of these patients, so that to make sure the optimal ways for early diagnosis and treatment for H7N9 virus infection in community hospitals or primary hospitals as soon as possible. Methods The early symptoms, the data of early laboratory findings, the early imaging study, the early process of diagnosis and treatment of these six patients were collected and analyzed. Results All six patients had high fever, dry cough, hypocalcemia, and hypophosphatemia, with advanced CT image lesions manifested as consolidation and ground-grass opacity in bilateral lower lung lobes. Some patients had typically leukopenia, lymphopenia, thrombocytopenia. And most of them had a history of direct exposure to live poultry before complaining of flu-like syndromes. However, the flu can not be effectively controlled by routine anti-infection. Conclusion The human infection with H7N9 virus can be early identified by combining the epidemiology of live poultry exposure, the symptoms of high fever, dry cough, dramatical leukopenia, lymphopenia, thrombocytopenia, the typical CT image, and the rapidly worsen clinical condition.
Objective To study the effect of nontypeable Hemophilus influenzae(NTHi) strain ATCC49247 on proinflammatory cytokines expression of human A549 lung epithelial cell line. Methods Confluent A549 cells were co-incubated with NTHi, NTHi+Erythromycin(10 mg/L), NTHi+Gentamicin(100 mg/L), and NTHi+Dexamethasone(100 μmol/L),and nuclear factor kappa B(NF-κB) inhibitor primed cells were co-incubated with NTHi for 24 h. Then levels of interleukin-8（IL-8） and tumor necrosis factor-α(TNF-α) in the supernatant was assayed by enzyme-linked immunosorbent assay(ELISA) and the expression of intercellular adhesion molecule-1(ICAM-1) in cells was detected by immunohistochemistry staining. Results A549 cells were transformed and died after co-intubated with NTHi for 24 h. NTHi induced A549 cells to release significantly greater amounts of IL-8, which was inhibited by NF-κB inhibitor pyrrolidine dithiocarbamate（PDTC）. Incubating of A549 cells with NTHi significantly induced release of IL-8 and the expression of ICAM-1, which was blocked by erythromycin and dexamethasone and not by gentamicin. TNF-α was not detected in all circumstances. Conclusions NTHi can increase significantly the release and expression of proinflammatory cytokines through NF-κB pathway. Antibacterial drug erythromycin also has anti-inflammatory effect.
Objective To explore the clinical characteristics of patients with severe pandemic H1N1 Influenza in Sichuan and risk factors related to patients’ prognosis. Methods We observed 135 severe patients who came to hospitals for pandemic H1N1 Influenza from 12 cities in Sichuan, China,between September 12, 2009 to December 14, 2009, and described their baseline characteristics, treatment,and outcomes. A stepwise multiple Logistic-regression analysis was used to evaluate the independentpredictors of death. Results Of the 135 patients we studied, 86 patients were male. The average age was ( 28. 2 ±19. 3) years old, while patients between 19 to 45 years of age accounted for 47. 4% . 96 patients ( 71. 1% ) presented with fever. 51 patients( 37. 8% ) had comorbid conditions. The most frequent organdysfunction was seen in lung ( 71. 1% ) , liver( 27. 4% ) and cardia( 24. 4%) ; 130 patients( 96. 3% ) had received oseltamivir, 26 patients ( 19. 3% ) required mechanical ventilation. 12 of the 135 patients died.Compared with the survivors, patients who died were more likely to have a higher age, lower average bloodpressure when admitted, more organ dysfunction, and more likely to have cardia or nervous system dysfunction. The nonsurvivors also seemed to have less opportunity to be exposed to neuraminidase inhibitors, and have more demand for mechanical ventilation. The P value were all under 0. 05. The multipleLogistic-regression analysis showed the independent predictors of death were the average blood pressure when admitted and the demand for mechanical ventilation . The P value were both under 0. 05. The OR value was 0. 86(95% CI 0. 002-0. 936) and 13. 86( 95% CI 1. 146-16. 583) , respectively. Conclusions For these severe patients with pandemic H1N1 Influenza we study, the male patients are more than female. Most patients are between 19 to 45 years of age. The most frequent organ dysfunction is seen in lung, liver and cardia. The mortality of these patients is 8. 9% . Compared with the survivors, patients who died were morelikely to have a higher age, lower average blood pressure when admitted, more organ dysfunction, and more likely to have cardia ornervous systemdysfunction. The nonsurvivors also seemed to have less opportunity to be exposed to neuraminidase inhibitors, and more demand for mechanical ventilation. The multiple Logisticregression analysis showed the independent predictors of death are the average blood pressure and the demand for mechanical ventilation. The OR value is 0. 86 ( 95% CI 0. 002-0. 936) and 13. 86 ( 95% CI1. 146-16. 583) respectively.
【Abstract】 Objective To analyze the lung pathological features of type A H1N1 influenza and respiratory failure. Methods The data of imaging and aspiration lung biopsy of five patients with type A H1N1 influenza and respiratory filure since October 2009 were retrospectively analyzed. Results Common clinical manifestations of patients with type A H1N1 influenza and respiratory failure were rapid progress of illness after common cold-like symptoms with high fever, dyspnea, severe hypoxemia, large amounts of bloody sputum, wet rales over both lungs, and with other organs involved or even septic shock. Early lung pathological features were inflammatory exudate in alveoli and lung interstitium, infiltration of inflammatory cells, and extensive hemorrhage. Middle and late pathological features were hyperplasia of alveolar epithelial,disconnection of alveolar septa, replaced of alveolar spaces by fibrosis. Conclusions The pathology of patients with type A H1N1 influenza and respiratory failure is similiar with ARDS. Development of treatment strategies targeted to pathological characteristics of ARDS caused by type A H1N1 influenza is of greatsignificance for effective and timely treatment.
摘要:目的: 探讨传染病医院工作人员对甲型H1N1流感医院感染控制知识的认知程度。 方法 :选择救治甲型H1N1流感期间传染病医院不同岗位工作人员进行无记名自填式调查问卷。 结果 :全院对甲型H1N1流感医院感染控制认知总体情况良好,认知的薄弱环节是对防护措施,尤其是一级防护和三级防护的认知;不同工作岗位的工作人员对甲型H1N1流感医院感染控制认知程度不同,与甲型H1N1流感有接触的工作人员认知度高于其他工作人员,中高级职称、高年龄段(35岁以上)的医务人员认知度高于初级职称及低年龄段(35岁以下)的医务人员。 结论 :针对薄弱环节,进一步加强全员医院感染控制知识、技能的培训考核。Abstract: Objective: To explore the knowledge about the Influenza A (H1N1) of Chengdu Hospital for Infectious Diseases ‘s staff. Methods : Different medical staff of the infectious Disease Hospital during the influenza A (H1N1) treatment in Chinese mainland was selected to fill in anonymous questionnaire. Results : The awareness of the hospital is well about the hospital infection control to Influenza A (H1N1). Preventive measure is weak, especially about the primary barriers and the third barriers. The different position awareness is different. The staff who is in touch with Influenza A (H1N1) is more awareness than the others, the senior and intermediate title is more awareness than the Junior Title, the high ages group(over 35 ages) is more awareness than the low ages group (under 35 ages). Conclusion : For the weak link, further strengthens the entire hospital infection control knowledge, skills training and examination.
Objective To investigate the free influenza vaccination of health care workers in major departments and explore the possible influencing factors of influenza vaccination of staff. Methods In November 2021, a questionnaire survey was conducted among health care workers who received free influenza vaccination in 19 major departments of West China Hospital of Sichuan University, and the un-vaccinated workers’ information was obtained from the registration system of staff information. Multiple logistic regression model was used to analyze the possible influencing factors of free influenza vaccination. Results The coverage rate of centralized free influenza vaccination of staff in major departments was 32.7% (1101/3369). Multiple logistic regression analysis showed that workers who were female [odds ratio (OR)=1.853, 95% confidence interval (CI) (1.481, 2.318), P<0.001], with an educational background of high school or below [OR=4.304, 95%CI (2.484, 7.455), P<0.001], engaged in nursing work [OR=2.341, 95%CI (1.701, 3.221), P<0.001], and with 11 or more years of working experience [OR=2.410, 95%CI (1.657, 3.505), P<0.001] were more likely to inject influenza vaccine, and workers who had a bachelor’s degree were less likely to inject influenza vaccine. Conclusions The rate of free influenza vaccination among medical staff is low. In order to mobilize the enthusiasm of influenza vaccination among medical staff, it is necessary to analyze the characteristics of the population and take targeted measures to improve the level of vaccination among medical staff.
ObjectiveTo evaluate the effect of low-to-moderate doses of corticosteroids on human infections with avian influenza A (H7N9) virus, and explore when to initiate the treatment of corticosteroids and the duration of corticosteroids administration.MethodsThe study collected clinical data of 8 cases with avian influenza A (H7N9) virus infection admitted from January 25, 2017 to May 12, 2017. The final analysis included 5 severe patients who had received adjuvant corticosteroid treatment. The variation curves of WBC, CRP, PCT, CK, HBDH, LDH, temperature, ratio of SpO2/FiO2 were depicted and analyzed. The progress of clinical improvements, deterioration and prognosis were observed and discussed.ResultsThere were 1 female and 4 males in the 5 included patients with a median age of 58.0 years, among them 3 survived. The median time of illness onset to hospitalization and diagnosis confirmed were 4 days and 8 days respectively; the median duration of hospitalization to admission to infective ICU were 3 days. The first course of adjuvant corticosteroid treatment was initiated 11 days (median) after admission with a duration of 4 days (median), during which, the serum levels of HBDH and LDH decreased remarkably except the patient 3, and the oxygenation (SpO2/FiO2) improved except the patient 3. The second course of systemic administration of corticosteroid was given at a median of 26.5 days after admission with a duration of 9 days (median), during which, the patients survived with improved oxygenation (SpO2/FiO2), and weaned from mechanical ventilation.ConclusionsFor patients suffered severe human infection with avian influenza A (H7N9) virus, low-to-moderate doses of corticosteroids may decrease the level of inflammation, regulate the aberrant immune response, improve the oxygenation, make an early unassisted breathing. And corticosteroids treatment can be initiated at the time of disease deterioration, after/at the peak inflammatory response, and within 10-14 days of ARDS. Also, the adjuvant corticosteroids may be administered when oxygenation is dificult to be improved by other ways, or dificult to be liberated from mechanical ventilation, suffering severe septic shock, and refractory fever. And the duration of corticosteroids may be prolonged to 10-14 days, or until the higher level of HBDH and LDH decreased again.
Objective To investigate the clinical characteristics of patients with sever H1N1 influenza in Xinjiang region, and analyze risk factors related to patients’prognosis. Methods 63 patients with severe H1N1 influenza from September 2009 to December 2009, who came from five general hospitals and contagious disease hospitals were retrospectively studied. Data of baseline characteristics, treatment, and outcomes were collected. Results Among the 63 cases of severe H1N1 influenza patients, 46 patients survived, in which 30 cases were complicated with pneumonia( 63. 8% ) , 10 cases with MODS ( 43. 48% ) ;26 were male,20 were female; the median age was ( 28. 48 ±19. 59) years old.17 patients died, in which 11 were male, 6 were female; the median age was ( 39. 47 ±21. 23) years old. There were no significantdifferences in white blood cells, neutrophils, granulocytes, lymphocytes, Hb, platelets, CK-MB, HB, DH, UN,APTT, INR, K+ , Na+ , Cl - , PaO2 , SaO2 between the survival patients and the died patients ( P gt; 0. 05) .However there were significant differences in AST, ALT, CK, LDH, AL, CR, and pH ( P lt; 0. 05) .Conclusions Most of the patients with sever H1N1 influenza are young. The typical clinical manifestations are fever, cough, and expectoration. The patients usually are complicated with pneumonia. The patients complicated with MODS have a higher risk of death. Early administration of effective antiviral agents, low dose corticosteroids, and reasonable mechanical ventilation may improve the prognosis.
ObjectiveTo analyze risk factors, clinical features and outcome factors of invasive pulmonary aspergillosis (IPA) in severe H1N1 patients so as to achieve early diagnosis and improve prognosis.MethodsFifty severe H1N1 influenza patients with IPA admitted to West China Hospital and 64 severe H1N1 influenza patients in the same period matched by age and gender were collected. Patient characteristics, laboratory examinations, radiological imaging, microbiology data and prognostic indicators were involved into analysis.ResultsThe mortality of severe H1N1 influenza patients with IPA was significantly higher than those without IPA (51.6% vs. 32.0%, P=0.036). However, the incidence of IPA in severe H1N1 influenza patients was not related with the patient's age, gender, underlying disease, glucocorticoid use and CD4+ T cell count. Serum C-reactive protein level [(125.0±88.8) vs. (86.1±80.1) mg/L, P=0.038] and interleukin-6 level [(148.7±154.2) vs. (81.7±110.2) μg/L, P=0.039] of severe H1N1 influenza patients with IPA were significantly higher than those without IPA. Besides, more patients presented with fever (81.3% vs. 64.0%, P=0.038) and dyspnea (51.6% vs. 24.0%, P=0.003) in severe H1N1 patients with IPA. The radiological imaging of severe H1N1 patients with IPA were mostly characterized by combining with nodular changes on the basis of ground-glass opacity.ConclusionThe occurrence of IPA in severe H1N1 influenza patients may be related with pulmonary excessive inflammatory response secondary to viral invasion rather than basic condition of the patient.