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日本呼吸器学会英文誌 Respiratory Investigation
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Abstract

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Article in Japanese

Case Report

Three cases of influenza A (H1N1) 2009 pdm severe pneumonia

Takashi Ishiia  Atsuhisa Tamuraa  Yoshinori Matsuia,*  Hirotoshi Matsuia  Hideaki Nagaia  Shinobu Akagawaa  Akira Hebisawab 

aDepartment of Respiratory Medicine, Center for Pulmonary Diseases, National Hospital Organization of Tokyo Hospital
bDepartment of Clinical Laboratory, Center for Pulmonary Diseases, National Hospital Organization of Tokyo Hospital
cPresent address: Fukui Saiseikai Hospital

ABSTRACT

In January and February 2011, we experienced on 3 cases of severe pneumonia caused by influenza A (H1N1) 2009 pdm. The patients were 2 males and 1 female: 2 were obese, 2 with psychiatric disorders, 1 was diabetic, and 1 had been vaccinated for the influenza virus. The disease progressed in the 5 to 7 days from the onset of symptoms to admission with acute respiratory failure. Although nasal swab rapid-diagnostic tests were negative except for one patient, the final diagnosis of the other pneumonia was later made. A detection of the other RNA in two cases and with elevation of anti-H1 antibody titer by paired serum in the other. HRCT images demonstrated panlobular ground glass opacities in all cases. A transbronchial lung biopsy, performed in two cases, detected diffuse alveolar damage in one case and organizing pneumonia in the other. As for treatment, along with oseltamivir and/or peramivir applied as antiviral drugs, steroid pulse therapy and/or polymyxin-B direct hemoperfusion (PMX-DHP) therapy were applied in two cases. One patient was intubated and mechanically ventilated, and the other was noninvasively ventilated. All cases were fully recovered and discharged, although we experienced difficulty in initial diagnosis and treatment.

KEYWORDS

Influenza A (H1N1) 2009 pdm  Severe pneumonia  Combined modality therapy 

Received 6 Dec 2011 / Accepted 29 Mar 2012

AJRS, 1(7): 567-572, 2012

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