SEVERE COMMUNITY-ACQUIRED PNEUMONIA IN PATIENTS WITH SEASONAL INFLUENZA
Keywords:
seasonal influenza, severe apneumoniaAbstract
Introduction: Seasonal influenza is most commonly presented as light upper respiratory disease. However, globally around 3-5 million severe cases and 290,000 – 650,000 deaths are registered during seasonal epidemics. Severe pneumonia is a common respiratory complication and the main cause for hospitalization and death.
Aim: To present the characteristics of patients with seasonal influenza and severe community-acquired pneumonia.
Materials and methods: A prospective, group-comparative clinical study was conducted at the Clinic for Infectious Diseases and Febrile Conditions in a three-year period. A total of 98 adult patients with clinically and laboratory-confirmed influenza and pneumonia as a complication were analyzed. The study included demographic and general data, clinical symptoms and signs, as well as complications. The influenza virus was confirmed through a nasopharyngeal swab using the method of real time RT-PCR (real-time reverse polymerase chain reaction).
Results: Severe pneumonia requiring extensive monitoring and treatment was registered in 32/98 (32.7%) patients, with a mean age of 54.6±16.9 years. ARDS as the most serious complication occurred in 7/32 (7.14%) patients. Diffuse bilateral consolidation was found only in patients with sCAP. In our study, the mortality rate in the group of patients with sCAP was 31.25%
Conclusion: Timely treatment, as well as determining the critical point when respiratory complications usually begin, is of crucial importance in preventing death in patients with seasonal nfluenza and severe pneumonia.
References
Thompson WW, Moore MR, Weintraub E, Cheng PY, Jin X, Bridges CB, et al. Estimating influenza-associated deaths in the United States. Am J Public Health 2009; 99 Suppl 2(Suppl 2): S225-S230. doi: 10.2105/AJPH.2008.151944.
Fraaij PL, Houmes RJ, Geukers VM, Gesink-van der Veer BJ, Kneyber MC, Tibboel D. 'Acute respiratory distress syndrome' (ARDS) als ernstige complicatie van influenza ['Acute respiratory distress syndrome' (ARDS) as a serious complication of influenza]. Ned Tijdschr Geneeskd 2010; 154: A1640. Dutch. PMID: 20619053.
Corrin B. Diffuse alveolar damage: the pathological basis of adult respiratory distress syndrome. In: Corrin B, editor. Pathology of the lungs. London: Churchill Livingston 2000;121–143.
Levy MM, Baylor MS, Bernard GR, Fowler R, Franks TJ, Hayden FG, et al. National Heart, Lung, and Blood Institute; Centers for Disease Control and Prevention; Institute of Allergy and Infectious Diseases. Clinical issues and research in respiratory failure from severe acute respiratory syndrome. Am J Respir Crit Care Med 2005; 171(5): 518-526. doi: 10.1164/rccm.200405-621WS.
Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, Hernandez M, Quiñones-Falconi F, Bautista E, et al. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med 2009; 361(7): 680-689. doi: 10.1056/NEJMoa0904252.
Loubet P, Samih-Lenzi N, Galtier F, Vanhems P, Loulergue P, Duval X, et al. Factors associated with poor outcomes among adults hospitalized for influenza in France: A three-year prospective multicenter study. J Clin Virol 2016; 79: 68-73. doi: 10.1016/j.jcv.2016.04.005.
Mata-Marín LA, Mata-Marín JA, Vásquez-Mota VC, Arroyo-Anduiza CI, Gaytán-Martínez JE, Manjarrez-Téllez B, et al. Risk factors associated with mortality in patients infected with influenza A/H1N1 in Mexico. BMC Res Notes 2015; 8: 432. doi: 10.1186/s13104-015-1349-8.
Cavallazzi R, Furmanek S, Arnold FW, Beavin LA, Wunderink RG, Niederman MS, et al. The Burden of Community-Acquired Pneumonia Requiring Admission to ICU in the United States. Chest 2020; 158(3): 1008-1016. doi: 10.1016/j.chest.2020.03.051.
Ferrer M, Travierso C, Cilloniz C, Gabarrus A, Ranzani OT, Polverino E, et al. Severe community-acquired pneumonia: Characteristics and prognostic factors in ventilated and non-ventilated patients. PLoS One 2018; 13(1): e0191721. doi: 10.1371/journal.pone.0191721.
Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44 Suppl 2(Suppl 2): S27-S72. doi: 10.1086/511159.
Chu S, Park SJ, Koo SM, Kim YK, Kim KU, Uh ST, et al. Incidence and Risk Factors of Pneumonia in Hospitalized Patients with Seasonal Influenza A or B. Tuberc Respir Dis (Seoul) 2017; 80(4): 392-400. doi: 10.4046/trd.2016.0015.
Garg S, Jain S, Dawood FS, Jhung M, Pérez A, D'Mello T, et al. Pneumonia among adults hospitalized with laboratory-confirmed seasonal influenza virus infection-United States, 2005-2008. BMC Infect Dis 2015; 15: 369. doi: 10.1186/s12879-015-1004-y.
Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 2019; 200(7): e45-e67. doi: 10.1164/rccm.201908-1581ST.
Nardocci P, Gullo CE, Lobo SM. Severe virus influenza A H1N1 related pneumonia and community-acquired pneumonia: differences in the evolution. Rev Bras Ter Intensiva 2013; 25(2): 123-129. doi: 10.5935/0103-507X.20130023.
Martin-Loeches I, Torres A, Nagavci B, Aliberti S, Antonelli M, Bassetti M, et al. ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia. Intensive Care Med 2023; 49(6): 615-632. doi: 10.1007/s00134-023-07033-8.
Funaki T, Shoji K, Yotani N, Katsuta T, Miyazaki O, Nosaka S, et al. The value of radiographic findings for the progression of pandemic 2009 influenza A/H1N1 virus infection. BMC Infect Dis 2013; 13: 516. doi: 10.1186/1471-2334-13-516.
Kumar S, Havens PL, Chusid MJ, Willoughby RE Jr, Simpson P, Henrickson KJ. Clinical and epidemiologic characteristics of children hospitalized with 2009 pandemic H1N1 influenza A infection. Pediatr Infect Dis J 2010; 29(7): 591-594. doi: 10.1097/inf.0b013e3181d73e32.
Cui W, Zhao H, Lu X, Wen Y, Zhou Y, Deng B, et al. Factors associated with death in hospitalized pneumonia patients with 2009 H1N1 influenza in Shenyang, China. BMC Infect Dis 2010; 10: 145. doi: 10.1186/1471-2334-10-145.
Chien YS, Su CP, Tsai HT, Huang AS, Lien CE, Hung MN, et al. Predictors and outcomes of respiratory failure among hospitalized pneumonia patients with 2009 H1N1 influenza in Taiwan. J Infect 2010; 60(2): 168-174. doi: 10.1016/j.jinf.2009.12.012.
Palacios G, Hornig M, Cisterna D, Savji N, Bussetti AV, Kapoor V, et al. Streptococcus pneumoniae coinfection is correlated with the severity of H1N1 pandemic influenza. PLoS One 2009; 4(12): e8540. doi: 10.1371/journal.pone.0008540.
Cao B, Li XW, Mao Y, Wang J, Lu HZ, Chen YS, et al. Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China. N Engl J Med 2009; 361(26): 2507-2517. doi: 10.1056/NEJMoa0906612.
Kumar A, Zarychanski R, Pinto R, Cook DJ, Marshall J, Lacroix J, et al. Critically ill patients with 2009 influenza A(H1N1) infection in Canada. JAMA 2009; 302(17): 1872-1879. doi: 10.1001/jama.2009.1496.
Kalyanil D, Srikanth BS, Chitralekha T, et al. Comorbidities In H1N1 Positive Patients-Hospital Based Study, IOSR. Journal of Dental and Medical Sciences 2011; 15: 52-55.
Campbell A, Rodin R, Kropp R, Mao Y, Hong Z, Vachon J, et al. Risk of severe outcomes among patients admitted to hospital with pandemic (H1N1) influenza. CMAJ 2010; 182(4): 349-355. doi: 10.1503/cmaj.091823.
Self WH, Wunderink RG, Williams DJ, Zhu Y, Anderson EJ, Balk RA, et al. Staphylococcus aureus Community-acquired Pneumonia: Prevalence, Clinical Characteristics, and Outcomes. Clin Infect Dis 2016; 63(3): 300-309. doi: 10.1093/cid/ciw300.
Teng F, Liu X, Guo SB, Li Z, Ji WQ, Zhang F, et al. Community-acquired bacterial co-infection predicts severity and mortality in influenza-associated pneumonia admitted patients. J Infect Chemother 2019; 25(2): 129-136. doi: 10.1016/j.jiac.2018.10.014.
Witczak A, Prystupa A, Kurys-Denis E, Borys M, Czuczwar M, Niemcewicz M, et al. Acute respiratory distress syndrome (ARDS) complicating influenza A/H1N1v infection--a clinical approach. Ann Agric Environ Med 2013; 20(4): 820-822. PMID: 24364461.
Töpfer L, Menk M, Weber-Carstens S, Spies C, Wernecke KD, Uhrig A, et al. Influenza A (H1N1) vs non-H1N1 ARDS: analysis of clinical course. J Crit Care 2014; 29(3): 340-346. doi: 10.1016/j.jcrc.2013.12.013.
BinSaeed AA. Characteristics of pandemic influenza A (H1N1) infection in patients presenting to a university hospital in Riyadh, Saudi Arabia. Ann Saudi Med 2010; 30(1): 59-62. doi: 10.4103/0256-4947.59377.
Domínguez-Cherit G, Lapinsky SE, Macias AE, Pinto R, Espinosa-Perez L, et al. Critically Ill patients with 2009 influenza A(H1N1) in Mexico. JAMA 2009; 302(17): 1880-1887. doi: 10.1001/jama.2009.1536.
Timothy M. U, Henry H. B, John S. B, Janet A. E, Thomas M. F. J, Alicia M. F, Stefan G, Frederick G. H, Scott A. H, Jon Mark H, Michael G. I, B. Lynn J, Shandra L. K, Allison McG, Laura E. R, Cameron R. W, Paul E. A, Andrew T. P. Clinical Practice Guidelines for the Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza: 2018 Update by IDSA.Clinical Infectious Diseases, 2019; 68(6): e1-e47.
Muthuri SG, Venkatesan S, Myles PR, Leonardi-Bee J, Al Khuwaitir TS, Al Mamun A, et al. Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data. Lancet Respir Med 2014; 2(5): 395-404. doi: 10.1016/S2213-2600(14)70041-4.
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Copyright (c) 2026 Marija Cvetanovska, Cana Fadil, Ilir Demiri, Vlatko Cvetanovski , Marija Dimzova, Borislav Kondov , Mesut Hasipi , Vladimir Vasilev
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