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High mortality from respiratory failure secondary to swine-origin influenza a (h1n1) in south africa

dc.contributor.authorKoegelenberg C.F.N.
dc.contributor.authorIrusen E.M.
dc.contributor.authorCooper R.
dc.contributor.authorDiacon A.H.
dc.contributor.authorTaljaard J.J.
dc.contributor.authorMowlana A.
dc.contributor.authorVon Groote-Bidlingmaier F.
dc.contributor.authorBolliger C.T.
dc.date.accessioned2011-05-15T16:17:47Z
dc.date.available2011-05-15T16:17:47Z
dc.date.issued2010
dc.identifier.citationQJM
dc.identifier.citation103
dc.identifier.citation5
dc.identifier.issn14602725
dc.identifier.other10.1093/qjmed/hcq022
dc.identifier.urihttp://hdl.handle.net/10019.1/14368
dc.description.abstractBackground: The novel influenza A (H1N1) pandemic affected South Africa late during the 2009 Southern hemisphere winter and placed an extra burden on a health care system already dealing with a high prevalence of chronic lung diseases and human immunodeficiency virus (HIV) infection.Aim: The aim of this study was to describe the epidemiological characteristics, clinical features, management and outcomes of patients with confirmed influenza A (H1N1) infection complicated by respiratory failure.Methods: We included all adult patients with confirmed influenza A (H1N1) infection that were referred to the medical intensive care unit of a large academic hospital in Cape Town for ventilatory support in this prospective observational study.Results: A total of 19 patients (39.5 ± 14.8 years) needed ventilatory support over a 6-week period. Of these, 15 were female and 16 had identifiable risk factors for severe disease, including pregnancy (n = 6), type 2 diabetes mellitus (n = 6), obesity (n = 4), HIV infection (n = 3), immunosuppressive therapy (n = 3) and active pulmonary tuberculosis (n = 2). The most frequent complications were acute renal failure (n = 13), acute respiratory distress syndrome (n = 12) and ventilator associated pneumonia (n = 10). Thirteen patients died (mortality: 68.4%). Fatal cases were significantly associated with an APACHE II score >20 (P = 0.034), but not with a PaO2/FIO2 <200 (P = 0.085) and a chest radiograph score >12 (P = 0.134).Conclusions: The majority of patients with respiratory failure secondary to influenza A (H1N1) infection were young females and had an underlying risk factor for severe disease. The condition had a high mortality, particularly amongst patients with an APACHE II score >20. © The Author 2010. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org.
dc.subjectazathioprine
dc.subjectcyclosporin
dc.subjectmethotrexate
dc.subjectmethylprednisolone
dc.subjectoseltamivir
dc.subjectprednisone
dc.subjecttacrolimus
dc.subjectacute kidney failure
dc.subjectadult
dc.subjectAPACHE
dc.subjectarticle
dc.subjectartificial ventilation
dc.subjectcause of death
dc.subjectclinical article
dc.subjectclinical feature
dc.subjectcontrolled study
dc.subjectdisease severity
dc.subjectfemale
dc.subjecthuman
dc.subjectHuman immunodeficiency virus infection
dc.subjectimmunosuppressive treatment
dc.subjectinfection risk
dc.subjectinfluenza A (H1N1)
dc.subjectlung tuberculosis
dc.subjectmale
dc.subjectmortality
dc.subjectnon insulin dependent diabetes mellitus
dc.subjectobesity
dc.subjectpregnancy
dc.subjectpriority journal
dc.subjectrespiratory distress
dc.subjectrespiratory failure
dc.subjectrheumatoid arthritis
dc.subjectrisk factor
dc.subjectsex difference
dc.subjectSouth Africa
dc.subjecttreatment duration
dc.subjectventilator associated pneumonia
dc.subjectAdult
dc.subjectAge Distribution
dc.subjectAged
dc.subjectDisease Outbreaks
dc.subjectFemale
dc.subjectHIV Seropositivity
dc.subjectHumans
dc.subjectInfluenza A Virus, H1N1 Subtype
dc.subjectInfluenza, Human
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectPregnancy
dc.subjectProspective Studies
dc.subjectRespiration, Artificial
dc.subjectRespiratory Insufficiency
dc.subjectRisk Factors
dc.subjectSeverity of Illness Index
dc.subjectSex Distribution
dc.subjectSouth Africa
dc.subjectYoung Adult
dc.titleHigh mortality from respiratory failure secondary to swine-origin influenza a (h1n1) in south africa
dc.typeArticle
dc.description.versionArticle


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