High mortality from respiratory failure secondary to swine-origin influenza a (h1n1) in south africa
Date
2010
Authors
Koegelenberg C.F.N.
Irusen E.M.
Cooper R.
Diacon A.H.
Taljaard J.J.
Mowlana A.
Von Groote-Bidlingmaier F.
Bolliger C.T.
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Background: 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.
Description
Keywords
azathioprine, cyclosporin, methotrexate, methylprednisolone, oseltamivir, prednisone, tacrolimus, acute kidney failure, adult, APACHE, article, artificial ventilation, cause of death, clinical article, clinical feature, controlled study, disease severity, female, human, Human immunodeficiency virus infection, immunosuppressive treatment, infection risk, influenza A (H1N1), lung tuberculosis, male, mortality, non insulin dependent diabetes mellitus, obesity, pregnancy, priority journal, respiratory distress, respiratory failure, rheumatoid arthritis, risk factor, sex difference, South Africa, treatment duration, ventilator associated pneumonia, Adult, Age Distribution, Aged, Disease Outbreaks, Female, HIV Seropositivity, Humans, Influenza A Virus, H1N1 Subtype, Influenza, Human, Male, Middle Aged, Pregnancy, Prospective Studies, Respiration, Artificial, Respiratory Insufficiency, Risk Factors, Severity of Illness Index, Sex Distribution, South Africa, Young Adult
Citation
QJM
103
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103
5