Caracterización demográfica y clínica de pacientes críticos con neumonía por influenza A H1N1 / Demographic and clinical characterization of critically ill patients with influenza A H1N1 pneumonia

INTRODUCCIÓN. La epidemia de influenza y sus complicaciones profundizaron el estudio de las neumonías virales en cuidados intensivos. En nuestro país hay pocos datos sobre este tema. OBJETIVOS. Realizar una caracterización demográfica y clínica de pacientes críticos con neumonía por Influenza A H1N1 en un hospital de tercer nivel de complejidad. MATERIALES Y MÉTODOS. Estudio observacional, analítico, retrospectivo, con análisis univariante y multivariante. Población de 293 y muestra de 44 datos de historias clínicas electrónicas de pacientes diagnosticados con A H1N1 ingresados a la Unidad de cuidados intensivos del Hospital de Especialidades Carlos Andrade Marín en el período enero 2016 a diciembre de 2018. Como criterios de inclusión se consideró a todos los pacientes adultos mayores de 18 años que ingresaron a la UCI, con el diagnóstico de neumonía comunitaria grave con confirmación por reacción de cadena de polimerasa en tiempo real para influenza A H1N1 en hisopado nasal o aspirado traqueal. Se excluyó a pacientes embarazadas con diagnóstico de influenza A H1N1, pacientes con más de 48 horas de ingreso hospitalario previo a su ingreso a UCI, pacientes con datos insuficientes en los registros. Los datos se obtuvieron del sistema AS-400. El análisis estadístico se realizó en el programa Statistical Package for Social Sciences, versión 22. El nivel de significación fue una p<0.05. RESULTADOS. La prevalencia en pacientes críticos de neumonía por influenza A H1N1 durante 2016-2018 fue de 16,72%, la mediana de edad fue de 55 años, 25% masculinos, 34% obesos, 34% con hipertensión arterial. Escala "Acute Physiology and Chronic Health Evaluation II" 23,50, "Simplified Acute Physiologic Score III" 54, "Sepsis related Organ Failure Assessment" 11,50, Lactato deshidrogenasa 99,50, Procalcitonina 0,99; 9 días de ventilación mecánica invasiva, 10,50 días de estancia en la unidad. El 91% presentó shock séptico, 59% lesión renal aguda. El 89% tuvo Síndrome de Distrés Respiratorio del Adultos, 69% fue grave, 87% usó ventilación mecánica, 38,50% corticoides, 36% posición prona, Presión parcial de oxígeno/Fracción inspirada de oxígeno 74, volumen tidal/kilogramo de 7 mililitros, presión plateau de 27,50 centímetros de agua. La mortalidad general en la Unidad de Cuidados Intensivos fue de 38,63% y a los 28 días de 63,60%, en shock séptico fue 42,50% y en Síndrome de Distrés Respiratorio del Adultos del 41,02%. El análisis de regresión logística multivariable identificó como factores independientes asociados a mortalidad el incremento de Lactato deshidrogenasa (OR 2,69, 9% IC 1,090-6,642) y Procalcitonina (OR 2,51, IC 1,005-6,272). CONCLUSIONES. Las características, frecuencia y mortalidad de este grupo de pacientes críticos con neumonía por influenza A H1N1 son similares a lo reportado en la literatura mundial.

INTRODUCTION. The influenza epidemic and its complications deepened the study of viral pneumonias in intensive care. In our country there is little data on this subject. OBJECTIVES. To perform a demographic and clinical characterization of critical patients with pneumonia due to pneumonia due to Influenza A H1N1 in a third level hospital. MATERIALS AND METHODS. Observational, analytical, retrospective study, with univariate and multivariate analysis. We compared the groups of dead patients and survivors. The significance level was p<0,05. RESULTS. The prevalence in critically ill patients of influenza A H1N1 pneumonia during 2016-2018 was 16,72%, 44 cases were collected, median age 55 years, 25% male, 34% obese, 34% with arterial hypertension. APACHE II 23,50, SAPS III 54, SOFA 11,50, LDH 99,50, PCT 0,99, 9 days of invasive mechanical ventilation, 10,50 days of unit stay. 91% presented septic shock, 59% with acute kidney injury 89% had ARDS, 69% were severe, 87% used mechanical ventilation, 38,50% corticosteroids, 36% prone position, PaO2/FiO2 74, tidal volume/kg of 7 ml, plateau pressure of 27,50 cmH2O. Overall mortality in the ICU was 38,63% and at 28 days was 63,60%, in septic shock it was 42,50% and in Adult Respiratory Distress Syndrome it was 42,50%. was 42,50% and 41,02% in Adult Respiratory Distress Syndrome. The ultivariate logistic regression analysis identified as independent factors associated with mortality, the increase in LDH (OR 2,69, 9% CI 1,090-6,642) and PCT (OR 2,51, CI 1,005-6,272). CONCLUSIONS. The characteristics, frequency and mortality of this group of critical patients with pneumonia due to influenza A H1N1 are similar to those reported in the world literature.

A recursive sub-typing screening surveillance system detects the appearance of the ZIKV African lineage in Brazil: Is there a risk of a new epidemic?

There is currently no system to track the emergence of Zika virus (ZIKV) subtypes. We developed a surveillance system able to retrieve sequence submissions and further classify distinct ZIKV genotypes in the world. This approach was able to detect a new occurrence of ZIKV from an African lineage in Brazil in 2019.

Characterization of influenza A(H1N1)pdm09 isolates of Peru using HRM, a post PCR molecular biology method.

Influenza caused by A(H1N1)pdm09 is a public health issue with severe conditions in vulnerable populations leading to death. Therefore, it is of interest to characterize and monitor influenza A(H1N1)pdm09 genotypes using High Resolution Melting (HRM), a post PCR molecular biology method. We used HRM analysis (using RotorGene Q thermocycler) to characterize A(H1N1)pdm09 genotypes from several places of Peru. RNA was purified from nasal and pharyngeal swab samples referred to LRNVR-INS, synthesized cDNA, and then the hemagglutinin gene and matrix fragment were amplified. Thus, 287 samples positive for influenza A(H1N1)pdm09 were identified across Peru where places like Lima, Piura, and Arequipa documented highest number of cases. The HRM data was analyzed and results showed different profiles which were further grouped into four genotypes for the HA (A, B, C, D) and 3 for the M (a, b, c) genes. We also report ten genotypes (I-X) of virus using combined HA (hemagglutinin) and M gene profiles representing a national geography. The prevalent genotypes are I and II with a frequency of 35.89% (103) and 29.27% (84), respectively linking with severe acute respiratory infection.

[Clinical characteristics of pediatric patients treated for influenza A (H1N1). The 2009 pandemic in Mexico]. / Características de los pacientes pediátricos atendidos por influenza A H1N1. La pandemia de 2009 en México.

BACKGROUND: Pandemic influenza A (H1N1) virus was first reported in April 2009. The aim of this study is to describe the clinical course of patients with influenza-like illness treated in a tertiary care pediatric hospital. METHODS: Cross-sectional analytical study, encompassing the period from April 2009 to March 2010. Clinical and demographic information was obtained from clinical records. Data analysis was carried out using descriptive statistics, using a univariate analysis with the chi-square test, the exact Fisher test, and the Mann-Whitney U test for quantitative variables. RESULTS: 240 patients were included, out of which 53.9 % were female; median age was 5 years. Sixty four cases (26.6 %) were confirmed, 38 % had and underlying condition, and 10 % had received the influenza vaccine. One hundred and sixteen patients (48 %) were hospitalized. With regard to mortality, 10 out of 64 confirmed cases died, 3 of the 86 of the disregarded cases, and 2 of 90 without a confirmatory test died (p < 0.05). The patients who died started antiviral treatment on day 7; conversely, those who survived started the treatment on day 4 (p < 0.05). CONCLUSIONS: Lethality was higher in patients with confirmed infection. Antiviral treatment within the first 48 hours was observed to be essential for patients with risk for the development of complications.

INTRODUCCIÓN: en abril de 2009 se informó por primera vez del virus pandémico de la influenza A H1N1. El objetivo del presente estudio es describir el curso clínico de los pacientes atendidos con enfermedad tipo influenza en un hospital pediátrico de tercer nivel. MÉTODOS: estudio transversal analítico que comprendió el periodo de abril de 2009 a marzo de 2010. La información clínica y demográfica se obtuvo de los expedientes clínicos. El análisis de los datos se llevó a cabo mediante estadística descriptiva e inferencial, para lo cual se aplicó análisis univariado mediante chi cuadrada, prueba exacta de Fisher y U de Mann-Whitney para las variables cuantitativas. RESULTADOS: se incluyeron 240 pacientes, 53.9 % del sexo femenino; la mediana de la edad fue de cinco años. Se confirmaron 64 casos (26.6 %), 38 % tenía enfermedad subyacente y 10 % había sido vacunado contra el virus de la influenza. Fueron hospitalizados 116 pacientes (48 %). Respecto a la mortalidad, 10 casos fallecieron de los 64 confirmados, tres de los 86 casos descartados y dos de los 90 que carecían de prueba confirmatoria (p < 0.05). Los pacientes que fallecieron iniciaron tratamiento antiviral el séptimo día; por su parte, los que no fallecieron iniciaron el tratamiento en el cuarto día (p < 0.05). CONCLUSIONES: la letalidad fue mayor en los pacientes con infección confirmada. Se observó que el tratamiento antiviral en las primeras 48 horas es esencial para los pacientes con riesgo para desarrollar complicaciones.

Estudio comparativo entre una prueba rápida y RT-PCR tiempo real en el diagnóstico de influenza AH1N1 2009 / Comparative study of a rapid testing with real time RT-PCR for diagnosis of influenza AH1N1 2009

OBJETIVO: Comparar la prueba QuickVue Influenza A+B empleando como estándar la RT-PCR tiempo real para influenza AH1N1 2009. MATERIAL Y MÉTODOS: Estudio retrospectivo-comparativo de 135 muestras de vías respiratorias de individuos sintomáticos para influenza procesadas de mayo 2009 a octubre 2010.Las pruebas citadas se realizaron simultáneamente. Se utilizó el software Confidence Interval Analysis 2000. RESULTADOS: Sensibilidad 62.96; especificidad 94.44; valor predictivo negativo 62.9; valor predictivo positivo 94.44; razón de probabilidad positiva 11.33 y razón de probabilidad negativa 0.39. Se calcularon intervalos de confianza a 95. DISCUSIÓN: Los valores obtenidos concuerdan con otros estudios donde la sensibilidad fluctúa de 50 a 70 y especificidad entre 90 y 95 por ciento. La prueba QuickVue Influenza A+B es rápida, simple y de menor costo que el RT-PCR tiempo real, útil para identificar el tipo de virus en brotes de influenza de una población determinada.

OBJECTIVE: Compare QuickVue Influenza A+B test with real-time RT-PCR for the diagnosis of influenza AH1N1 2009. MATERIAL AND METHODS: Retrospective-comparative study of 135 respiratory specimens from individuals with symptoms of influenza processed from May 2009 to October 2010.The above mentioned tests were performed simultaneously. For statistic analysisthe softwareof Confidence IntervalAnalysis 2000 was used. RESULTS: The parameters obtained were: sensitivity 62.96; specificity 94.44; negative predictive value 62.9; positive predictive value 94.44; positive likelihood ratio 11.33; negative likelihood ratio 0.39. Confidence intervals to 95,were calculated to all of the above data. DISCUSSION: The test QuickVue InfluenzaA+B is a rapid,simple test,with lower cost than real-time RT-PCR useful for identifying the type of virus outbreaks of influenza in a given population.It correlates well with more specific test and similar reports.

Manifestações da infecção pelo novo vírus influenza A (H1N1) na tomografia computadorizada de tórax / Manifestations of infection by the novel influenza A (H1N1) virus at chest computed tomography

OBJETIVO: Descrever as alterações na tomografia computadorizada de tórax de casos comprovados de infecção pelo novo vírus influenza A (H1N1). MATERIAIS E MÉTODOS: Três observadores avaliaram, em consenso, nove tomografias computadorizadas de pacientes com infecção pelo vírus influenza A (H1N1) comprovada laboratorialmente. A idade dos pacientes variou de 14 a 64 anos (média de 40 anos), sendo cinco do sexo masculino e quatro do sexo feminino. Quatro pacientes eram previamente hígidos, quatro eram transplantados renais e uma era gestante à época do diagnóstico. Foram avaliadas a presença, a extensão e a distribuição de: a) opacidades em vidro fosco; b) nódulos centrolobulares; c) consolidações; d) espessamento de septos interlobulares; e) derrame pleural; f) linfonodomegalias. RESULTADOS: As alterações mais frequentemente encontradas foram opacidades em vidro fosco, nódulos centrolobulares e consolidações, presentes em nove (100 por cento), cinco (55 por cento) e quatro (44 por cento) dos casos, respectivamente. Derrames pleurais e linfonodomegalias foram menos comuns, ocorrendo em apenas dois (22 por cento) dos casos estudados. CONCLUSÃO: Os achados mais comuns nos casos de infecção pelo novo vírus influenza A (H1N1) foram opacidades em vidro fosco, nódulos centrolobulares e consolidações. Estas alterações não são típicas ou únicas a este agente, podendo ocorrer também em outras infecções virais ou bacterianas.

OBJECTIVE: The objective of this study was to describe chest computed tomography findings in confirmed cases of infection by the novel influenza A (H1N1) virus. MATERIALS AND METHODS: Computed tomography studies of nine patients with laboratory-confirmed infection by the novel influenza A (H1N1) virus were consensually evaluated by three observers. The sample of the present study included five male and four female patients with ages ranging from 14 to 64 years (mean, 40 years). Four of the patients were previously healthy, four were kidney transplant recipients and one was pregnant at the time of diagnosis. Presence, extent and distribution of the following findings were evaluated: a) ground-glass opacities; b) centrilobular nodules; c) consolidation; d) interlobular septa thickening; e) pleural effusion; f) lymphadenopathy. RESULTS: The most frequent findings were ground-glass opacities, centrilobular nodules and consolidations, present in nine (100 percent), five (55 percent) and four (44 percent) of cases, respectively. Pleural effusions and lymphadenopathy were less common findings, occurring in only two (22 percent) of the cases. CONCLUSION: Ground-glass opacities, centrilobular nodules and consolidation were the most frequent findings in cases of infection by the novel influenza A (H1N1) virus. These changes are not typical or unique to this agent and may also occur in other viral or bacterial infections.