Novel influenza A (H1N1) virus is the pathogen of recent global outbreaks of febrile respiratory infection. We herein report the imaging findings of pulmonary complication in two patients with novel influenza A (H1N1) infection. The first patient without secondary infection showed the ill-defined ground-glass opacity nodules and patch areas of ground-glass opacities. The second patient with secondary pneumococcal pneumonia showed areas of lobar consolidation in the right middle lobe and left lower lobe and ground-glass opacities.
Adolescent ; Adult ; Female ; Humans ; *Influenza A Virus, H1N1 Subtype ; Influenza, Human/complications/drug therapy/*radiography/virology ; Lung/*radiography/virology ; Pneumonia, Pneumococcal/drug therapy/*radiography ; Radiography, Thoracic ; Reverse Transcriptase Polymerase Chain Reaction ; *Tomography, X-Ray Computed

Leukocytoclastic vasculitis (LCV) usually presents palpable purpura characterized by inflammation of vessel walls and fragmentation of nuclei. Various conditions can cause LCV, and it can be induced by influenza A virus infection. We report a 2-yr-old Korean girl who presented palpable purpuric and hemorrhagic lesions with fever. She was diagnosed as LCV by skin biopsy, and influenza A virus was isolated from nasopharyngeal swab. She was treated with oseltamivir (Tamiflu(R)) and prednisolone with dramatic effect of vasculitis and fever.
Anti-Inflammatory Agents/therapeutic use ; Antiviral Agents/therapeutic use ; Child, Preschool ; Female ; Fever/etiology ; Humans ; Influenza A virus/*genetics/isolation & purification ; Influenza, Human/*complications/drug therapy/virology ; Nasopharynx/virology ; Oseltamivir/therapeutic use ; Prednisolone/therapeutic use ; Reverse Transcriptase Polymerase Chain Reaction ; Skin/pathology ; Vasculitis, Leukocytoclastic, Cutaneous/*diagnosis/drug therapy/etiology

PURPOSE: Pneumonia was an important cause of death in 2009 H1N1 influenza pandemic (pH1N1). Clinical characteristics of pH1N1 have been described well, but discriminative characteristics suggesting pH1N1 infection in pneumonia patients are not evident today. We evaluated differences between clinical and radiologic characteristics for those associated and not associated with pH1N1 influenza during the pandemic period. MATERIALS AND METHODS: We reviewed all patients with pneumonia who visited the Armed Forces Capital Hospital between July 2009 and February 2010. During this period, all pneumonia patients were tested for pH1N1 by reverse transcription-polymerase chain reaction (RT-PCR) using nasopharyngeal specimens. RESULTS: In total, 98 patients with pneumonia were enrolled. Their median age was 20 years and all patients were males. Forty-nine (50%) of patients had pH1N1 infection and the others (50%) had negative results in pH1N1 RT-PCR. Patients with pH1N1 infection complained of dyspnea more commonly (83.3% vs. 29.0%; p<0.001), had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores [5 (range, 0-12) vs. 3 (range, 0-11); p<0.01], fewer days of prehospital illness [2 (range, 0-10) vs. 4 (range, 0-14); p=0.001], and a higher chance of bilateral infiltrates on chest X-ray (CXR) (67.3% vs. 14.3%; p<0.001) and ground-glass opacity (GGO) lesions on computed tomography (CT; 48.9% vs. 22.0%; p<0.001) than patients without pH1N1 infection. CONCLUSION: Dyspnea, bilateral infiltrates on CXR, and GGO on CT were dominant features in pH1N1-associated pneumonia. Understanding these characteristics can help selection of patients who require prompt antiviral therapy.
Adolescent ; Adult ; Antiviral Agents/therapeutic use ; Dyspnea/virology ; Humans ; Influenza A Virus, H1N1 Subtype/genetics/*pathogenicity ; Influenza, Human/*complications/radiography/virology ; Male ; Middle Aged ; Pneumonia/etiology/radiography ; Pneumonia, Viral/drug therapy/etiology/*radiography/*virology ; Radiography, Thoracic ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo summarize and analyze the clinical characteristics and diagnostic and therapeutic measures for the first human case of H5N1 avian influenza pneumonia in mainland of China.

METHODSThe clinical data of the first case of H5N1 avian influenza virus infection in China were analyzed and summarized.

RESULTSThe case is a 9-year old boy, who developed acute symptoms of a light common respiratory infection, including fever and dry cough without obvious catarrh. On the 7th day after onset, his temperature reached 40 degrees C, tachypnea occurred, distinct rales could be heard and large areas of consolidation were seen in the lungs on chest X-ray. The patient's peripheral blood leukocyte count was 2.81 x 10(9)/L and neutrophils dominated. After comprehensive therapeutic approaches, including antiviral therapy (amantadine) and use of low-dosage glucocorticoid, the patient's temperature returned to normal on the 3rd hospitalization day, chest X-ray showed absorbed inflammatory change on the 5th day after admission, and leukocyte count became normal on the 6th day. No complication occurred during the whole course. The case was diagnosed by the 4 fold raised antibody to the H5N1 influenza virus in recovery stage serum because the H5N1 nucleic acid test in early stage was negative. The case was cured and discharged after 3 weeks comprehensive treatment.

CONCLUSIONSIt is very important for clinicians to pay enough attention to epidemiological history, especially history of exposure to avian influenza virus contaminated material, which will be very helpful for early detection, early diagnosis of the disease, and also very important for effective treatment and better prognosis.

Amantadine ; therapeutic use ; Animals ; Antibodies, Viral ; blood ; immunology ; Antiviral Agents ; therapeutic use ; Birds ; Child ; China ; Glucocorticoids ; therapeutic use ; Humans ; Influenza A Virus, H5N1 Subtype ; immunology ; isolation & purification ; Influenza in Birds ; transmission ; Influenza, Human ; complications ; diagnosis ; Male ; Pneumonia ; diagnosis ; drug therapy ; physiopathology ; virology ; Treatment Outcome