Influenza A (HlNl) 2009 Fatal Cases at Sisaket Hospital

Abstract

Background: Influenza A (HlNl) 2009 has spread globally including Thailand. In the year 2009 the world is at the start of the 2009 influenza pandemic. HlNl virus preferentially infects younger people. Most case of severe and fatal infections have been in adults between the ages of 30 and 50 years. Severe cases have occurred in people with underlying chronic conditions, most frequently seen include respiratory diseases , notably asthma . cardiovascular diseases , diabetes 1 autoimmune disorders and obesity. Around one third of the severe and fatal infections occurred in previously healthy people .Pregnant women are at increased risk of complications. WHO recommends treatment with Oseltamivir or Zanamivir as soon as possible for patients with symptoms of severe illness and patients with high risk including pregnant women 1 children under age 5 year and those with certain underlying medical conditions. Primary viral pneumonia is the most common finding in severe cases and a frequent cause of death. Secondary bacterial infections have been found in approximately 30% of fatal cases. Respiratory failure and refractory shock have been the most common causes of death.
Objectives: To evaluate the clinical features of the fatal cases of Influenza HlNl 2009 patients. And to identify the underlying conditions 1 risk factors , clinical courses , complications and causes of death.
Study Design: Retrospective descriptive study.
Method: Data were collected from patient’s charts. Of fatal cases diagnosed Influenza (HlNl) 2009 in Sisaket Hospital during 1st JAN 2009 to 30th DEC 2009 .
Result: From 66 patients diagnosed with Influenza HlNl 2009 1 6 were died , 4 females 2 males. Ages between 8 months and 43 years. 5 of 6 patients were referred from community hospital with respiratory failure. All of the patients had underlying diseases or risk factors. Two were children under 2 years 1 one pregnant woman 1 one alcoholic cirrhosis , one thalassemia s/p splenectomy 1 and the last was obesity with asthma. 4 of 6 developed ARDS. Hemoculture for bacteria was positive in 2 cases (Burkholderia pseudomallei and Streptococcus pneumoniae). Bacterial pneumonia superimposed was suspected in the others 3 cases. Throat swab was rechecked in 2 patients that were admitted more than 1 week. The result was negative.
Conclusion: In this study patients who were in high risk of severe and fatal illness including three groups : pregnant woman 1 especially during the third trimester , children younger than 2 years of age 1 and people with chronic diseases , including asthma. Bacterial superimposed infection was common. ARDS and septic shock were the common causes of death.