Clinical Manifestations of Emerged Novel Influenza A (H1N1) Patients

Abstract

Clinical Manifestations of Emerged Novel Influenza A (H1N1) Patients

Taweewong Tantracheewathorn  MD*

Dussadee Duangmanee             BNS**

Supapan Tantracheewathorn  MD*

* Department of Pediatrics, BMA Medical College and Vajira Hospital

** Infectious Control Unit, BMA Medical College and Vajira Hospital

Objectives: To study clinical manifestations, clinical course and treatment outcomes of pandemic emerged novel influenza A (H1N1) patients.

Study design: Descriptive study.

Subjects: One hundred of pandemic emerged novel influenza A (H1N1) patients treated at BMA Medical College and Vajira Hospital during May 1-August 31, 2009.

Methods: Data including age, gender, underlying diseases, history of contact, clinical manifestations, laboratory data, treatment outcomes from epidemiologic investigation report form of Infectious Control Unit, medical records and electronic database of BMA Medical College and Vajira Hospital were collected and analyzed.

Main outcome measures: signs, symptoms, laboratory results and treatment outcomes.

Results: From a total of 100 patients with a confirmed diagnosis, 40.0% were males. Mean age was 22.4 + 13.6 years (1.2-70.6 years). The common clinical manifestations were fever (91.9%), cough (97.0%), sore throat (79.8%), producing sputum (76.0%), headache (76.0%), rhinorrhea (71.0%), malaise (70.8%). Peak of clinical manifestations were on the 3^rd-4^th day of illness. Cough, producing sputum, sore throat, rhinorrhea, chills, headache, malaise and diarrhea on the 5^th-6^th day were statistically significantly decreased when compared to the 3^rd-4^th days. All, except superimposed nosocomial infectious patients were cured of the disease within the 7^th-8^th day. Seventy seven patients (77.0%) received oseltamivir and the average defervescence time was 2.1 + 1.1 days after receiving drug. The patients who received oseltamivir had significantly greater risk factors and complicated pneumonia but lesser sore throat, rhinorrhea, producing sputum and diarrhea on the 5^th-6^th day than the patients who did not received drug. Patients with complicated pneumonia (19.0%) had significantly more risk factors, tachypnea, and oseltamivir treatment within 48 hours after the disease onset than those without complication but treatment outcomes were not different. One case died from severe pneumonia and ARDS. This patient had Graves' disease complicating pregnancy. She received oseltamivir on the 6^th day after onset of illness.

Conclusion: The common clinical manifestations of pandemic emerged novel influenza A (H1N1) patients were fever, cough, producing sputum, sore throat, and headache. Peak of clinical manifestations were on the 3^rd-4^th day of illness and improvement occurred on the 5^th-6^th day. All, except superimposed nosocomial infectious patients, would be cured within the 7^th-8^th day. Oseltamivir significantly decreases the severity and duration of illness. The importance of treatment is to initiate oseltamivir as soon as possible especially within 48 hours after onset of illness.

Keywords: clinical manifestations, emerged novel Influenza A (H1N1)

Vajira Med J 2010 ; 54 : 109 - 122