Terapevticheskii arkhivTerapevticheskii arkhiv0040-36602309-5342LLC Obyedinennaya Redaktsiya30696Outcomes of severe pandemic influenza A/H1N1/2009KlimovaElena Anatol'evnaelena_klimova@mail.ruYushchukNikolay Dmitrievichmsmsu_rector@mtu-net.ruKaretkinaGalina Nikolaevnakaretkinagn@mail.ruBoytsovPavel Vladimirovichikb1@mosgorzdrav.ruSerobyanAvet Grigor'evichikb1@mosgorzdrav.ruKelliElena Ivanovnaekelly@yandex.ruMalyshevNikolay Aleksandrovichikb1@mosgorzdrav.ruGolokhvastovaNatal'ya Olegovnapavo@mail.ruEsaulovaMadina Ruslanovnaemadina@inbox.ruKarchevskayaNatal'ya Anatol'evnakarchevskaia@mail.ruAvdeevSergey Nikolaevichserg_avdeev@list.ruKlimovaE AMoscow State University of Medicine and Dentistry-YushchukN DMoscow State University of Medicine and Dentistry-KaretkinaG NMoscow State University of Medicine and Dentistry-BoitsovP VInfectious Clinical Hospital One-SerobyanA GInfectious Clinical Hospital One-KelliE IInfectious Clinical Hospital One-MalyshevN AInfectious Clinical Hospital One-GolokhvastovaN OMoscow State University of Medicine and Dentistry-EsaulovaM RInfectious Clinical Hospital One-KarchevskayaN AResearch Institute of Pulmonology, Federal Biomedical Agency-AvdeyevS NResearch Institute of Pulmonology, Federal Biomedical Agency-Moscow State University of Medicine and DentistryInfectious Clinical Hospital OneResearch Institute of Pulmonology, Federal Biomedical Agency151120108211151809042020Copyright © 2010, Consilium Medicum2010Aim. To study the outcomes of severe pandemic influenza A/H1N1/2009.
Subjects and methods. The study enrolled 24 patients, including 8 males and 16 females (10 of whom were pregnant), aged 17 to 58 years, with a laboratorily verified diagnosis of pandemic influenza A/H1N1/2009, treated at the intensive care unit for the significant symptoms of acute respiratory failure (RF). Real-time RT-PCR was used to verify the diagnosis. Organs and tissues from deceased patients were histologically studied; chest computed tomography, body plethysmography, fibrobronchoscopy, breath test, and 6-minute walk test were performed in the late period.
Results. Within the first 30 days, a fatal outcome caused by therapy-resistant progressive RF was observed in 33% of the patients with pandemic influenza treated at the intensive care unit. Diffuse alveolar damage caused by influenza virus, which gives rise to hyaline membranes, underlies RF. Lung tissue fibrosis formed in recovered patients.
Conclusion. The severity of pandemic influenza A/H1N1/2009 was determined by massive bilateral pneumonia, interstitial (alveolar) pulmonary edema, formation of diffuse bilateral lung fibrosis at the outcome of severe virus pneumonia (acute respiratory distress syndrome) with a decrease in vital and diffusing capacities, thereby generating a need to follow up this patient category and, possibly, to elaborate special rehabilitation programs.influenzapandemicacute respiratory distress syndromediffuse alveolar damagelung fibrosisгрипппандемияОРДСдиффузное альвеолярное повреждениефиброз легких[Онищенко Г. Г. Эпидемическая ситуация по гриппу, вызванному высокопатогенным вирусом типа A(H1N1) в Российской Федерации и в мире. Журн. микробиол. 2010; 1: 3-9.][Киселев О. И., Ершов Ф. И., Быков А. Т., Покровский В. И. Пандемия гриппа 2009/10: противовирусная терапия и тактика лечения. СПб.: НИИ гриппа СЗО РАМН; 2010.][CDC news conference with Thomas R. Frieden, Centers for Disease Control and Prevention, Dec. 10, 2009. CDC web site, "CDC Estimates of 2009 H1N1 Influenza Cases, Hospitalizations and Deaths in the United States, April-November 14, 2009", Dec. 10, 2009. http:flu.gov/individualfamily/about/ h1n1/estimates_2009_h1n1.html.][CDC estimates of 2009 H1N1 influenza cases, hospitalizations and deaths in the United States, April 2009-February 13, 2010. Atlanta: Centers for Disease Control and Prevention, 2010. (Accessed April 9, 2010, at http://flu.gov/individualfamily/about/h1n1/estimates_2009_h1n1.html).][Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza. Clinical aspects of pandemic 2009 influenza A(H1N1) virus infection. N. Engl. J. Med. 2010; 362:1708-1719.][CDC, Influenza Division. FluView. Available at: http:// www.cdc.gov/flu/weekly/Accessed September 16, 2009.][Гендон Ю. З. Проблема профилактики гриппа у беременных женщин и новорожденных детей. Вопр. вирусол. 2009; 2: 4-10.][Jamieson D. J., Honein M. A., Rasmussen S. A. et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet 2009; 374: 451-458.][Mangtani P., Mak T. K., Pfeifer D. Pandemic H1N1 infection in pregnant women in the USA. Lancet 2009; 374: 429-430.]