Long-term respiratory follow-up of H1N1 infection

Abstract

Background: The first case of 2009 pandemic influenza A (H1N1) virus infection was documented in our Hospital on 10th August 2009.

Methods and findings: Real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) testing was used to confirm the diagnosis. All patients were treated with oseltamivir from the first day of hospitalization. Upon admission 12/44 had local patchy shadowing in their chest x-ray and additionally antibiotic regimen was added to these patients as pneumonia was suspected based on clinical evidence. In total 44 patients were hospitalized 15/44 had asthma, 6/44 COPD, 5/44 leukemia. Lung function was evaluated with forced vital capacity, forced expiratory volume in 1 sec and diffused carbon monoxide upon discharge and every 3 months, until 6 months of observation was completed after discharge. The purpose of this retrospective cohort study was to evaluate whether influenza A (H1N1) had an impact on the respiratory capacity of the infected patients.

Conclusions: An improvement of pulmonary function tests was observed between the first two measurements, implicating an inflammatory pathogenesis of influenza A (H1N1) to the respiratory tract. This inflammation was not associated with the severity or clinical outcome of the patients. All patients had a mild clinical course and their respiratory capacity was stable between the second and third measurement, suggesting that the duration of respiratory inflammation was two months. Early treatment with antiviral agents and vaccination represent the mainstay of management.

Figure 1

Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 sec (FEV1), Carbon Monoxide Diffusing Capacity (DLCO) mean values for patients with Chronic Obstructive Pulmonary Disease (COPD), patients with Asthma, patients without any respiratory disease (NO RD), patients with co-morbidities.