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Case Reports
. 2016 May 24:19:1-4.
doi: 10.1016/j.rmcr.2016.05.005. eCollection 2016.

Association of influenza with severe pneumonia/empyema in the community, hospital, and healthcare-associated setting

Masafumi Seki  1 , Ryota Fuke  1 , Nozomi Oikawa  2 , Maya Hariu  2 , Yuji Watanabe  2
Affiliations
Case Reports

Association of influenza with severe pneumonia/empyema in the community, hospital, and healthcare-associated setting

Masafumi Seki et al. Respir Med Case Rep. .

Abstract

We presented three cases of influenza-related severe pneumonia/empyema that occurred in one season.

Case 1: A 76-year-old diabetic man, developed empyema as a result of severe community-acquired pneumonia (CAP) secondary to Haemophilus influenzae, as confirmed on sputum culture. Nasal swab was positive for influenza A antigen. After drainage of empyema, intravenous peramivir and piperacillin/tazobactam were administered for 3 days and 2 weeks, respectively, followed by oral levofloxacin for 2 weeks. Eventually, he recovered. In this case, the isolated H. influenzae was non-typeable and negative for beta-lactamase.

Case 2: A 55-year-old man with suspected cerebral infarction and diabetes mellitus (DM) developed severe pneumonia/empyema as result of hospital-acquired pneumonia (HAP). Although influenza A antigen was detected, no bacterium was isolated from the sputum, blood, or pleural effusion. He showed severe hypoxia, but recovered after administration of peramivir and levofloxacin with prednisolone for 5 days and 2 weeks, respectively.

Case 3: A 76-year-old woman with heart failure and DM was followed-up on an outpatient basis and was under nursing home care for four months. Subsequently, she developed pneumonia and was admitted to our hospital; influenza antigen was isolated from nasal swab. Healthcare-associated pneumonia (HCAP)/empyema were diagnosed and were effectively treated with peramivir and levofloxacin for 4 days and 1 week, respectively. In diabetic patients, influenza virus may possibly accelerate pneumonia/empyema due to bacterial coinfection. Although non-typeable H. influenzae is a rare causative pathogen of empyema, it can be expected as a result of "pathogen shift" due to the increased use of the H. influenzae type b vaccine in Japan.

Keywords: Beta-lactamase negative Haemophilus influenzae; Influenza; Non-typeable Haemophilus influenzae; Vaccine.

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Figures

Fig. 1
Fig. 1
Chest radiography and computed tomography images of Case 1 (A and B), Case 2 (C and D), and Case 3 (E and F). All images showed infiltration shadows and pleural effusions, suggested severe pneumonia/empyema.
See this image and copyright information in PMC

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