Radiological findings of pneumonia in patients with swine-origin influenza A virus (H1N1).
Busi Rizzi E, Schininà V, Ferraro F, Rovighi L, Cristoforo M, Chiappetta D, Lisena F, Lauria F, Bibbolino C.
Diagnostic Department, Radiology, National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149, Rome, Italy, radiologia@inmi.it.
Abstract
PURPOSE:
During spring 2009, a pandemic swine-origin influenza A (H1N1) virus (S-OIV) emerged and spread globally. We describe the chest X-ray and computed tomography (CT) findings of 40 patients with pneumonia due to S-OIV observed in our institution.
MATERIAL AND METHODS:
Among 534 patients with S-OIV, according to the US Centers for Disease Control and Prevention case definition, seen between June and November 2009, 121 underwent chest X-ray and 40 (median age 44 years, range 16-79) had pneumonia. The initial chest radiographs were evaluated for pattern, distribution and extent of lung abnormalities. Unenhanced chest CT scans were performed in two patients and were reviewed for the same findings. Underlying medical conditions were present in 42% of patients (17/40).
RESULTS:
Our patients had predominantly mild illness, and pneumonia was observed in 40 individuals (40/121 patients who had chest X-rays, 33%; and 40/534 patients with S-OIV, 7.5%). However, S-OIV can cause severe illness requiring admission to the intensive care unit for advanced mechanical ventilation and extracorporeal life support, including adult respiratory distress syndrome (ARDS) and death. The major radiological abnormalities observed were interstitial changes (60.0%), with (22.0%) or without patchy ground-glass appearance, mostly bilateral, and located in the lower lung zones (7.5%). Extensive disease was seen in 37.5% (15/40), and ARDS was observed in three individuals (0.30%)with underlying medical conditions. Subtle pleural effusion was noted in four patients.
CONCLUSIONS:
In our series, the most frequent pneumonia patterns observed during S-OIV (H1N1) virus were interstitial changes and patchy ground-glass appearance, mostly bilateral, and located in the lower lung zones. CT, performed in severely ill patients, confirmed the ARDS identified with chest X-rays, better depicting the features and extent of lung abnormalities.
Mostrando entradas con la etiqueta Neumología. Mostrar todas las entradas
Mostrando entradas con la etiqueta Neumología. Mostrar todas las entradas
martes, 22 de junio de 2010
martes, 6 de octubre de 2009
Seguimos con la Influenza A H1 N1
Con el enfriamiento del hemisferio Norte esperamos un repunte de la epidemia de influenza A H1 N1, por lo que los siguientes datos publicados por el Colegio Americano de Médicos en el ACP Internist Weekly del 6 de Octubre del 2009, son muy útiles e interesantes. Además contien enlaces para profundizar sobre los temas que incluye.
Influenza: masks, bacteria and vaccination effectiveness
A comparison of surgical masks and N95 respirators, reports of bacterial co-infections, and evaluations of the effectiveness of widespread vaccination were among the top news about influenza last week.
Surgical masks were about as effective as N95 respirators in preventing influenza infection among health care workers in a recent randomized trial. More than 400 nurses in eight Ontario hospitals were assigned to wear either a fit-tested N95 respirator or a surgical mask when providing care to patients with febrile respiratory illness during the 2008-2009 influenza season. Influenza infection was measured by polymerase chain reaction or a fourfold rise in hemagglutinin titers. Influenza infection occurred in 50 nurses (23.6%) in the surgical mask group and 48 (22.9%) in the respirator group, an absolute risk difference of -0.73% (P=0.86). The results were published online Oct. 1 by the Journal of the American Medical Association.
The level of protection provided by the two kinds of masks appears to be similar in routine health care settings, although the results cannot be generalized to higher-risk procedures producing aerosolization, the study authors concluded. Current CDC recommendations call for N95 respirators for all health care worker contacts with influenza patients, although the agency is now reviewing its guidelines. According to an accompanying editorial, the JAMA study will likely not resolve debate on the issue, and should not distract from other means to prevent influenza spread in health care facilities, including hand hygiene, staying home from work when sick and vaccination of health care workers.
Vaccination against pneumococcus could play a role in reducing mortality from H1N1 influenza, according to the CDC's Morbidity and Mortality Weekly Report. An analysis of specimens from 77 patients who died of the pandemic strain this summer revealed that 22 of them (29%) had concurrent bacterial infections. Ten of the patients had pneumococcus. In addition to highlighting the benefits of vaccination, the findings underscore the importance of managing influenza patients who might also have bacterial pneumonia with both empiric antibacterial therapy and antiviral medications, the CDC said. The agency also released a 2009-2010 Influenza Season Triage Algorithm to assist physicians and those under their supervision in identifying indicators of and responses to symptoms of influenza-like illness in adults.
In the latest issue of Annals of Internal Medicine, researchers used mathematical models of New York City to forecast the effectiveness and cost-effectiveness of vaccination against the current H1N1 outbreak as well as a hypothetical pandemic of H5N1. In the case of an H5N1 pandemic, they concluded that expanded use of an adjuvanted vaccine would be worthwhile. As for the current influenza, the study concluded that vaccination would be effective in shortening the pandemic if about 40% of the population could be vaccinated in November, although the results would depend on when the epidemic peaks.
Influenza: masks, bacteria and vaccination effectiveness
A comparison of surgical masks and N95 respirators, reports of bacterial co-infections, and evaluations of the effectiveness of widespread vaccination were among the top news about influenza last week.
Surgical masks were about as effective as N95 respirators in preventing influenza infection among health care workers in a recent randomized trial. More than 400 nurses in eight Ontario hospitals were assigned to wear either a fit-tested N95 respirator or a surgical mask when providing care to patients with febrile respiratory illness during the 2008-2009 influenza season. Influenza infection was measured by polymerase chain reaction or a fourfold rise in hemagglutinin titers. Influenza infection occurred in 50 nurses (23.6%) in the surgical mask group and 48 (22.9%) in the respirator group, an absolute risk difference of -0.73% (P=0.86). The results were published online Oct. 1 by the Journal of the American Medical Association.
The level of protection provided by the two kinds of masks appears to be similar in routine health care settings, although the results cannot be generalized to higher-risk procedures producing aerosolization, the study authors concluded. Current CDC recommendations call for N95 respirators for all health care worker contacts with influenza patients, although the agency is now reviewing its guidelines. According to an accompanying editorial, the JAMA study will likely not resolve debate on the issue, and should not distract from other means to prevent influenza spread in health care facilities, including hand hygiene, staying home from work when sick and vaccination of health care workers.
Vaccination against pneumococcus could play a role in reducing mortality from H1N1 influenza, according to the CDC's Morbidity and Mortality Weekly Report. An analysis of specimens from 77 patients who died of the pandemic strain this summer revealed that 22 of them (29%) had concurrent bacterial infections. Ten of the patients had pneumococcus. In addition to highlighting the benefits of vaccination, the findings underscore the importance of managing influenza patients who might also have bacterial pneumonia with both empiric antibacterial therapy and antiviral medications, the CDC said. The agency also released a 2009-2010 Influenza Season Triage Algorithm to assist physicians and those under their supervision in identifying indicators of and responses to symptoms of influenza-like illness in adults.
In the latest issue of Annals of Internal Medicine, researchers used mathematical models of New York City to forecast the effectiveness and cost-effectiveness of vaccination against the current H1N1 outbreak as well as a hypothetical pandemic of H5N1. In the case of an H5N1 pandemic, they concluded that expanded use of an adjuvanted vaccine would be worthwhile. As for the current influenza, the study concluded that vaccination would be effective in shortening the pandemic if about 40% of the population could be vaccinated in November, although the results would depend on when the epidemic peaks.
martes, 11 de agosto de 2009
Mortalidad materna e Influenza A H1 N1
Cómo explicar la mortalidad materna en la epidemia de Influenza A H1 N1
La epidemia del virus H1N1 en la Argentina sorprendió afectando gravemente a mujeres embarazadas o puérperas. Entre ellas se contabilizaron los primeros casos fatales. Esta característica no se destacaba en las series de casos mejicanos y norteamericanos y recién ahora se lo cita en los informes epidemiológicos. En Argentina aparentemente hay 12 muertes maternas por neumonías sucedidas en las últimas cuatro semanas y habría dos casos más por confirmar, que las elevarían a 14 muertes maternas por neumonías ( 1 ).
En el hospital nacional de Antigua Guatemala, Sacatepéquez, Guatemala, el Jefe del Intensivo reporta verbalmente una muerte por Influenza A H1 N1 confirmada por laboratorio (2 ).
Cambios inmunitarios en el embarazo
The normal course of pregnancy is associated with a variety of changes in humoral and cellular immunity, such as a loss in CD4+ cells and other alterations in T-cell subsets. Reports on T-cell subsets during pregnancy have been conflicting. Some studies have found a progressive fall in the CD4+ count throughout pregnancy, from a mean of 950 cells/ml before 18 weeks to 720 cells/ml at term. Others have either reported a U-shaped CD4+ cell count profile during pregnancy, with a minimum at approximately 32 weeks of gestation (CD4 of 30% and a CD4+ count of 876 cells/ml), or have found stable CD4 levels and CD4:CD8 ratios during pregnancy with a rise (rebound) afterwards. Such differences may be attributable to different methodology (manual fluorescence microscopy versus automated flow cytometry), to differences in study populations or to the fact that blood was taken at different times during pregnancy. The altered immune status of pregnant women may also alter the response of the host to infectious agents.
Despite conflicting laboratory data, most studies agree that the humoral immune response in pregnancy is similar to that in nonpregnant women but that the cellular immune response is diminished. Mortality rates of, for example, pneumococcal pneumonia, malaria or influenza have been found to be higher in pregnant than in nonpregnant women ( 3 )
Bibliografia:
1.- Medardo Ávila Vázquez es Medico, Ex subsecretario de Salud de la ciudad de Córdoba. (especial para ARGENPRESS.info). Jueves 06/08/2009 14:11
2.- Comunicciòn verabal del Dr. Erick Yoc, Médico Internista y Neumólogo, Jefe del Intensivo del Hospital Pedro de Bethancourt de la Antigua Guatemala, Sacatepéquez, Guatemala.
3.- Cohen & Powderly: Infectious Diseases, 2nd ed. Copyright © 2004 Mosby, An Imprint of Elsevier Chapter 64 – Complications of Pregnancy: Maternal Perspectives. Marleen Temmerman
La epidemia del virus H1N1 en la Argentina sorprendió afectando gravemente a mujeres embarazadas o puérperas. Entre ellas se contabilizaron los primeros casos fatales. Esta característica no se destacaba en las series de casos mejicanos y norteamericanos y recién ahora se lo cita en los informes epidemiológicos. En Argentina aparentemente hay 12 muertes maternas por neumonías sucedidas en las últimas cuatro semanas y habría dos casos más por confirmar, que las elevarían a 14 muertes maternas por neumonías ( 1 ).
En el hospital nacional de Antigua Guatemala, Sacatepéquez, Guatemala, el Jefe del Intensivo reporta verbalmente una muerte por Influenza A H1 N1 confirmada por laboratorio (2 ).
Cambios inmunitarios en el embarazo
The normal course of pregnancy is associated with a variety of changes in humoral and cellular immunity, such as a loss in CD4+ cells and other alterations in T-cell subsets. Reports on T-cell subsets during pregnancy have been conflicting. Some studies have found a progressive fall in the CD4+ count throughout pregnancy, from a mean of 950 cells/ml before 18 weeks to 720 cells/ml at term. Others have either reported a U-shaped CD4+ cell count profile during pregnancy, with a minimum at approximately 32 weeks of gestation (CD4 of 30% and a CD4+ count of 876 cells/ml), or have found stable CD4 levels and CD4:CD8 ratios during pregnancy with a rise (rebound) afterwards. Such differences may be attributable to different methodology (manual fluorescence microscopy versus automated flow cytometry), to differences in study populations or to the fact that blood was taken at different times during pregnancy. The altered immune status of pregnant women may also alter the response of the host to infectious agents.
Despite conflicting laboratory data, most studies agree that the humoral immune response in pregnancy is similar to that in nonpregnant women but that the cellular immune response is diminished. Mortality rates of, for example, pneumococcal pneumonia, malaria or influenza have been found to be higher in pregnant than in nonpregnant women ( 3 )
Bibliografia:
1.- Medardo Ávila Vázquez es Medico, Ex subsecretario de Salud de la ciudad de Córdoba. (especial para ARGENPRESS.info). Jueves 06/08/2009 14:11
2.- Comunicciòn verabal del Dr. Erick Yoc, Médico Internista y Neumólogo, Jefe del Intensivo del Hospital Pedro de Bethancourt de la Antigua Guatemala, Sacatepéquez, Guatemala.
3.- Cohen & Powderly: Infectious Diseases, 2nd ed. Copyright © 2004 Mosby, An Imprint of Elsevier Chapter 64 – Complications of Pregnancy: Maternal Perspectives. Marleen Temmerman
jueves, 15 de enero de 2009
Neumonía y servicios médicos
La neumonía vinculada con los servicios médicos suele ser más letal
( Outcomes of Patients Hospitalized With Community-Acquired, Health Care–Associated, and Hospital-Acquired Pneumonia )
Mario Venditti, MD; Marco Falcone, MD; Salvatore Corrao, MD; Giuseppe Licata, MD; Pietro Serra, MD; and the Study Group of the Italian Society of Internal Medicine* Annals 2009 150: I-36. 6 January 2009 Volume 150 Issue 1 Pages 19-26.
En este estudio publicado en Anales de Medicina Interna y conducido por médicos italianos de la Universidad de Roma, se ha encontrado que la gravedad y mortalidad de la neumonía provocada por el contacto con un paciente ambulatorio en un centro de asistencia médica es mayor que la generada por la enfermedad adquirida en la comunidad. Se encontró en el estudio que los peores resultados se encontraron con el tratamiento inadecuado de antibióticos.
Los resultados del estudio revelan que comparando los resultados de 362 pacientes tratados en 55 hospitales durante el 2007 por neumonía adquirida en la comunidad, el hospital u otro establecimiento de asistencia médica, la neumonía asociada con la atención médica ambulatoria fue más severa, requirió más días de hospitalización y las tasas de mortalidad fueron más elevadas (un 17,8 frente a un 6,7 por ciento). La tasa de mortalidad de la neumonía adquirida en el hospital fue aún mayor, siendo del 18,4 por ciento.
Dentro de la investigación se encontró además, que menos del 30 por ciento de los pacientes con neumonía asociada con la asistencia médica recibían los antibióticos recomendados, comparado con el 60 o 70 por ciento de los otros pacientes.
Por otro lado, se encontró, que para mejorar los resultados de la neumonía vinculada a la atención médica, se aconseja que la terapia con antibióticos pueda combatir el Staphylococcus aureus resistente a la meticilina o SARM y otros organismos resistentes a múltiples fármacos.
Para quién quiera leer el artículo completo, lo encontrarán a continuación
Outcomes of Patients Hospitalized With Community-Acquired, Health Care–Associated, and Hospital-Acquired Pneumonia
Mario Venditti, MD; Marco Falcone, MD; Salvatore Corrao, MD; Giuseppe Licata, MD; Pietro Serra, MD; and the Study Group of the Italian Society of Internal Medicine* 6 January 2009 Volume 150 Issue 1 Pages 19-26
Background: Traditionally, pneumonia has been classified as either community- or hospital-acquired. Although only limited data are available, health care–associated pneumonia has been recently proposed as a new category of respiratory infection. "Health care–associated pneumonia" refers to pneumonia in patients who have recently been hospitalized, had hemodialysis, or received intravenous chemotherapy or reside in a nursing home or long-term care facility. Objective: To ascertain the epidemiology and outcome of community-acquired, health care–associated, and hospital-acquired pneumonia in adults hospitalized in internal medicine wards. Design: Multicenter, prospective observational study. Setting: 55 hospitals in Italy comprising 1941 beds. Patients: 362 patients hospitalized with pneumonia during two 1-week surveillance periods. Measurements: Cases of radiologically and clinically assessed pneumonia were classified as community-acquired, health care–associated, or hospital-acquired and rates were compared. Results: Of the 362 patients, 61.6% had community-acquired pneumonia, 24.9% had health care–associated pneumonia, and 13.5% had hospital-acquired pneumonia. Patients with health care–associated pneumonia had higher mean Sequential Organ Failure Assessment scores than did those with community-acquired pneumonia (3.0 vs. 2.0), were more frequently malnourished (11.1% vs. 4.5%, and had more frequent bilateral (34.4% vs. 19.7%) and multilobar (27.8% vs. 21.5%) involvement on a chest radiograph. Patients with health care–associated pneumonia also had higher fatality rates (17.8% [CI, 10.6% to 24.9%] vs. 6.7% [CI, 2.9% to 10.5%]) and longer mean hospital stay (18.7 days [CI, 15.9 to 21.5 days] vs. 14.7 days [CI, 13.4 to 15.9 days]). Logistic regression analysis revealed that depression of consciousness (odds ratio [OR], 3.2 [CI, 1.06 to 9.8]), leukopenia (OR, 6.2 [CI, 1.01 to 37.6]), and receipt of empirical antibiotic therapy not recommended by international guidelines (OR, 6.4 [CI, 2.3 to 17.6]) were independently associated with increased intrahospital mortality. Limitations: The number of patients with health care–associated pneumonia was relatively small. Microbiological investigations were not always homogeneous. The study included only patients with pneumonia that required hospitalization; results may not apply to patients treated as outpatients.
Conclusion: Health care–associated pneumonia should be considered a distinct subset of pneumonia associated with more severe disease, longer hospital stay, and higher mortality rates. Physicians should differentiate between patients with health care–associated pneumonia and those with community-acquired pneumonia and provide more appropriate initial antibiotic therapy.
( Outcomes of Patients Hospitalized With Community-Acquired, Health Care–Associated, and Hospital-Acquired Pneumonia )
Mario Venditti, MD; Marco Falcone, MD; Salvatore Corrao, MD; Giuseppe Licata, MD; Pietro Serra, MD; and the Study Group of the Italian Society of Internal Medicine* Annals 2009 150: I-36. 6 January 2009 Volume 150 Issue 1 Pages 19-26.
En este estudio publicado en Anales de Medicina Interna y conducido por médicos italianos de la Universidad de Roma, se ha encontrado que la gravedad y mortalidad de la neumonía provocada por el contacto con un paciente ambulatorio en un centro de asistencia médica es mayor que la generada por la enfermedad adquirida en la comunidad. Se encontró en el estudio que los peores resultados se encontraron con el tratamiento inadecuado de antibióticos.
Los resultados del estudio revelan que comparando los resultados de 362 pacientes tratados en 55 hospitales durante el 2007 por neumonía adquirida en la comunidad, el hospital u otro establecimiento de asistencia médica, la neumonía asociada con la atención médica ambulatoria fue más severa, requirió más días de hospitalización y las tasas de mortalidad fueron más elevadas (un 17,8 frente a un 6,7 por ciento). La tasa de mortalidad de la neumonía adquirida en el hospital fue aún mayor, siendo del 18,4 por ciento.
Dentro de la investigación se encontró además, que menos del 30 por ciento de los pacientes con neumonía asociada con la asistencia médica recibían los antibióticos recomendados, comparado con el 60 o 70 por ciento de los otros pacientes.
Por otro lado, se encontró, que para mejorar los resultados de la neumonía vinculada a la atención médica, se aconseja que la terapia con antibióticos pueda combatir el Staphylococcus aureus resistente a la meticilina o SARM y otros organismos resistentes a múltiples fármacos.
Para quién quiera leer el artículo completo, lo encontrarán a continuación
Outcomes of Patients Hospitalized With Community-Acquired, Health Care–Associated, and Hospital-Acquired Pneumonia
Mario Venditti, MD; Marco Falcone, MD; Salvatore Corrao, MD; Giuseppe Licata, MD; Pietro Serra, MD; and the Study Group of the Italian Society of Internal Medicine* 6 January 2009 Volume 150 Issue 1 Pages 19-26
Background: Traditionally, pneumonia has been classified as either community- or hospital-acquired. Although only limited data are available, health care–associated pneumonia has been recently proposed as a new category of respiratory infection. "Health care–associated pneumonia" refers to pneumonia in patients who have recently been hospitalized, had hemodialysis, or received intravenous chemotherapy or reside in a nursing home or long-term care facility. Objective: To ascertain the epidemiology and outcome of community-acquired, health care–associated, and hospital-acquired pneumonia in adults hospitalized in internal medicine wards. Design: Multicenter, prospective observational study. Setting: 55 hospitals in Italy comprising 1941 beds. Patients: 362 patients hospitalized with pneumonia during two 1-week surveillance periods. Measurements: Cases of radiologically and clinically assessed pneumonia were classified as community-acquired, health care–associated, or hospital-acquired and rates were compared. Results: Of the 362 patients, 61.6% had community-acquired pneumonia, 24.9% had health care–associated pneumonia, and 13.5% had hospital-acquired pneumonia. Patients with health care–associated pneumonia had higher mean Sequential Organ Failure Assessment scores than did those with community-acquired pneumonia (3.0 vs. 2.0), were more frequently malnourished (11.1% vs. 4.5%, and had more frequent bilateral (34.4% vs. 19.7%) and multilobar (27.8% vs. 21.5%) involvement on a chest radiograph. Patients with health care–associated pneumonia also had higher fatality rates (17.8% [CI, 10.6% to 24.9%] vs. 6.7% [CI, 2.9% to 10.5%]) and longer mean hospital stay (18.7 days [CI, 15.9 to 21.5 days] vs. 14.7 days [CI, 13.4 to 15.9 days]). Logistic regression analysis revealed that depression of consciousness (odds ratio [OR], 3.2 [CI, 1.06 to 9.8]), leukopenia (OR, 6.2 [CI, 1.01 to 37.6]), and receipt of empirical antibiotic therapy not recommended by international guidelines (OR, 6.4 [CI, 2.3 to 17.6]) were independently associated with increased intrahospital mortality. Limitations: The number of patients with health care–associated pneumonia was relatively small. Microbiological investigations were not always homogeneous. The study included only patients with pneumonia that required hospitalization; results may not apply to patients treated as outpatients.
Conclusion: Health care–associated pneumonia should be considered a distinct subset of pneumonia associated with more severe disease, longer hospital stay, and higher mortality rates. Physicians should differentiate between patients with health care–associated pneumonia and those with community-acquired pneumonia and provide more appropriate initial antibiotic therapy.
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