Hüsnü PULLUKÇU, Abdullah SAYINER, Feza BACAKOĞLU, Mehmet Sezai TAŞBAKAN, Özen BAŞOĞLU KAÇMAZ, Alev GÜRGÜN

Pandemik (H1N1) influenza A virüsü pnömonisi ve toplum kökenli pnömoni olgularının karşılaştırılması

Toplum kökenli pnömoni (TKP) ile karşılaştırıldığında, pandemik (H1N1) influenza A virüsüne bağlı pnömoninin prognozunun daha kötü olması nedeniyle, her iki pnömoniyi ayıran klinik özelliklerin bilinmesi önem taşımaktadır. Bu çalışmada; pandemik (H1N1) influenza A pnömonisi ile TKP olgularının klinik özelliklerinin ve prognozlarının karşılaştırılması amaçlanmıştır. 1 Ekim-30 Aralık 2009 tarihleri arasında kliniğimize yatırılan 20 pandemik (H1N1) influenza A pnömonisi olgusu ile 18 TKP olgusunun demografik verileri, yakınmaları ve bulguları değerlendirilmiştir. TKP olgularının %55.6sı, pandemik (H1N1) influenza A pnömonisi olgularının ise 1 (%5.0)i 65 yaş üzerindedir (p= 0.001). Pandemik (H1N1) influenza A pnömonisi olgularında; ateş, nefes darlığı, yorgunluk, kas ve eklem ağrıları, bulantı, kusma ve baş ağrısı yakınmaları daha fazla (p< 0.05), trombosit düzeyi (p= 0.024) ve PaO2/FiO2 oranı (p= 0.006) daha düşük, trombositopenik olgu sayısı (p= 0.024) ve laktat dehidrogenaz (LDH) düzeyi (p= 0.016) daha yüksek, hastanede yatış süresi daha uzun (p= 0.038) bulunmuştur. Radyolojik bulgular açısından gruplar arasında fark saptanmamıştır. TKP olgularından hiçbirisine yoğun bakım izlemi gerekmemişken, pandemik (H1N1) influenza A pnömonisi olgularının 5 (%25.0)i yoğun bakıma alınmış, üç olgu invaziv mekanik ventilasyon uygulanmasına karşın eksitus olmuştur. Sonuç olarak, influenza mevsiminde pnömoni kliniği ile başvuran olgularda; ateş, nefes darlığı, yanı sıra akciğer dışı semptomların olması ve bunlara radyolojik olarak alveoler opasitelerin eşlik etmesi, pandemik (H1N1) influenza A pnömonisini düşündürmelidir. Özellikle nefes darlığı ve yaygın radyolojik bulguları olan olgularda, yoğun bakım ve mekanik ventilasyon gereksinimi açısından dikkatli olunmalıdır

Comparison of the patients with pandemic (H1N1) influenza A virus pneumonia and community-acquired pneumonia

Prognosis of pandemic influenza A (H1N1) virus pneumonia is worse than community-acquired pneumonia (CAP), therefore it is important to know distinctive clinical features of both pneumonias. The aims of this study were to compare clinical features and prognosis of patients with pandemic influenza A (H1N1) pneumonia and CAP due to other agents. Demographic features, symptoms and findings of 20 pandemic influenza A (H1N1) pneumonia and 18 CAP patients hospitalized between October 1st and December 30th, 2009 were evaluated. One patient (5.0%) with pandemic Influenza A (H1N1) pneumonia and 55.6% of CAP patients were over 65 years (p= 0.001). Symptoms of fever, dyspnea, fatigue, muscle and joint pain, nausea, vomiting and headache were more frequent (p< 0.05), platelet count (p= 0.024) and PaO2/FiO2 ratio (p= 0.006) were lower, number of thrombocytopenic patients (p= 0.024) and LDH levels (p= 0.016) were higher, duration of hospitalization was longer (p= 0.038) in patients with pandemic influenza A (H1N1) pneumonia. There was no difference in terms of radiological findings between two groups. None of the CAP patients were followed-up in the intensive care, whereas five pandemic influenza A (H1N1) pneumonia patients (25.0%) required intensive care and three of them died despite invasive mechanical ventilation. In conclusion, in the presence of fever, dyspnea with non-pulmonary symptoms and accompanying radiological alveolar opacities should be considered as pandemic influenza A (H1N1) pneumonia should be suspected in patients admitted with findings of pneumonia during influenza season. Admission to the intensive care unit and mechanical ventilation should be considered in patients with dyspnea and diffuse radiological findings.

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