Meltem Arzu YETKİN, Esragül AKINCI, Hürrem BODUR, Gülruhsar YILMAZ, Oya KILCI, Bircan KAYAASLAN, Selim Sırrı EREN, Sevim YILMAZ, Işıl Deniz ALIRAVCI, Sümeyye YILDIZ, Fatmanur ÜLGEN, Ayşe BUT, Hatice YAĞMURDUR, Nevzat Mehmet MUTLU

Analysis of 113 hospitalized patients with confi rmed 2009 infl uenza A (H1N1) virus infection

Amaç: Bu çalışmanın amacı, 2009 infl uenza A(H1N1) kesin tanısı konulan ve yatırılarak takip edilen hastaların demografi k özellikleri, klinik ve laboratuvar bulguları, altta yatan hastalıkları, tedavi ve prognozunu değerlendirmektir. Yöntem ve gereç: Bu prospektif çalışma Ekim-Aralık 2009 tarihleri arasında yapıldı. 2009 infl uenza A(H1N1) tanısı kesinleşmiş yatan hastalar çalışmaya alındı. Tanı, nazal ve nazofaringeal sürüntü örneklerinde RT-PCR ile virüs tespit edilerek konuldu. Hastaların demografi k ve epidemiyolojik özellikleri, klinik bulguları, tedavi ve prognozu hazırlanan hasta formlarına kaydedildi. Pnömonisi olan ve olmayan hastalar arasında karşılaştırma yapıldı. Bulgular: Ekim-Aralık 2009 arasında, 2009 infl uenza A(H1N1) enfeksiyonu tanısıyla 113 hasta kliniğimizde yatırılarak takip edildi. Hastaların yaşları 17-77 (ortalama 35,7 ± 15,8) arasında değişmekte idi ve 73’ü (% 64,6) kadındı. En sık görülen semptomlar, öksürük (% 92,9), ateş (% 85,8), halsizlik (% 85,8), baş ağrısı (% 80,5) ve kas ağrısı (% 85) idi. Hastaneye yatışa kadar olan semptomların süresi 1-15 gün (ortalama 3,8 ± 3) arasında değişmekteydi. Fizik muayenede ateş (% 74,3), faringeal hiperemi (% 66,4), ral (% 43,4), dispne (% 29,2) ve siyanoz (% 4,4) tespit edildi. Hastaların 64’ünde (% 56,6) altta yatan en az bir hastalık vardı ve en sık tespit edilen kronik akciğer hastalığı (% 14,5) idi. Gebelik 25 hastada mevcuttu. Yatışta 25 hastada (% 22,1) lökopeni, 12 hastada (% 10,6) lökositoz ve 29 hastada (% 25,7) trombositopeni tespit edildi. Akciğer grafi sinde pnömoni ile uyumlu infi ltrasyonlar 47 (% 41,6) hastada saptandı. Oseltamivir 98 (% 86,7) hastaya verildi. Hastaların 6’sı (% 5,3) akut solunum yetmezliği nedeniyle yoğun bakım ünitesine kabul edildi ve 4’ü (% 3,5) mekanik ventilator bağlandı. Üç hasta (% 2,7) kaybedildi. Pnömonisi olan ve olmayan hastalar istatistiksel olarak karşılaştırıldı. Yaşın 40’ın üzerinde olması, semptomların süresinin 3 günden fazla olması, lökositoz, ALT/AST yüksekliği ve hiperglisemi, pnömonisi olanlarda anlamlı oranda yüksek bulundu. Sonuç: 2009 infl uenza A(H1N1) enfeksiyonu, pnömoni ve ölüm gibi ciddi tablolara yol açsa da mortalite oranı çok yüksek değildir. Hastalığın özellikleri mevsimsel infl uenza gibidir. Genç erişkinler en çok etkilenen kişilerdir ve çoğunda altta yatan hastalık vardır.

2009 infl uenza A (H1N1) enfeksiyonu tanısıyla yatırılan 113 hastanın analizi

Aim: To evaluate the demographic characteristics, clinical and laboratory features, underlying medical conditions, treatment, and outcome of hospitalized patients with laboratory-confi rmed infection due to the 2009 infl uenza A(H1N1) virus. Materials and methods: Th is prospective study was performed between October and December 2009. Th e hospitalized patients with laboratory-confi rmed diagnosis of 2009 infl uenza A(H1N1) virus infection were included in the study. Th e diagnosis was confi rmed with detection of the virus in nasal and nasopharyngeal swabs by RT-PCR assay. Demographic and epidemiological characteristics, clinical features, treatment, and outcome of the patients were recorded on the individual forms. A comparison was made between patients with and without pneumonia. Results: From October to December 2009, 113 confi rmed patients with 2009 infl uenza A(H1N1) virus infection were hospitalized in our clinic. Th e ages of the patients were between 17 and 77 years (mean age 35.7 ± 15.8 years) and 73 (64.6%) were female. Cough (92.9%), fever (85.8%), malaise (85.8%), headache (80.5%), and muscle aches (85.0%) were the most common presenting symptoms. Th e time from symptom onset to hospital admission was 1-15 days (mean time 3.8 ± 3 days). On physical examination, fever (74.3%), pharyngeal hyperemia (66.4%), rales (43.4%), dyspnea (29.2%), and cyanosis (4.4%) were the presenting clinical fi ndings. Of the patients, 64 (56.6%) had at least 1 underlying medical condition. Th e most common underlying disease was chronic pulmonary disease (14.5%). A total of 25 patients were pregnant. On admission to hospital, 25 patients (22.1%) had leukopenia, 12 patients (10.6%) had leukocytosis, and 29 patients (25.7%) had thrombocytopenia. Pulmonary infi ltrates consistent with pneumonia were detected on chest radiography in 47 (41.6%) patients.Of these patients, 98 (86.7%) received oseltamivir treatment on admission. Six patients (5.3%) were admitted to the ICU because of acute respiratory failure and 4 of them (3.5%) required mechanical ventilation. Among these patients, 3 (2.7%) died. A comparison between the patients with and without pneumonia was performed statistically. Age older than 40 years old, time from onset of symptoms to admission longer than 3 days, leukocytosis, ALT/AST elevation, and hyperglycemia were signifi cantly higher in patients with pneumonia. Conclusion: Although the 2009 infl uenza A(H1N1) virus causes severe illness including pneumonia and death, the mortality rate is not very high. Th e characteristics of the disease are similar to those of seasonal infl uenza. Young adults were the most aff ected persons and most of the patients had underlying medical conditions

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