Abstract
Background
Pandemic influenza A (H1N1) has emerged rapidly in Argentina since May 2009. Preliminary
comparisons with seasonal influenza suggest that H1N1 disproportionately affects younger
patients, generally causing mild disease, but in a minority of cases can be lethal.
Objective
The aim of this study was to develop a clinical tool for the initial management of
patients with influenza-like syndrome, within the context of the novel H1N1 virus
epidemic, to detect patients who need further investigation (e.g., chest X-ray study)
for the diagnosis of pneumonia.
Methods
We prospectively studied 1090 consecutive patients with influenza-like syndrome for
a period of 15 days. Based on the presence of inspiratory crackles and the level of
transcutaneous pulse oximetry, we selected 217 patients requiring chest X-ray study,
and pneumonia was confirmed in all of these patients.
Results
Among the patients with pneumonia, 132 viral diagnostic tests were available, from
which specimens tested by real-time reverse-transcriptase polymerase-chain reaction
(RTPCR) were positive for H1N1 in 61 patients (46%). Comparison between RTPCR-positive
and RTPCR-negative patients did not show any significant difference. Eighty-seven
randomly selected patients with influenza-like syndrome, but without crackles and
with O2 saturation>96%, received chest X-ray studies; none demonstrated pulmonary infiltrates.
Conclusion
Within the context of an influenza epidemic with the new H1N1 virus, the use of two
simple and accessible clinical signs permits a rapid differentiation between those
patients requiring close monitoring vs. those with mild and self-resolving disease.
Keywords
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Article info
Publication history
Published online: October 04, 2010
Accepted:
May 28,
2010
Received in revised form:
March 7,
2010
Received:
November 24,
2009
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
