Clinicopathologic Characteristics of Influenza А(H1n1)pdm during 2015–2016 Epidemic Period in Elderly Persons
The objective of the study is to investigate clinical progression of influenza A(H1N1), influenzal pneumonia, pathomorphological pulmonary changes in the lungs in elderly persons in 2015–2016. Materials and methods. During 2015–2016 epidemic period 36 patients suffering from influenza А(H1N1) aged of 60–84 years old (24 male and 12 female patients) were attended to the Donetsk Central Municipal Clinical Hospital № 1. Influenza with pneumonia was diagnosed in 24 patients (66.7 %). In 33.3 % the diagnosis of influenza А(H1N1) was confirmed by viral serology testing (hemagglutination-inhibition test), in 63.9 % — by the polymerase chain reaction method, including 87.5 % of deceased patients. Research findings. During 5 years prior to the disease there was no history of influenza vaccination in all patients. On the 5–9th sick day 66.7 % of the patients were hospitalized, 1 female patient (2.8 %) was admitted to the department in 2 weeks after the disease onset. Apparent intoxication syndrome was observed from the first day of the disease in 41.7 % of patients with uncomplicated influenza. The duration of fever was 8.7 ± 2.6 days. All elderly patients with uncomplicated influenza recovered. Influenza complicated by pneumonia was diagnosed in 24 patients (66.7 %). In 36.1 % of patients pneumonia was total or subtotal, complicated by respiratory failure of II–III degree of severity. Patients suffering from influenza and influenzal pneumonia did not receive antiviral treatment with oseltamyvirum (Tamiflu) due to the lack of this medicinal product in the pharmacy network under the conditions of the local armed conflict. Antibacterial therapy included intravenous meropenum, protected 3rd generation cephalosporins, respiratory fluoroquinolones, macrolides in usual dosages. Oxygen therapy was an indispensable condition for the complex treatment of patients with influenzal pneumonia via a facemask, airtight reservoir bag mask, airtight positive end-expiratory pressure support mask (PEEP), non-invasive ventilation. Pathogenetic therapy included a restrictive type of infusion therapy, focused on relief of pulmonary edema and respiratory distress syndrome, correction of anemia, blood pressure and glucose levels, and administration of bronchial mucolytics. Sixteen of 36 elderly patients with influenzal pneumonia died (case fatality rate was 44.4 %). Conclusion. Influenzal pneumonia mortality in elderly persons within the area of the local armed conflict was characterized by a high rate due to the lack of influenza vaccination and antiviral therapy, late presentation, as well as the presence of severe chronic background diseases.
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