Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Radiological and Clinical Characteristics of a Military Outbreak of Pandemic H1N1 2009 Influenza Virus Infection

  • Yun, Tae-Jin (Department of Radiology, Armed Force Byukjae Hospital) ;
  • Kwon, Gu-Jin (Department of Family Medicine, Armed Force Byukjae Hospital) ;
  • Oh, Mi-Kyeong (Department of Family Medicine, Gangneung Asan Hospital, Ulsan University College of Medicine) ;
  • Woo, Sung-Koo (Department of Radiology, Armed Force Byukjae Hospital) ;
  • Park, Seung-Hoon (Department of Internal Medicine, Armed Force Byukjae Hospital) ;
  • Choi, Seung-Hong (Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center) ;
  • Lee, Hyun-Ju (Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center) ;
  • Goo, Jin-Mo (Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center) ;
  • Yim, Jae-Joon (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine) ;
  • Kim, Jong-Sung (Department of Family Medicine, Chungnam National University School of Medicine) ;
  • Park, Chang-Min (Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center)
  • Received : 2010.01.25
  • Accepted : 2010.03.16
  • Published : 2010.08.01
⟨ Previous Next ⟩

Abstract

Objective: To describe detailed clinical and radiological features of the pandemic H1N1 2009 influenza viral infection among healthy young males in a semiclosed institutionalized setting. Materials and Methods: A total of 18 patients confirmed with the pandemic H1N1 2009 influenza virus infection from July 18 to July 30, 2009 were enrolled in this study. Each patient underwent an evaluation to determine detailed clinical and radiological features. Results: All patients presented with high fever (> $38.0^{\circ}C$), with accompanying symptoms of cough, rhinorrhea, sore throat, myalgia and diarrhea, and increased C-reactive protein (CRP) values with no leukocytosis nor elevated erythrocyte sedimentation rate (ESR). All patients, including one patient who progressed into acute respiratory distress syndrome, were treated with oseltamivir phosphate and quickly recovered from their symptoms. Chest radiographs showed abnormalities of small nodules and lobar consolidation in only two out of 18 patients. However, six of 12 patients who underwent thin-section CT examinations showed abnormal findings for small ground-glass opacities (GGOs) in addition to poorly-defined nodules with upper lobe predominance. Conclusion: In a population of healthy young adults, elevated CRP with normal ESR and white blood cell levels combined with GGOs and nodules on thinsection CT scans may indicate early signs of infection by the pandemic H1N1 2009 influenza virus.

Keywords

References

  1. World Health Organization. Influenza A (H1N1) - update 68. (Accessed October 8, 2009, at http://www.who.int/csr/don/ 2009_10_02/en/index.html)
  2. World Health Organization. World now at the start of 2009 influenza pandemic. (Accessed October 8, 2009, at http://www.who.int/mediacentre/news/statements/2009/h1n1_p andemic_phase6_20090611/en/index.html)
  3. Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, Hernandez M, Quinones-Falconi F, Bautista E, et al. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med 2009;361:680-689 https://doi.org/10.1056/NEJMoa0904252
  4. Chowell G, Bertozzi SM, Colchero MA, Lopez-Gatell H, Alpuche-Aranda C, Hernandez M, et al. Severe respiratory disease concurrent with the circulation of H1N1 influenza. N Engl J Med 2009;361:674-679 https://doi.org/10.1056/NEJMoa0904023
  5. Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team, Dawood FS, Jain S, Finelli L, Shaw MW, Lindstrom S, et al. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med 2009;360:2605-2615 https://doi.org/10.1056/NEJMoa0903810
  6. Shinde V, Bridges CB, Uyeki TM, Shu B, Balish A, Xu X, et al. Triple-reassortant swine influenza A (H1) in humans in the United States, 2005-2009. N Engl J Med 2009;360:2616-2625 https://doi.org/10.1056/NEJMoa0903812
  7. Belshe RB. Implications of the emergence of a novel H1 influenza virus. N Engl J Med 2009;360:2667-2668 https://doi.org/10.1056/NEJMe0903995
  8. United States Centers for Disease Control and Prevention. Interim WHO guidance for the surveillance of human infection with swine influenza A (H1N1) virus, April 27, 2009. (Accessed October 8, 2009, at http://www.wpro.who.int/NR/rdonlyres/ 0057E73B-E9DE-470D-8B21-B5E7AFE570D0/0/ WHO_guidanceforsurveillanceofswineflu27Apr2009.pdf)
  9. Hospitalized patients with novel influenza A (H1N1) virus infection - California, April-May, 2009. MMWR Morb Mortal Wkly Rep 2009;58:536
  10. World Health Organization. Human infection with new influenza A (H1N1) virus: clinical observations from Mexico and other affected countries, May 2009. Weekly Epidemiological Record 2009;84:185
  11. Lee CW, Seo JB, Song JW, Lee HJ, Lee JS, Kim MY, et al. Pulmonary complication of novel influenza A (H1N1) infection: imaging features in two patients. Korean J Radiol 2009;10:531- 534 https://doi.org/10.3348/kjr.2009.10.6.531
  12. Agarwal PP, Cinti S, Kazerooni EA. Chest radiographic and CT findings in novel swine-origin influenza A (H1N1) virus (S-OIV) infection. AJR Am J Roentgenol 2009;193:1488-1493 https://doi.org/10.2214/AJR.09.3599
  13. Ajlan AM, Quiney B, Nicolaou S, Muller NL. Swine-origin influenza A (H1N1) viral infection: radiographic and CT findings. AJR Am J Roentgenol 2009;193:1494-1499 https://doi.org/10.2214/AJR.09.3625
  14. Dolin R. Infections due to DNA and RNA respiratory viruses. In: Fauci AS, Braunwald E, Isselbacher KJ, eds. Harrison's principles of internal medicine, 17th ed. New York, USA: McGraw-Hill, 2008:1127-1132
  15. Grinblat L, Shulman H, Glickman A, Matukas L, Paul N. Severe acute respiratory syndrome: radiographic review of 40 probable cases in Toronto, Canada. Radiology 2003;228:802-809 https://doi.org/10.1148/radiol.2283030671
  16. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008;246:697-722 https://doi.org/10.1148/radiol.2462070712
  17. Wong KT, Antonio GE, Hui DS, Lee N, Yuen EH, Wu A, et al. Thin-section CT of severe acute respiratory syndrome: evaluation of 73 patients exposed to or with the disease. Radiology 2003;228:395-400 https://doi.org/10.1148/radiol.2283030541

Cited by

  1. A Case of Novel Influenza A (H1N1) Virus Pneumonia Complicated Pnemomediastinum and Subcutenous Emphysema vol.70, pp.2, 2011, https://doi.org/10.4046/trd.2011.70.2.155
  2. Radiological prognostic factors in patients with pandemic H1N1 (pH1N1) infection requiring hospital admission vol.18, pp.4, 2010, https://doi.org/10.1007/s10140-011-0964-5
  3. Confirmed Swine-Origin Influenza A(H1N1) Viral Pneumonia: Computed Tomographic Findings in the Immunocompetent and the Immunocompromised vol.35, pp.5, 2011, https://doi.org/10.1097/rct.0b013e31822c56f1
  4. High-resolution computed tomography findings of influenza virus pneumonia: a comparative study between seasonal and novel (H1N1) influenza virus pneumonia vol.30, pp.2, 2010, https://doi.org/10.1007/s11604-011-0027-6
  5. Chest radiological findings of influenza A H1N1 pneumonia vol.18, pp.3, 2010, https://doi.org/10.1016/j.rppnen.2011.12.006
  6. Serum Inflammatory Markers in Patients with Adenovirus Respiratory Infection vol.24, pp.None, 2010, https://doi.org/10.12659/msm.910692