14th ICID - Poster Abstracts - International Society for Infectious ...

When citing these abstracts please use the following reference:
Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number.
Please note that the official publication of the International Journal of Infectious Diseases 2010, Volume 14, Supplement 1
is available electronically on http://www.sciencedirect.com
Final Abstract Number: 28.045
Session: Influenza
Date: Wednesday, March 10, 2010
Time: 12:30-13:30
Room: Poster & Exhibition Area/Ground Level
Type: Poster Presentation
Co-infection between the pandemic influenza virus A H1N1 and seasonal influenza A virus in a
patient presenting severe acute respiratory disease
A. Feltrin 1 , K. Augusto 1 , V. Isper 1 , J. Delamain 1 , B. Kemp 2 , A. R. R. Freitas 2 , M. Pacola 3 , R.
Angerami 4
1 Hospital Madre Theodora, Campinas, SP, Brazil, 2 Epidemiological Surveillance Coordination of
Campinas, Campinas, SP, Brazil, 3 Epidemiological Surveillance Group, Regional Division of
Health VII,State Department of Health of São Paulo, Campinas, SP, Brazil, 4 State University of
Campinas, Campinas, SP, Brazil
Background: With the pandemic circulation of the new influenza A/H1N1 virus in 2009, became
mandatory to implement the national preparedness plan to improve both health care and
laboratory settings activities. However, it is also important a continuous surveillance is essential
to promote a better comprehension of mechanisms of transmission, viral virulence, and treatment
efficacy. The aim of this study is to describe the clinical, laboratorial, and epidemiological aspects
of a fatal case of severe acute respiratory disease (SARD) with simultaneous identification of both
pandemic and seasonal influenza A virus.
Methods: Retrospective and descriptive study based on information collected in medical records
and notification file about a patient hospitalized in Campinas, State of São Paulo, during the first
influenza A/H1N1 epidemic period in Brazil.
Results: A white female patient, 25 years old, with antecedent of obesity and diabetes, was
admitted in July/2009 with 2 days history of fever, cough, sore throat, myalgia, and malaise. On
admission, chest X-ray showed bilateral, diffuse, and intersticial-alveolar opacities. Despite the
started treatment with oseltamivir, ceftriaxone, and azithromycin, she presented with tachypnoea,
tachycardia, cyanosis, and hypoxemia in the day-3 of disease. In day-4, her respiratory pattern
progressed to severe respiratory distress, lung hemorrhage, and shock; invasive ventilatory
support and vasoactive drugs were introduced. Her outcome was death in the 8-day of disease.
The specific RT-PCR performed by Instituto Adolfo Lutz – a public health laboratory reference for
laboratorial diagnostic of pandemic influenza virus in Brazil – identified seasonal influenza virus in
respiratory secretion and pandemic A/H1N1 pandemic virus in lung specimen collected post
morten.
Conclusion: In the present case, it is not possible to postulate the real impact of simultaneous
infection predicting the poor clinical evolution. However, it reinforces the importance of a
continuous and sensitive epidemiological and laboratorial surveillance of respiratory syndromes,
during epidemic and interepidemic period, as a strategy to detect early changes in the
epidemiological pattern and to know what respiratory virus are circulating, including possible
emerging new influenza virus strains eventually more virulent or antiviral resistant.