Severe Novel Influenza A(H1N1) in Shanghai:Clinical Features, Therapeutic Management and Risk Factors for Mortality

Objective To analyze the clinical features,therapeutic management and risk factors for mortality of patients with severe novel A(H1N1)influenza in Shanghai,China.Methods All patients were diagnosed by influenza A(H1N1)virus mRNA detection.Chest CT scan,routine blood,hepatic function,humoral and cellular immunity,sputum smears,and sputum cultures were performed.Logistic analysis was applied to identify risk factors for mortality.Results Total of 68 patients were enrolled in this study,the primary clinical symptoms including cough(66,97.1%),expectoration(41,60.3%),and polypnea(41,60.3%).Altogether,37(54.4%)and 11(16.2%)patients were infected with bacterial and fungal,respectively.CT scan demonstrated that 67(98.6%)patients had pneumonia.Oxygen therapy,oseltamivir,antibiotic and antifungal drugs were performed in 68(100%),66(97.1%),39(57.4%),and 11(16.2%)patients,respectively.Finally,4 of 68 patients died.Logistic analysis demonstrated that there was a significant correlation between the percentage of neutrophils and mortality before therapy and direct bilirubin content and mortality after therapy,respectively.Conclusions Patients with severe H1N1 influenza were susceptible to bacterial and/or fungal infection.The risk factors for mortality may be associated with pre-therapeutic neutrophil percentage and post-therapeutic direct bilirubin content.

甲型H1N1流感的胸部X线和CT对比研究

目的探讨H1N1流感的胸部常规X线、CT表现,并对两种影像学方法进行比较.方法回顾性对比分析31例H1N1流感患者的X线、多层螺旋CT成像资料.结果 X线及CT检出肺部病变分别为19例和30例,两者病变检出率比较具有高度统计学意义（P〈0.01）;甲型H1N1流感的肺部病变影像学上主要表现为磨玻璃影伴或不伴实变,以两肺中、下叶分布多见,胸膜下分布或沿支气管血管树分布为主.结论 X线及CT作为甲型H1N1流感肺部病变的主要检查手段,能较好地检出肺部病变及对其分布范围、密度特点等进行观察,CT在甲型H1N1流感肺部情况的显示方面明显优于常规X线.

Detection and pathogenesis of a novel swine H3N2 influenza virus containing three genes from the 2009 pandemic H1N1 influenza viruses in Korea in 2015

Dear Editor,Influenza A viruses cause pandemics at an interval of approximately 10-40 years,and pigs are regarded as a＂mixing vessel＂because they are easily infected with avian and human influenza viruses（Ito et al.,1998）.According to previous studies,H3N2,H1N2,and H1N1 subtypes o（swine influenza viruses have been detected in Korean pigs （Pascua et al., 2013; Kim et al., 2014; Song et al., 2007）. Moreover, a novel H3N2 influenza virus containing the matrix （34） gene from a 2009 pandemic influenza virus was detected in Korean pigs in 2013 （Pascua et al., 2013）, an H1N2 influenza virus con- taining the internal genes from a 2009 pandemic influ- enza virus was found in Korean pigs in 2014 （Kim et al., 2014）, and an H1N1 influenza virus containing all genes from the classical swine influenza viruses was isolated from Korean pigs in 2007 （Song et al., 2007）.

Comorbid presentation of severe novel influenza A （H1N1） and Evans syndrome： a case report

One 22-month-old boy who was admitted for a fever lasting 6 days as well as a cough and wheezing lasting 2 days was reported. He was diagnosed with influenza A （H1N1, severe type）, severe pneumonia, acute respiratory distress syndrome （ARDS）, Evans syndrome and multiple organ failure. This is the first case of novel influenza A （HIN1） and Evans syndrome. The pathogenesis is still unknown.

Endemicity of H9N2 and H5N1 avian influenza viruses in poultry in China poses a serious threat to poultry industry and public health

The H9N2 and H5N1 avian in fluenza viruses(AIVs) have been circulating in poultry in China and become endemic since 1998 and 2004, respectively.Currently, they are prevalent in poultry throughout China. This endemicity makes them actively involved in the emergence of the novel lineages of other subtypes of in fluenza viruses, such as the well-known viruses of the highly pathogenic avian in fluenza(HPAI) H5N2 and the2013 novel H7N7, H7N9 and H10N8 subtypes, thereby threatening both the poultry industry and public health.Here, we will review brie fly the prevalence and evolution,pathogenicity, transmission, and disease control of these two subtypes and also discuss the possibility of emergence of potentially virulent and highly transmissible AIVs to humans.

2009甲型H1N1流感相关性神经系统并发症

引起季节性流行性感冒的甲型或乙型流感病毒可导致神经系统并发症，包括惊厥、脑炎、脑病、瑞综合征以及其它神经系统异常。其中使用最多的命名是“流感相关性脑病（influenza associated encephalopathy）”，其报道多来自日本，欧洲、加拿大、美国也有零星报道。

新型甲型H1N1流感92例死亡高危因素分析

目的分析新型甲型H1N1流感患者死亡的高危因素。方法回顾性分析中国医科大学附属第一医院呼吸科2009—10—24—2010—01—15收治的92例新型甲型H1N1流感患者病程早期的临床资料，比较死亡组和存活组之间临床特征，经多变量Logistic回归分析确定患者死亡的高危因素。结果单因素分析中，早期呼吸困难、咯血痰、肌酸激酶同工酶和乳酸脱氢酶升高、低钙血症、T细胞亚群降低、D-二聚体升高、肺损伤程度和氧合指数降低、ASOFA评分、APACHⅡ评分等因素在死亡组和存活组之间差异有统计学意义；经多变量Logistic回归分析，继发感染（OR=1．563，95％CI：1．213～1．682）、APACHⅡ评分（OR=1．217，95％CI：1．052～1．435）和ASOFA评分（OR=1．136，95％CI：1．024～1．213）是患者死亡的独立危险因素。结论临床上应重视并针对上述危险因素制订相应的防治措施，以期降低病死率。