Division of Infectious Disease and Department of Microbiology, Jewish General Hospital, Montréal, Québec, Canada.
Diagn Microbiol Infect Dis. 2011 Jun;70(2):213-7. doi: 10.1016/j.diagmicrobio.2010.12.013. Epub 2011 Mar 11.
The recent pandemic of the 2009 pandemic influenza A (H1N1) infrequently caused severe disease. We describe 2 cases of 2009 H1N1 influenza with rapid progression resulting in respiratory failure and need for prolonged intensive care support. Real-time polymerase chain reaction amplification for influenza A (using a Centers for Disease Control and Prevention protocol) and the 2009 H1N1 influenza (using an in-house protocol) was performed on serial respiratory and serum specimens from both patients collected over 3 weeks. Both patients repeatedly demonstrated 2009 H1N1 influenza in respiratory specimens. Evidence of influenza A viremia was also detected in both cases, although it was confirmed as 2009 H1N1 influenza in only one. The presence of viremia in cases of severe 2009 H1N1 influenza has potential prognostic and therapeutic implications. Detection of viremia may be useful as a predictive marker for severe disease. Antiviral agents with low serum levels may be ineffective if administered to patients with influenza viremia.
2009 年甲型 H1N1 流感大流行期间，该病很少导致严重疾病。我们描述了两例 2009 年 H1N1 流感患者，其病情迅速进展导致呼吸衰竭，需要长期重症监护支持。对两例患者在 3 周内采集的连续呼吸道和血清标本进行了甲型流感（采用疾病预防控制中心的方案）和 2009 年 H1N1 流感（采用内部方案）的实时聚合酶链反应扩增。两例患者的呼吸道标本中均反复检测到 2009 年 H1N1 流感。两例患者均检测到流感 A 血症，但仅一例得到证实为 2009 年 H1N1 流感。重症 2009 年 H1N1 流感患者存在病毒血症可能具有预后和治疗意义。病毒血症的检测可能作为严重疾病的预测标志物有用。如果给予流感病毒血症患者低血清水平的抗病毒药物，可能无效。
