Community Medicine Research Center & Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2011 Jul;74(7):298-304. doi: 10.1016/j.jcma.2011.05.005. Epub 2011 Jul 6.
A novel influenza H1N1 began in March 2009, rapidly spread, and then became a pandemic outbreak. Diagnosis by polymerase chain reaction result was not always available because of a surge in workload and therefore clinical diagnosis became important. However, clinical differences between the patients infected by the novel H1N1 virus and those infected by the influenza-like non-novel H1N1 have not been reported. This study was conducted to compare the demographic background, clinical manifestations, and laboratory findings between novel H1N1 influenza infections and other non-novel H1N1 infections.
At an early stage of H1N1 spread, cases presenting with influenza-like symptom and travel or contact history were quarantined into infection disease-designated hospitals in Taiwan. Data on consecutive patients under investigation for infection with novel influenza A (H1N1) were collected between April 29 and June 19, 2009. The data set consisted of clinical manifestations, plain chest radiography, hematological results, and biochemical findings. Testing of nasopharyngeal swab samples by reverse transcription polymerase chain reaction was used to detect H1N1.
Overall, 166 cases were collected. Among these individuals, there were 14 confirmed H1N1 cases. The clinical manifestations of the H1N1 cases included fever in 13 patients (92.9%), followed by cough, rhinorrhea, a sore throat, myalgia, headache, malaise, abdominal tenderness, and diarrhea. Leukopenia was present in nine patients (64.2%) and lymphocytopenia was present in five (35.7%). The duration of virus shedding was 7.0 ± 1.8 days. When compared with the non-H1N1 cases by multiple logistic regression analysis, cases infected by the novel H1N1 virus were more likely to be younger than 20 years [Odds ratio (OR) = 27.7, 95% confidence interval (CI) = 1.3-597.8, p = 0.034), have traveled from the US (OR = 14.5, 95% CI = 2.1-101.4, p = 0.007) or Thailand (OR = 56.7, 95% CI = 4.6-700.6, p = 0.002) and to have presented with myalgia (OR = 8.5, 95% CI = 1.4-52.0, p = 0.021) or leukopenia (OR = 17.4, 95% CI = 3.4-90.5, p = 0.001).
When a patient presents with influenza-like acute febrile respiratory illness symptoms and is young in age, has a travel history involving an affected area, and is suffering from myalgia or leukopenia, physicians should be alerted to the possibility of novel H1N1 virus infection.
一种新型甲型 H1N1 流感于 2009 年 3 月开始出现，迅速传播，并随后成为一种大流行疫情。由于工作量激增，聚合酶链反应结果的诊断并不总是可用，因此临床诊断变得重要。然而，新型 H1N1 病毒感染者与非新型 H1N1 流感病毒感染者之间的临床差异尚未报道。本研究旨在比较新型 H1N1 流感感染与其他非新型 H1N1 感染患者的人口统计学背景、临床表现和实验室结果。
在甲型 H1N1 流感传播的早期阶段，出现流感样症状且有旅行或接触史的患者被隔离到台湾的传染病指定医院。2009 年 4 月 29 日至 6 月 19 日期间，收集了连续调查的新型甲型流感（H1N1）感染患者的数据。该数据集包括临床表现、胸部平片、血液学结果和生化发现。使用逆转录聚合酶链反应检测鼻咽拭子样本以检测 H1N1。
总共收集了 166 例病例。其中，有 14 例确诊为 H1N1 病例。H1N1 病例的临床表现包括发热 13 例（92.9%），其次是咳嗽、流涕、咽痛、肌痛、头痛、不适、腹痛和腹泻。白细胞减少 9 例（64.2%），淋巴细胞减少 5 例（35.7%）。病毒排出时间为 7.0±1.8 天。通过多元逻辑回归分析与非 H1N1 病例比较，新型 H1N1 病毒感染者更可能年龄小于 20 岁[优势比（OR）=27.7，95%置信区间（CI）=1.3-597.8，p=0.034]，有美国旅行史（OR=14.5，95%CI=2.1-101.4，p=0.007）或泰国旅行史（OR=56.7，95%CI=4.6-700.6，p=0.002），表现为肌痛（OR=8.5，95%CI=1.4-52.0，p=0.021）或白细胞减少（OR=17.4，95%CI=3.4-90.5，p=0.001）。
当患者出现流感样急性发热呼吸道疾病症状且年龄较小，有疫区旅行史，且出现肌痛或白细胞减少时，医生应警惕新型 H1N1 病毒感染的可能性。
