Ijaz Muhammad, Jaffar Khan Muhammad, Khan Jawad, Usama Usama
Northwest General Hospital and Research Center Peshawar.
Monaldi Arch Chest Dis. 2017 May 18;87(1):765. doi: 10.4081/monaldi.2017.765.
Clinical judgement and suspicion of influenza based on signs and symptoms of influenza-like illness and severe acute respiratory illness are critical for better patient outcome. Whether clinical characteristics of patients are associated with the development of acute respiratory distress syndrome and PCR positivity of samples was the aim of this study. We included all patients (n=37) presenting with influenza like illness (ILI) or severe acute respiratory illness (SARI) to a tertiary care hospital in northwest Pakistan during December 2015 until the end of January 2016. Each patient was assessed for signs and symptoms, clinical features, treatment, complications and outcome of ILI and SARI. Throat or nasopharyngeal swabs were obtained from 36 patient and analyzed for the presence of Influenza virus by quantitative PCR. Patients presenting with ILI or SARI were febrile (p<0.001, one sample t-test), significantly tachypneic (p<0.001) and had critically lower oxygen saturation (p<0.001). Nasal congestion at presentation (p=0.006, chi-square test for association) and infiltrates on chest radiographs (p=0.025) were significantly associated with acute respiratory distress syndrome. Likelihood of the occurrence of ARDS was significantly increased with decrease in oxygen saturation (Odds ratio; 0.75, 95% CI; 0.46, 1.21, p=0.048) and marginally significantly increased in lower age (Odds ratio; 0.82, 95% CI; 0.58, 1.15, p=0.055) and higher white cell count (Odds ratio; 1.001, 95% CI; 0.99, 1.002, p=0.054). The presence of Influenza type A/H1N1pdm09 strains was confirmed in 7/11 patients. However no significant difference was observed in the clinical features and complications of PCR positive and negative patients. Clinical signs and symptoms of influenza-like illness or severe acute respiratory illness significantly predict the development of complications irrespective of the positivity or negativity of laboratory qPCR reports.
基于流感样疾病和严重急性呼吸疾病的体征和症状进行临床判断并怀疑流感，对于改善患者预后至关重要。本研究的目的是探讨患者的临床特征是否与急性呼吸窘迫综合征的发生及样本的PCR阳性有关。我们纳入了2015年12月至2016年1月底在巴基斯坦西北部一家三级护理医院就诊的所有出现流感样疾病（ILI）或严重急性呼吸疾病（SARI）的患者（n = 37）。对每位患者的ILI和SARI的体征和症状、临床特征、治疗、并发症及预后进行评估。从36例患者中采集咽喉或鼻咽拭子，通过定量PCR分析流感病毒的存在情况。出现ILI或SARI的患者发热（p<0.001，单样本t检验）、呼吸显著急促（p<0.001）且氧饱和度极低（p<0.001）。就诊时鼻塞（p = 0.006，关联的卡方检验）和胸部X光片上的浸润影（p = 0.025）与急性呼吸窘迫综合征显著相关。随着氧饱和度降低，发生ARDS的可能性显著增加（比值比；0.75，95%可信区间；0.46，1.21，p = 0.048），在较低年龄组中略有显著增加（比值比；0.82，95%可信区间；0.58，1.15，p = 0.055），在白细胞计数较高时也略有显著增加（比值比；1.001，95%可信区间；0.99，1.002，p = 0.054）。在11例患者中确认了7例甲型H1N1pdm09流感毒株的存在。然而，PCR阳性和阴性患者的临床特征及并发症未观察到显著差异。无论实验室qPCR报告呈阳性或阴性，流感样疾病或严重急性呼吸疾病的临床体征和症状都能显著预测并发症的发生。
