Casalino Enrique, Antoniol Stephanie, Fidouh Nadhira, Choquet Christophe, Lucet Jean-Christophe, Duval Xavier, Visseaux Benoit, Pereira Laurent
Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Universitaire Paris Nord Val de Seine, Emergency Department, Paris, France.
Université Paris Diderot, Sorbonne Paris Cité, EA 7334 Recherche clinique coordonnée ville-hôpital, Méthodologies et Société (REMES), Paris, France.
PLoS One. 2017 Aug 16;12(8):e0182191. doi: 10.1371/journal.pone.0182191. eCollection 2017.
The role of influenza virus in patients presenting at ED during seasonal-epidemic periods has not previously been specified. Our objective was to determine its frequency according to clinical presentation.
This is a prospective observational study conducted during three-consecutive seasonal Influenza epidemics (2013-2015), including patients presenting i) community-acquired pneumonia (CAP); ii) severe acute symptoms (SAS): respiratory failure (RF), hemodynamic failure (HF), cardiac failure (CF), and miscellaneous symptoms (M); iii) symptoms suggesting influenza (PSSI). Patients were tested for influenza using specific PCR on naso-pharyngeal swabs.
Of 1,239 patients, virological samples were taken from 784 (63.3%), 213 (27.2%) of whom were positive for the influenza virus: CAP 52/177 (29.4%), SAS 115/447 (25.7%) and PSSI 46/160 (28.8%) (p = 0.6). In the SAS group positivity rates were: RF 76/263 (28.9%), HF 5/29 (17.2%), CF 15/68 (22.1%), and M 19/87 (21.8%) (p = 0.3). Among the major diagnostic categories, the influenza virus positivity rates were: asthma 60/231 (26%), acute exacerbation of chronic obstructive pulmonary disease 18/86 (20.9%), HIV 5/21 (23.8%) and cardiac failure 33/131 (25.2%). The positivity of the samples has not been associated (p>0.1) nor the presence of signs of severity or admission rate in medical ward nor intensive care unit.
Our results indicate that during seasonal influenza epidemics, Influenza virus-positivity rate is similar in patients attending ED for influenza-compatible clinical features, patients with acute symptoms including pneumonia, respiratory, hemodynamic and cardiac distress, and patients presenting for acute decompensation of chronic respiratory and cardiac diseases.
季节性流行期间急诊科就诊患者中流感病毒的作用此前尚未明确。我们的目的是根据临床表现确定其发生率。
这是一项在连续三个季节性流感流行期（2013 - 2015年）进行的前瞻性观察性研究，纳入的患者包括：i）社区获得性肺炎（CAP）；ii）严重急性症状（SAS）：呼吸衰竭（RF）、血流动力学衰竭（HF）、心力衰竭（CF）及其他症状（M）；iii）提示流感的症状（PSSI）。采用鼻咽拭子特异性PCR检测患者是否感染流感病毒。
1239例患者中，784例（63.3%）采集了病毒学样本，其中213例（27.2%）流感病毒检测呈阳性：CAP组177例中有52例（29.4%），SAS组447例中有115例（25.7%），PSSI组160例中有46例（28.8%）（p = 0.6）。SAS组的阳性率分别为：RF组263例中有76例（28.9%），HF组29例中有5例（17.2%），CF组68例中有15例（22.1%），M组87例中有19例（21.8%）（p = 0.3）。在主要诊断类别中，流感病毒阳性率分别为：哮喘231例中有60例（26%），慢性阻塞性肺疾病急性加重86例中有18例（20.9%），HIV感染21例中有5例（23.8%），心力衰竭131例中有33例（25.2%）。样本的阳性结果与（p>0.1）、内科病房或重症监护病房的严重程度体征或住院率均无关联。
我们的结果表明，在季节性流感流行期间，因具有流感相关临床特征而到急诊科就诊的患者、有包括肺炎、呼吸、血流动力学和心脏窘迫等急性症状的患者以及因慢性呼吸和心脏疾病急性失代偿而就诊的患者中，流感病毒阳性率相似。
