Uda Kazuhiro, Shoji Kensuke, Koyama-Wakai Chitose, Furuichi Munehiro, Iwase Noriyasu, Fujisaki Seiichiro, Watanabe Shinji, Miyairi Isao
Office for Infection Control, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo 157-8535, Japan.
Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo 157-8535, Japan.
J Infect Chemother. 2018 Jun;24(6):407-413. doi: 10.1016/j.jiac.2018.01.002. Epub 2018 Feb 9.
Influenza A(H1N1)pdm09 virus infections often manifest severe respiratory symptoms, particularly in patients with a past history of allergic disease. Most of these findings were reported during the 2009 pandemic. The purpose of this study was to detail the clinical characteristics of influenza virus-induced lower respiratory infection (LRI) during the A(H1N1)pdm09-predominant 2015-2016 season.
We retrospectively reviewed the clinical characteristics of influenza-induced LRI cases in children admitted to a tertiary children's hospital. Molecular diagnostic evaluation was performed on samples obtained from the most severe cases.
We identified 66 patients with influenza-associated hospitalization and included 21 patients with influenza virus-induced LRI for analyses. Twelve patients (57%) were admitted to the pediatric intensive care unit, seven (33%) required mechanical ventilation, and three (14%) required extracorporeal membrane oxygenation. Plastic bronchitis (PB) was identified in six patients (29%), among whom a past medical history of asthma or food allergy were noted in all six patients. A past history of allergic disease was more common among patients with, than among those without, PB (p = 0.009). A(H1N1)pdm09 was detected from all the PB cases, and phylogenetic analyses of the hemagglutinin and neuraminidase genes demonstrated that this virus belonged to subclades 6B.1 and 6B.2. In the six PB cases, we found one patient with H275Y mutation in neuraminidase.
Allergic disease was a risk factor for developing PB due to influenza A(H1N1)pdm09 infection during the 2015-16 season.
甲型H1N1pdm09流感病毒感染常表现出严重的呼吸道症状，尤其是在有过敏性疾病既往史的患者中。这些发现大多是在2009年大流行期间报告的。本研究的目的是详细描述在以甲型H1N1pdm09为主的2015 - 2016季节流感病毒引起的下呼吸道感染（LRI）的临床特征。
我们回顾性分析了一家三级儿童医院收治的流感引起的LRI患儿的临床特征。对病情最严重的病例所采集的样本进行了分子诊断评估。
我们确定了66例因流感住院的患者，其中21例为流感病毒引起的LRI患者纳入分析。12例（57%）患者入住儿科重症监护病房，7例（33%）需要机械通气，3例（14%）需要体外膜肺氧合。6例（29%）患者被诊断为塑料支气管炎（PB），这6例患者均有哮喘或食物过敏病史。有PB的患者比没有PB的患者更常见有过敏性疾病既往史（p = 0.009）。所有PB病例均检测到甲型H1N1pdm09，血凝素和神经氨酸酶基因的系统发育分析表明该病毒属于6B.1和6B.2亚分支。在这6例PB病例中，我们发现1例患者神经氨酸酶存在H275Y突变。
过敏性疾病是2015 - 16季节甲型H1N1pdm09感染导致PB发生的一个危险因素。
