Fulminating influenza pneumonia in the elderly: a case demonstration.
An 82-year-old male Bangkokian with hypertension, diabetes mellitus, end-stage renal disease, and coronary artery disease for many years, was hospitalized due to deterioration of a 3-day influenza-like-illness with one-day chest oppression and respiratory failure. At the emergency room, oxygen saturation was 79% on room air Chest X-ray revealed bilateral diffuse pulmonary infiltrates. He was intubated and hemodialysis was initiated. Emergency coronary angiography revealed patent coronary artery. Sputum gram stain revealed numerous leukocytes with no bacteria. On day three of hospitalization, empiric treatment with oseltamivir and clarithromycin was administered Seventy-two hours later his clinical condition began to improve and fever subsided 7 days later Rapid test of tracheal secretion with immunofluorescence assay was positive for moderate amount of influenza A virus. Viral isolation yielded influenza A virus subtype H1N1. Review of in-patient records at this hospital using ICD-10 codes as J10 and J11 during 1995-2005, discovered 32 cases with claim diagnosis of influenza. However this is the first case with proven influenza pneumonia that was given empiric oseltamivir. Rapid deterioration of influenza-like illness due to human influenza virus in the elderly and pathogenesis of pulmonary in this case are discussed to alert physicians to recognize this dreadful illness and treat it in timely fashion.
Leelarasamee
Amorn
A
Division of Infectious Disease and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Jongwutiwes
Ubonvan
U
Tantipong
Hatsaya
H
Puthavathana
Pilaipan
P
Siritantikorn
Sonthana
S
D000367:Age Factors; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use; D006801:Humans; D009980:Influenza A virus; D007251:Influenza, Human / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D053139:Oseltamivir / Q000627:therapeutic use; D011024:Pneumonia, Viral / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology
D000900:Anti-Bacterial Agents; D000998:Antiviral Agents; D053139:Oseltamivir; D017291:Clarithromycin