title: Impact of pandemic influenza (H1N1) virus-associated community-acquired pneumonia among adults in a tertiary hospital in Thailand.
abstract: In July 2009, a pandemic influenza (H1N1) (pdm H1N1) virus epidemic emerged rapidly in Phitsanulok, Thailand. Adult cases of community-acquired pneumonia (CAP) were prospectively examined for pdm H1N1 virus infections by real-time PCR in a tertiary hospital in Phitsanulok from July to November 2009. Twenty-four cases of pdm H1N1 virus-associated CAP were confirmed, and their clinical features including bacterial infection, severity of disease, course of admission, treatment, and outcome were investigated. The median age of these cases was 39.5 years. Most cases appeared to be primary viral pneumonia, but only one case was positive for a urinary pneumococcal antigen. The median time from the onset of illness to admission was 4 days. All 24 patients received oseltamivir after admission. Twelve (50.0%) were defined as having severe CAP and 9 (37.5%) were diagnosed with acute respiratory distress syndrome (ARDS). During the study period, pdm H1N1 virus infections frequently caused severe CAP among young adults because of the delayed initiation of antiviral therapy. Of the 9 ARDS patients, 3 died of ventilator-associated pneumonia caused by multidrug-resistant Acinetobacter baumannii. Implementation of infection control targeting this pathogen is required in tertiary hospitals in Thailand.
authors.affiliation: Department of Medicine, Buddhachinaraj Hospital, Phitsanulok, Thailand.
authors.forename: Ratapum
authors.initials: R
authors.lastname: Champunot
authors.forename: Sansanee
authors.initials: S
authors.lastname: Tanjatham
authors.forename: Anusak
authors.initials: A
authors.lastname: Kerdsin
authors.forename: Parichart
authors.initials: P
authors.lastname: Puangpatra
authors.forename: Sunee
authors.initials: S
authors.lastname: Wangsai
authors.forename: Pornpit
authors.initials: P
authors.lastname: Treebuphachatsakul
authors.forename: Somboon
authors.initials: S
authors.lastname: Tasnsuphaswasdikul
authors.forename: Chavalit
authors.initials: C
authors.lastname: Kiatvitchukul
authors.forename: Harutaya
authors.initials: H
authors.lastname: Kasyanan
authors.forename: Jutharak
authors.initials: J
authors.lastname: Yimsabai
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Akeda
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Kawakami
authors.forename: Pathom
authors.initials: P
authors.lastname: Sawanpanyalert
authors.forename: Surang
authors.initials: S
authors.lastname: Dejsirilert
authors.forename: Kazunori
authors.initials: K
authors.lastname: Oishi
mesh_terms: D040981:Acinetobacter baumannii / Q000302:isolation & purification; D000293:Adolescent; D000328:Adult; D000368:Aged; D001431:Bacteriological Techniques / Q000379:methods; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D005260:Female; D006761:Hospitals; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000150:complications* / Q000453:epidemiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000382:microbiology; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology; D016133:Polymerase Chain Reaction / Q000379:methods; D011446:Prospective Studies; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult