ObjectiveTo compare the clinical characteristics of inpatients with different influenza subtypes, so as to identify the subtypes at an early stage.MethodsA retrospective case study was conducted, using influenza surveillance data from January 1st, 2016 to December 31st, 2018 at a tertiary surveillance outpost hospital in Chengdu. Patients diagnosed with different subtypes of influenza by nucleic acid testing or virus isolation and culture were investigated, and their clinical characteristics, laboratory test results, and prognosis were analyzed and compared among the four subtypes including H1N1, H3N2, Victoria (BV), and Yamagata (BY).ResultsThere were 127 inpatients with laboratory-confirmed influenza. Among the confirmed influenza patients, 85.8% (109/127) had low or normal white blood cell counts, and 78.8% (89/113) had abnormally high procalcitonin levels. Among the patients with different subtypes, statistical differences existed in age (P<0.001), low or normal white blood cell count (P=0.041), positive bacteria/fungus/mycoplasma/chlamydia culture (P=0.001), kidney damage (P=0.013), outcome at discharge (P<0.001), and hospitalization expenses (P=0.016). However, there was no statistical difference in gender, clinical symptoms, liver damage, cardiac damage, or length of hospital stay (P>0.05).ConclusionThe infection of influenza can lead to severe clinical complications or even death. The outcomes of patients with influenza A may be more severe. An elevated procalcitonin level can be detected in quite a few patients with influenza.
Objective To systematically review the clinical effectiveness and safety of Lianhuaqingwen capsule in the treatment of influenza. Methods Databases including MEDLINE, The Cochrane Library, PubMed, VIP, WanFang Data, CNKI and CBM were searched to collect the randomized controlled trials (RCTs) on Lianhuaqingwen capsule treating influenza published from 2000 to 2011. The studies were screened according to the inclusion and exclusion criteria, the data were extracted, the quality of the included RCTs was assessed, and meta-analysis was performed using RevMan 5.0 software. Results Among 12 RCTs included, 11 were in Chinese and 1 was in English. The results of meta-analyses based on stratified therapeutic strategies showed that: a) Lianhuaqingwen caspule vs. other traditional Chinese medicinals (TCM): A total of 5 RCTs were included. Compared with the Lingyangganmao capsule, significant differences were found in the clinically marked effective rate (RR=1.32, 95%CI 1.15 to 1.52), the marked effective rate of temperature (RR=1.31, 95%CI 1.10 to 1.55), and the time of defervescence (RR=3.98, 95%CI –4.81 to –3.15); compared with the Kugan granules, significant differences were found in the clinically marked effective rate (RR=1.33, 95%CI 1.08 to 1.64) and the marked effective rate of temperature (RR=1.58, 95%CI 1.20 to 2.09); compared with the TCM decoction, the time of defervescence was significantly different (WMD=5.52, 95%CI 0.32 to 10.72); and b) Lianhuaqingwen capsule vs. western drugs: A total of 9 RCTs were included. Compared with ribavirin, the clinically marked effective rate was significantly different (RR=1.52, 95%CI 1.15 to 2.02); compared with Phosphate oseltamivir, the clinically marked effective rate was not significantly different (RR=0.96, 95%CI 0.77 to 1.18), and the WMDs (95%CI) of such indexes as the time of defervescence, the duration of cough, sore throat, myalgia, expectoration and headache, and the time of viral shedding were –4.50 (–8.83, –0.17), –10.38 (–13.89, –6.87), –13.92 (–19.81, –8.04), –16.44 (–26.50, –6.39), –10.80 (–18.98, –2.63), –9.24 (–17.92, –0.57), and 1.39 (–7.24, 10.02), respectively. Except for the time of viral shedding, all the other indexes showed significant differences between the two groups. No obvious adverse reactions related to Lianhuaqingwen capsule were reported. Conclusion Current evidence shows that Lianhuaqingwen capsule is more effective than other Chinese medicinals and western drugs in alleviating flu-like symptoms when treating influenza. Due to the low methodological quality of the included RCTs, more high-quality large-scale RCTs need to be conducted to verify this conclusion.
ObjectiveTo analyze the clinical radiographic features and treatment of interstitial lung disease (ILD) inpatients infected with influenza virus. MethodsThe clinical data of ILD patients with influenza in Nanjing Drum Tower Hospital from October 2023 to January 2024 were collected. According to each patient results of influenza nucleic acid detection, they were divided into an influenza infection group and a non-infection group. ResultsA total of 73 patients received influenza nucleic acid detection were enrolled, 23 cases including 5 males and 18 females were positive. Twenty-one cases were infected with influenza A virus, 2 cases were infected with influenza B virus. The median age of influenza positive patients was 64.7±7.8 years. Cough (23 cases, 100.0%), sputum (23 cases, 100.0%), wheezing (20 cases, 87.0%) and fever (17 cases, 73.9%) were the most common symptoms of the patients infected with influenza. Compared with the non-infection patients, fever was more common in the influenza infection group (P<0.05). Laboratory examination indicated that lymphocytopenia were detected in the influenza infection patients. There was no statistical difference in the level of white blood cell count, neutrophil count, lactate dehydrogenase, creatine kinase, erythrocyte sedimentation rate, C-reactive protein, calcitonin, interleukin-6 and oxygenation index. Ground glass opacity in the influenza virus infection group was more common than that in the non-infection group (P<0.05). Ten ILD patients infected with influenza virus (43.5%) were co-infected with Aspergillus. The chest CT type of ILD patients with Aspergillus infection was usual interstitial pneumonia (UIP). Honeycombing was more common than those without Aspergillus infection group (P<0.05). Twenty-two patients (95.7%) received antiviral treatment, of which 20 patients (87.0%) were treated with oseltamivir, 5 patients (21.7%) were treated with mabaloxavir, and 4 patients (17.4%) were treated combined with paramivir. Seventeen patients (73.9%) were previously treated with glucocorticoids, and 16 patients did not adjust the glucocorticoids dosage; 9 patients (39.1%) were previously treated with immunosuppressants, and 2 patients stopped immunosuppressants. Four patients (17.4%) infected with influenza virus developed acute exacerbation of ILD. There was no statistically significant difference in acute exacerbation between the two groups (P>0.05). ConclusionsCompared with ILD patients not infected with influenza, fever, lymphocytopenia and ground-glass opacity are the common clinical and chest CT features of ILD patients infected with influenza. Patients with UIP type combined with honeycomb were prone to be co-infected with Aspergillus infection.
Co-infection with severe influenza and bacterial is well known, but in recent years, more and more studies report that aspergillus have been identified as important pathogens, secondary only to bacteria in severe influenza. Influenza-associated aspergillus (IAA) brings a high death rate and heavy burden to our country. Therefore, early diagnosis and effective treatment are needed. In order to better understand IAA, this review summarizes the available literature on the association of IAA, including epidemiology, diagnosis and treatment.
Influenza A is an acute infectious respiratory disease caused by influenza A virus, with typical signs and symptoms of upper and / or lower respiratory tract involvement, and symptoms of systemic disease such as fever, headache, myalgia and fatigue. Although it is a self-limited disease in the general population, it is associated with increased morbidity and mortality in some high-risk populations and often leads serious complications, such as severe acute lung injury, acute respiratory distress syndrome, as well as other extrapulmonary injuries. The exploration of the mechanisms of lung injury caused by influenza A infection could be helpful to understand the pathogenic mechanisms of other viral pneumonias, such as coronavirus disease 2019.
ObjectiveTo analyze the clinical features, laboratory examination, imaging findings, treatment and outcome of influenza A H1N1 virus infection in China, so as to improve the clinicians' understanding of the disease.MethodsOne patient with influenza A H1N1 pneumonia was reported in this hospital. The databases of CNKI, VIP network and Wanfang data were systematically consulted. After removing the duplicate and deleting the incomplete literature published between January 1989 and August 2019, 62 literatures were included, involving 880 patients. Hence, 881 patients in total were included. The clinical manifestations, laboratory examination, imaging manifestations, treatment and prognosis were analyzed.ResultsThere were 477 males and 404 females, aged from 50 days to 86 years old, with an average age of (20.4 ±10.0) years. The most common clinical symptoms were fever (99.4%, 876/881), followed by cough (85.0%, 749/881), expectoration (38.1%, 336/881), sore throat (37.0%, 326/881) and dyspnea (33.7%, 297/881), asthenia and general pain (33.5%, 295/881) and so on. Laboratory examination in the leukocyte decreased in 249 patients (28.3%), neutrophil increased in 143 patients (16.2%) and leukocyte increased in 141 patients (16.0%). Myocardial injury was found in 370 patients (42.0%), liver injury in 303 patients (34.4%) and renal insufficiency in 84 patients (9.5%). The main imaging manifestations were spotted, patchy or flaky shadows (41.8%, 362/866) in varying degrees, with consolidation shadows (19.3%, 167/866), thickening of lung texture (11.3%, 98/866), ground glass shadows (4.5%, 39/866), and pleural effusion (5.5%, 48/866). The most common treatments were anti-virus, anti-infection, anti-inflammation, mechanical ventilation and symptomatic support. Comprehensive treatment resulted good effects. There were 37 deaths and the mortality rate was 4.2%. The main cause of death was respiratory failure.ConclusionsInfluenza A H1N1 virus infection is a preventable, controllable and treatable infectious disease, which is similar to the general influenza virus. After active comprehensive treatment, most of the influenza A (H1N1) can be cured and the prognosis is benign.
Objective To explore the impact of community healthcare workers’ (CHWs) knowledge, attitude and practice (KAP) on the influenza vaccination among elderly people. Methods By means of simple random sampling, 1 residential quarter of each communities, 2 communities of each districts, 5 districts of Chengdu city were randomly selected, and the elderly equal to or more than 60-year-old were on-site investigated. Meanwhile, the questionnaire survey was conducted among healthcare workers in the selected communities. Results There were 4 KAP factors played a positive role in influenza vaccination among elderly people: CHWs’ affirmation of the effectiveness of influenza vaccine, explicitly knowing the focus groups for influenza vaccination, recommendation of vaccination in flu season when the elderly visits, and participation in flu-related education activities. When the accuracy rate of each factor got improved by 1%, the influenza vaccination rate would improve by 2.747%, 1.299%, 0.864%, 0.602%, respectively. Conclusion The knowledge, attitude and practice of HCWs have impacts on the influenza vaccination rates of elderly people. They are significant to improve the influenza vaccination rates of the elderly.
ObjectiveTo investigate the clinical characteristics and prognostic factors of influenza pneumonia from 2014 to early 2018.MethodsThe general information, clinical symptoms, laboratory examination and treatment of 69 patients with influenza pneumonia from October 2014 to March 2018 were collected. The clinical characteristics of 32 patients with influenza pneumonia from 2017 to 2018 were compared with 37 patients with influenza pneumonia from 2014 to 2016. The prognostic factors of influenza pneumonia were also investigated.ResultsThe median patient age was 68 (55-78) years, and 41 cases (59.4%) were men in 69 patients. The five most common comorbidities were hypertension (44.9%), diabetes (23.3%), chronic obstructive pulmonary disease (17.4%), coronary atherosclerotic heart disease (13.0%), and chronic kidney disease (10.1%). The median levels of fasting blood glucose, lactate dehydrogenase, C-reactive protein, and procalcitonin in the patients with influenza pneumonia in 2017-2018 were significantly higher than those in the same period of 2014-2016, which were respectively 7.1 (5.4 - 8.3)mmol/L vs. 5.2 (4.5 - 7.3)mmol/L (P=0.017), 213.0 (98.0 - 320.5)U/L vs. 178 (98.0 - 280.0)U/L (P=0.049), 65.5 (15.4 - 139.8)mg/L vs. 45.5 (14.1 - 75.3)mg/L (P=0.050), 0.66 (0.24 - 1.58)μg/L vs. 0.17 (0.11 - 0.43)μg/L (P=0.004). The proportion of bacterial infection, septic shock, acute renal failure and mortality in the patients with influenza pneumonia in 2017-2018 was higher than that in the 2014-2016 group, which were respectively 40.6% vs. 18.9% (P=0.047), 21.9% vs. 5.4% (P=0.043), 21.9% vs. 2.7% (P=0.035), 31.3% vs. 5.4% (P=0.005). Multivariate analysis showed that numbers of lymphocytes, blood urea nitrogen, and procalcitonin were independent risk factors for mortality in the patients with influenza pneumonia. The odds ratio was respectively 0.001 (95%CI 0.00 - 0.200), 1.342 (95%CI 0.996 - 1.808), 1.113. (95%CI 1.006 - 1.230).ConclusionsCompared with the patients with influenza pneumonia in 2014-2016, the patients in 2017-2018 have higher levels of fasting blood glucose and lactate dehydrogenase, and are also susceptible to secondary bacterial infection, septic shock, and acute renal failure. Decreased lymphocytes, elevated blood urea nitrogen, and elevated procalcitonin are independent risk factors for death in patients with influenza pneumonia.
Objective To investigate safety of influenza A H1N1 vaccine vaccinations. Methods A total of 3 300 medical workers were vaccinated by batch of 200909012 influenza A H1N1 vaccine produced by Shanghai Biological Products Corporation Limited according to the principle of voluntary and concentration. The adverse reactions were observed within half an hour, three days and a week after vaccinations, respectively. Results The inoculators with local or systemic reaction reached 1.18% (39/3 300). There were 0.15% (5/3 300) of the inoculators with adverse reaction within half an hour; 0.70% (23/3 300) within 1 to 3 days after vaccination; and 0.33% (11/3 300) within 3 days to 1 week after vaccination. No severe adverse events were found. Conclusion Influenza A H1N1 vaccine vaccinations is an economic and effective way of influenza A H1N1 prevention with mild reactions.