Analysis of clinical and lung imaging features of influenza A H1N1 cases of severe disease report.docx
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AnalysisofclinicalandlungimagingfeaturesofinfluenzaAH1N1casesofseverediseasereport
AnalysisofclinicalandlungimagingfeaturesofinfluenzaA(H1N1)casesofseveredisease(reportof3cases)
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DepositXialiangXuLinChiWangJun,JiangHandong
[Abstract]ObjectiveToimproveunderstandingofthecharacteristicsofinfluenzaA(H1N1)casesofseverediseaselungimaging.AnalysisofthreecasesofseverecasesofInfluenzaA(H1N1)clinicaldata,andanalysisoflungimagingfeatures.ThreecasesofpatientswithchestCTvaryingdegreesoflunginjuryinthecaseofachestCTfindingsofleftlung,lowerlobeblockbustersexudativedenseshadowoftherightlowerlobecanbeseenalittleoozingshadow,irregularborder.Example2chestCTshowedarightlungleafexudateshadowsscatteredinmultiplefoci.casesofchestCTperformanceforthenextbilateralpulmonaryexudativelesions,mainlyinthelowerlobe3casesclinicalmanifestationswerefever,coughandchesttightnesssymptoms,hypoxiaviremiaandleukopenia3casesweregivenantibioticsandoseltamivirtreatmenttogoodeffect,discharged.Conclusion(H1N1)casesofinfluenzawithseverelungimagingperformanceofmultiplelesionsmainlybilateralinthelowerlobetoinfiltrationsexoutoftheshadowofthemain,sometimesalittleinterstitialchange,thelesionsshowedadiversitycharacterizedtherapidprogressofanti-inflammatoryiswellabsorbedafterantiviraltherapy.
[Keywords:
]influenzavirustypeA,H1N1subtype;pneumonia;Tomography,X-raycomputed[ABSTRACT]ObjectiveToraisetheunderstandingoflungimagefeaturesinseverepatientswithinfluenzaAH1N1.MethodsAnanalysiswasdoneforclinicaldataofthreepatientswithsevereH1N1influenzaAandtheirfeaturesoflungimage.ResultsAchestCTscanofthethreepatientsshowedvariousextentsoflunginjuries:
Incase1,massivelyexudativedensesha-dowofmiddleandlowerlobesofleftlung,andalittleeffusionoflowerlobeintherightlungwithirregularityboundarycouldbeseen;Incase2,exudativeshadowinlowerlobeofrightlung,characterizedasdisseminatemultiplelesions;Incase3,exudativefocusinbilaterallungs,withmainlyinmiddleandlowerlobe.Themanifestationsofthosethreecaseswerethesame:
fever,cough,chestdistress,hyoxemia,andleucopenia.Theyweregivenantibioticsandoseltamivirwithagoodoutcomeandrehabilitationdischarged.ConclusionThemainmanifestationsoflungonCTinpatientswithsevereH1N1influenzaAaremultiplelesionsinmiddleandlowerlobesofbilaterallungswithfastdevelopment,whichcharacterizedmainlyaseffusionoralittlemesenchymalchanges.Thelesionsrespondwelltoanti-inflammatoryandantiviraltherapy.
[KEYWORDS]influenzaAvirus,H1N1subtype;pneumonia;tomography,X-raycomputedInfluenzaAH1N1influenzaglobalpandemic,broadcasttoover200countriesandregions,thecurrentoutbreakiseasingphaseofthisacuterespiratoryinfectiousdiseasecausedbytheH1N1influenzavirus,theearlysymptomsaresimilartonormalseasonalinfluenza,mainlyfever,cough,sorethroat,malaise,headacheandfatigue,flu-likesymptoms,mostofthegoodprognosispartofthepatient’sconditioncanrapidlyprogress,ferocious,andasuddenhighfever,atemperatureover39°C,andevensecondarytoseverepneumonia,acuterespiratorydistresssyndrome,pulmonaryhemorrhage,pancytopenia,renalfailure,sepsis,shock,respiratoryfailureandmultipleorgandamageleadingtodeath.hospitalsuccessfullytreatedthreecasesofinfluenzaA(H1N1)casesofseveredisease,nowtheclinicaldataandliteratureThereportisasfollows.
1clinicaldataExample1,female,11yearsold.October17,2009withfever,coughaccompaniedbychesttightness,bodytemperature39.5°C,athometreatment,symptomsdidnotimprove.October22tothefeverclinicofahospital,themeasuredbodytemperatureof40.5°C,thedateofhospitalization.ChestDRchecksshowedtheleftlowerlungfieldcoarsetexturedisorder,middlemediastinum,bilateralribeveryanglenoabnormalblood:
theWBC2.6×109/L.previousnine-yearhistoryofasthma,epilepsy,ahistoryofsevenyearsinthe10diagnosedasinfluenzaA(H1N1)casesofseverediseaseon23Maytoturnourhospitalforfurthertreatment.admissionexamination:
generallypoor,shortnessofbreath,tonsilIIdegree,in,underthelungscouldbeheardanddryrales.ChestCTacidissatisfied:
intheleftlung,lowerlobevisiblelargeareasofflocculentexudativeshadowoftherightlowerlobecanbeseenalittleoozingshadow.Bloodgasanalysisshowedhypoxemia.givenfurosemidewesttoeach1.0g,2adayintravenousinfusion;antiviralsAustrianSecretaryWei,eachof100mgtwicedailytreatment;aerosolinhalationRupumike,eachof1mg,2timesaday;takingantiepilepticdrugs.1026,ChestCTscanshowslungshadowsabsorptionisnotobvious,continuetogivetheanti-inflammatoryandantiviraltreatment.againreviewthechestCT,thelowerrightlung,leftlungmid-andlowerlobeeffusionshadowofapparentabsorption(seeFigure1a,b).
Example2,female,13yearsold.October24,2009fever,runnynose,sorethroat,headache,cough,bodytemperatureupto39.9°ConOctober26thtogotoahospitalfeveroutpatientchestDR-rayexaminationnoabnormalbloodtest:
WBC9.3×109/L,neutrophils0.892.10January27,diagnosedasinfluenzaA(H1N1)criticallyillcasestoturnthehospitaladmissionexamination:
pharyngealhyperemia,bilateraltonsilIlarge,coarsebreathsoundsinbothlungs.isnotknownandthewetanddrytone.bloodtest:
WBC3.2×109/Landneutrophils0.788.bloodgasanalysisshowedhypoxemiagiveceftriaxonesodium,each2.0g,2timesadayintravenously;AustriaOseltamivireach100mgtwicedailytreatment.October30chestCTexaminationshowed:
rightlowerlobecanbeseenscatteredinexudativeshadow.tocontinuetreatmentuntilNovember3rdtoreviewchestCTshowsrightlungleavesexudativeshadowsabsorption(Figure2a,b).
Example3,male,23yearsold,November20In2009,fever,runnynose,cough,bodytemperature39.9℃.November23,toahospitalfeveroutpatientchestDRfilmexaminationshowed:
lowerleftlungmarkings,bilateralribeveryanglesharp,middlemediastinum,initiallydiagnosedaspneumonia,receivedhospitaltreatment.November24,2009,thediseaseprogressesrapidlychesttightness,suffocation,significantlyworseaftertheevent.examination:
throatcongestion,tonsilⅠdegree,thelungscouldbeheardandscatteredmoistrales.Bloodgasanalysisshowedhypoxemiabloodtestsshowed:
WBCcount2.7×109/L,lymphocytes0.335,bloodbiochemicaltestsshowedalanineaminotransferaseandaspartateaminotransferase,bloodglucoseincreased.11January25chestCTshowed:
bilaterallunginthelowerlobewereseenscatteredintheflocculentexudateshadow,adouble-lowerlobeobvious.tocontinueanti-inflammatorytreatment.November27reviewofchestCT:
lunglowerlobelesionsprogress,mainlyininterstitiallungdisease.TurnourhospitaldiagnosedasinfluenzaA(H1N1)criticallyillcases.AustrianSecretarytogiveantiviraldrugsoseltamivirtreatment,thedoseofeach150mg2timesaday;tocontinueanti-inflammatoryandsymptomatictreatmentof.11onthe30thagaintoreviewthechestCT:
absorptionofleaflesionsonthelungs,lung,lowerlobeseetheshadowofthecord-likeabsorptionisnotobvious.DecemberreviewofchestCTinthe4th:
lunglesionsabsorption(Figure3a,b).Figure1CTofapatient’sperformanceFigure2casesof2patientswithCTfindingsofFigure3casesof3patientstheCTfindings
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discussionH1N1influenzavirusisavirusfamilyissticky,influenzavirus,itspreadbetweenpeoplemorevulnerabletoinfectionthanseasonalinfluenza,stronger,childrenandyoungadults,butalsoinmanycountriesaroundtheworldcontinuedtospread.Mildpatientstothecommunityorhomeisolationandtreatment,hospitaltreatmentandhometreatmenteffectdifferences[1-2],butwithcomplicationsrequiringhospitalization,andlongerhospitalstay,especiallythosewithlungdiseaseandheartdisease,diabetesorpatientsundergoingimmunosuppressivetherapyinourhospitalfromthreecasesofInfluenzaA(H1N1)casesofcriticallyillpatients,clinicalmanifestationsarefever,coughaccompaniedbychesttightnessandearlyonsetoflungX-rayexaminationwerenormal,asthediseaseprogresseschestCTscanshowedthelungtothelowerlobeofthemainexudativelesions,extentofdiseasewassporadic,interstitialchangesafterthe3casesofpatientsadmittedtohospitalweregivenantibioticsandantiviraldrugs,andsymptomatictreatment.AustriaOseltamivirasneuraminidaseinhibitorspreventsneuraminidaseresiduesdivision,theinterferenceofinfluenzavirusreplicationanddistributioninthemucosalsecretions,reducetheactivityofthevirusinfectionduringtreatmentnoadversereactionsoccur.patientsappearedgranulocytesduringtreatmentreducedanalysisandvirusinfectionandoraloseltamivirtreatmentrelatedtocompletionoftreatmentwerenormalinstableconditionafterthereview,thisneutropeniapresentsa.
ChestCTcanprovidemorelesionsthanchestDRtabletssignsofpulmonarylesionsmoreclearlyshowtheDR-chipinterferencebymanyfactors[3]andclinicalcasesofcriticallyillpatientsinthetreatmentperiod,inatimelymannerforchestCTchecktoaccuratelydeterminethescopeofthelungs,theextentoflungdamage,aswellasthesiteofdamage,withorwithoutcomplications,suchaschestX-rayfilmisdifficulttoshowtheheartshadoworparaspinallesions,chestCTcanbeeasilyshowTherefore,chestCTscanhassomeadvantages