Pulmonary Findings Of H1N1 Infection In Children With Malign Disease

INTRODUCTION: H1N1 influenza virus may be fatal due to immunosuppression in malignant diseases and chronic diseases. Patients frequently present with influenza-like symptoms, high fever, and diarrhea, and the clinical course may be aggressive, possibly ending in respiratory failure. The purpose of this study was to examine the radiological findings of patients who were diagnosed with cancer and had H1N1 infection.
METHODS: Ten cases with a positive H1N1 PCR among 94 patients who were followed-up with a diagnosis of cancer at the hematology and oncology clinic between January 2010 and January 2016 were included in the study. Cases were divided into two groups according to the absolute neutrophil count, having a neutrophil count ≥500 /µL and neutrophil count <500 µL. Chest x-ray and thoracic computed tomography of the patients were evaluated.
RESULTS: Eight of ten patients received active chemotherapy. Chest x-rays of all patients were initially within normal ranges. During follow-up, the most frequently encountered finding was involvement at the lower zones of the lungs. The most prominent lung finding was a wedge-shaped consolidation. A ground glass appearance and consolidation were seen frequently in the thoracic computed tomography. Four patients (three with severe neutropenia) died due to respiratory failure.
DISCUSSION AND CONCLUSION: Early chest x-ray findings might frequently be normal in patients who have H1N1 influenza virus infection at the moment, although they have clinical signs. Radiological findings become more significant with the advancement of the clinical picture. Therefore, H1N1 influenza virus infection should be considered when symptoms of influenza infection are encountered in patients who are receiving high dose chemotherapy or who have a malignant disease resistant to therapy, and treatment should be started immediately. The immediate initiation of treatment may be lifesaving in this group of patients.

H1N1 Ýnfeksiyonu Geçiren Kanserli Hastalarda Akciðer Bulgulari

GÝRÝÞ ve AMAÇ: H1N1 influenza virusu, malign hastalýklarda ve kronik hastalýklarda immunsupresyona baðlý öldürücü olabilmektedir. Hastalar gripal enfeksiyon semptomlarý, yüksek ateþ, ishal þikayeti ile daha çok baþvurmakta, klinik tablo solunum yetmezliðine kadar gidebilmektedir. Bu çalýþmada kanser tanýsý ile izlenen H1N1 enfeksiyonu geçiren hastalarýn radyolojik bulgularýnýn deðerlendirilmesi amaçlandý.
YÖNTEM ve GEREÇLER: Ocak 2010- Ocak 2016 yýllarý arasýnda hematoloji-onkoloji kliniðinde kanser tanýsý ile takip Ocak 2010- Ocak 2016 yýllarý arasýnda hematoloji-onkoloji kliniðinde kanser tanýsý ile takip edilen 94 vakadan, H1N1 PCR’ý pozitif olan 10 vaka çalýþmaya dahil edildi. Vakalar absolü nötrofil sayýsýna gore; ≥500 /µL üstü absolü nötrofil sayýsý olanlar ve <500 µL altý absolü nötrofil olanlar olmak üzere ikiye ayýrýldý. Hastalarýn akciðer grafileri ve toraks bilgisayarlý tomografi sonuçlarý deðerlendirildi.
BULGULAR: 10 hastadan 8’ i aktif kemoterapi alýyordu. Baþlangýçta tüm hastalarýn akciðer grafisi normaldi. Takibinde en sýk akciðer alt zonlarýnda tutulma izlendi. En belirgin akciðer grafi bulgusu yama þeklinde konsalidasyondu. Toraks bilgisayarlý tomografide buzlu cam alanlarý ve konsalidasyon sýk olarak gözlendi. Vakalarýn dördü (ciddi nötropenisi olan üç vaka) solunum yetmezliðinden kaybedildi.
TARTIÞMA ve SONUÇ: H1N1 influenza virus enfeksiyonu geçiren hastalarda hastanýn klinik bulgusu olmasýna raðmen erken dönemde akciðer grafi bulgularý sýklýkla normal olabilmektedir. Klinik tablo ilerledikçe radyolojik bulgu belirginleþmektedir. Bu nedenle yüksek doz kemoterapi tedavisi alan yada tedaviye dirençli malign hastalarda gripal enfeksiyon semptomlarý saptandýðýnda akla H1N1 influenza virus enfeksiyonu gelmeli ve tedaviye hemen baþlanmalýdýr. Erken tedaviye baþlanmasý bu hastalarda hayat kurtarýcý olabilmektedir.