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Prolonged viral shedding in pandemic influenza A H1N1: clinical significance and viral load analysis in hospitalized patients

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  • Prolonged viral shedding in pandemic influenza A H1N1: clinical significance and viral load analysis in hospitalized patients

    Clin Microbiol Infect. 2010 Oct 14. doi: 10.1111/j.1469-0691.2010.03399.x. [Epub ahead of print]
    Prolonged viral shedding in pandemic influenza A H1N1: clinical significance and viral load analysis in hospitalized patients.

    Giannella M, Alonso M, Viedma DG, Roa PL, Catal?n P, Padilla B, Mu?oz P, Bouza E.

    Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Mara??n, Madrid CIBER de Enfermedades Respiratorias (CIBERES), Spain.
    Abstract

    The clinical significance of prolonged viral shedding (PVS) and viral load (VL) dynamics has not been sufficiently assessed in hospitalized patients with pandemic 2009 influenza A. We performed a prospective study of adults with confirmed (H1N1)v infection admitted to our hospital from 20-09-09 to 31-12-09. Consecutive nasopharyngeal swabs were collected every two days during the first week after diagnosis, then every week or until viral detection was negative. Relative VL was measured on the basis of hemagglutinin and RNaseP gene analysis. PVS was defined as positive detection of (H1N1)v by real-time reverse transcriptase polymerase chain reaction at day 7 after diagnosis. We studied 64 patients: 16 (25%) presented PVS. The factors associated with PVS were admission to the ICU (69% vs. 33%, P=0.02), purulent expectoration (75% vs. 44%, P=0.04), higher dosage of oseltamivir (62.5% vs. 27%, P=0.016), corticosteroid treatment (50% vs. 21%, p=0.05), mechanical ventilation (MV) (50% vs. 12.5%, P=0.004), and longer stay (34 vs. 7 median days, P=0.003). Multivariate analysis revealed the factors independently associated with PVS to be immunosuppression (OR 5.15; 95% CI, 1.2-22.2; P=0.03) and the need for MV (OR 11.7; 95% CI, 2.5-54.4; P=0.002). VL at diagnosis correlated negatively with age and septic shock. VL dynamics of patients with acute respiratory distress syndrome and/or mortality was very different from that of other patients. PVS was detected in 25% of hospitalized patients with pandemic 2009 influenza A and was strongly associated with immunosuppression and need for MV. Diagnostic VL and viral clearance varied with the clinical course.
    Copyright ? 2010 European Society of Clinical Microbiology and Infectious.

    PMID: 20946412 [PubMed - as supplied by publisher]

    http://www.ncbi.nlm.nih.gov/pubmed/20946412
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