Giuseppe
Emeritus
H1N1 pneumonitis treated with intravenous zanamivir (The Lancet, Extract, edited)
[Original Full Document (Subscription): LINK. EDITED.]
H1N1 pneumonitis treated with intravenous zanamivir
I Michael Kidd, Jim Down, Eleni Nastouli, Rob Shulman, Paul R Grant, David CJ Howell, Mervyn Singer
On July 8, 2009, a 22-year-old woman, neutropenic after chemotherapy for Hodgkin?s disease, was referred to ICU with 3 days? (d) increasing dyspnoea, bilateral chest infiltrates, and laboratory-confirmed pandemic H1N1 2009 influenza virus infection not responding to oseltamivir 75 mg twice daily and broad-spectrum antimicrobials (mero penem, teicoplanin, and caspofungin).
No other organisms were detected from blood or respiratory tract. Deterioration necessitated invasive ventilation from ICU d 3 (fi gure). She remained in single organ failure requiring high inspired oxygen, protective lung ventilation (tidal volumes ≤6?8 mL/kg), and neutral fluid balance. Hydro cortisone was given (d 3?6), then gradually reduced and discontinued (d 13). Neutropenia recovered by d 6, although lymphopenia remained (...). High level H1N1 RNA was detected in bronchoalveolar lavage (BAL) on d 10, despite 6 d oseltamivir given nasogastrically; in view of high volume gastric aspirates, this was replaced by nebulised zanamivir (d 6?13). Treatment escalation on d 13?16 delivered neither clinical nor virological response (figure).
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[Original Full Document (Subscription): LINK. EDITED.]
H1N1 pneumonitis treated with intravenous zanamivir
I Michael Kidd, Jim Down, Eleni Nastouli, Rob Shulman, Paul R Grant, David CJ Howell, Mervyn Singer
On July 8, 2009, a 22-year-old woman, neutropenic after chemotherapy for Hodgkin?s disease, was referred to ICU with 3 days? (d) increasing dyspnoea, bilateral chest infiltrates, and laboratory-confirmed pandemic H1N1 2009 influenza virus infection not responding to oseltamivir 75 mg twice daily and broad-spectrum antimicrobials (mero penem, teicoplanin, and caspofungin).
No other organisms were detected from blood or respiratory tract. Deterioration necessitated invasive ventilation from ICU d 3 (fi gure). She remained in single organ failure requiring high inspired oxygen, protective lung ventilation (tidal volumes ≤6?8 mL/kg), and neutral fluid balance. Hydro cortisone was given (d 3?6), then gradually reduced and discontinued (d 13). Neutropenia recovered by d 6, although lymphopenia remained (...). High level H1N1 RNA was detected in bronchoalveolar lavage (BAL) on d 10, despite 6 d oseltamivir given nasogastrically; in view of high volume gastric aspirates, this was replaced by nebulised zanamivir (d 6?13). Treatment escalation on d 13?16 delivered neither clinical nor virological response (figure).
(...)
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