Bahar Gokturk1, Sevgi Pekcan2, Sukru Nail Guner3, Hasibe Artac4, Sevgi Keles3, Mine Kirac3, Ismail Reisli3. 1. Department of Pediatric Immunology and Allergy, Konya Training and Research Hospital, Konya, Turkey. 2. Division of Pediatric Pulmonology, Department of Pediatrics, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey. 3. Division of Pediatric Allergy and Immunology, Department of Pediatrics, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey. 4. Division of Pediatric Allergy and Immunology, Department of Pediatrics, Selcuk University Medical Faculty, Konya, Turkey.
Abstract
BACKGROUND AND AIMS: The appropriate treatment of pandemic H1N1 influenza which was first identified in April 2009 in Mexico is insufficient especially for immunocompromised patients. We aimed to evaluate the features and prognostic factors of the children with H1N1, especially immunocompromised ones, and whether intravenous immunoglobulin G (IVIG) replacement could aid for a better outcome. METHODS: Twenty-one hospitalized children with laboratory-confirmed H1N1 were evaluated retrospectively. Data were extracted from files and electronic medical records. RESULTS: The median age was 37 (1-216) months; 62% of them were under 5 years of age and 71.4% had one or more underlying disorders. Main symptoms were high fever, cough, fatigue and vomiting. Lower respiratory tract manifestations were seen in 66.6% of children. Mortality rate was 4.7%. The patient who died had the lowest lymphocyte (100/mm(3) ), thrombocyte (21 000/mm(3) ) and highest blood urea nitrogen (87 mg/dL) levels. Fifty-eight percent of evaluated patients had one of the primary immunodeficiency disorders. Surprisingly, none of the six patients with primary immunodeficiency who are on regular IVIG replacement needed intensive care unit and died. Although median durations of cough, fever and hospitalization were lower, they did not change statistically according to get IVIG replacement regularly (P = 0.47, 0.97, 0.09, respectively). CONCLUSION: Our study is important while it is the first one that shows the course of primary immunodeficient children with H1N1 infection who were on regular IVIG replacement. A trial of high-dose IVIG may be a useful adjunctive therapy in severe H1N1 influenza, particularly in the immunocompromised patients.
BACKGROUND AND AIMS: The appropriate treatment of pandemic H1N1 influenza which was first identified in April 2009 in Mexico is insufficient especially for immunocompromised patients. We aimed to evaluate the features and prognostic factors of the children with H1N1, especially immunocompromised ones, and whether intravenous immunoglobulin G (IVIG) replacement could aid for a better outcome. METHODS: Twenty-one hospitalized children with laboratory-confirmed H1N1 were evaluated retrospectively. Data were extracted from files and electronic medical records. RESULTS: The median age was 37 (1-216) months; 62% of them were under 5 years of age and 71.4% had one or more underlying disorders. Main symptoms were high fever, cough, fatigue and vomiting. Lower respiratory tract manifestations were seen in 66.6% of children. Mortality rate was 4.7%. The patient who died had the lowest lymphocyte (100/mm(3) ), thrombocyte (21 000/mm(3) ) and highest blood ureanitrogen (87 mg/dL) levels. Fifty-eight percent of evaluated patients had one of the primary immunodeficiency disorders. Surprisingly, none of the six patients with primary immunodeficiency who are on regular IVIG replacement needed intensive care unit and died. Although median durations of cough, fever and hospitalization were lower, they did not change statistically according to get IVIG replacement regularly (P = 0.47, 0.97, 0.09, respectively). CONCLUSION: Our study is important while it is the first one that shows the course of primary immunodeficientchildren with H1N1infection who were on regular IVIG replacement. A trial of high-dose IVIG may be a useful adjunctive therapy in severe H1N1 influenza, particularly in the immunocompromised patients.
Authors: Marie von Lilienfeld-Toal; Annemarie Berger; Maximilian Christopeit; Marcus Hentrich; Claus Peter Heussel; Jana Kalkreuth; Michael Klein; Matthias Kochanek; Olaf Penack; Elke Hauf; Christina Rieger; Gerda Silling; Maria Vehreschild; Thomas Weber; Hans-Heinrich Wolf; Nicola Lehners; Enrico Schalk; Karin Mayer Journal: Eur J Cancer Date: 2016-09-25 Impact factor: 9.162