Fatal Case of Pneumonia Associated with Pandemic (H1N1) 2009 in HIV-Positive Patient

摘要: To the Editor: Pandemic (H1N1) 2009 virus first appeared in March Mexico. In June 2009, a pandemic was declared by World Health Organization (1). Influenza A caused 1918–1919; estimated deaths were ≈100 million worldwide (2). Symptoms of are similar to those seasonal influenza (fever, cough, sore throat, body aches, headache, chills, and fatigue) (3). should be considered differential diagnosis patients with acute febrile respiratory illness who have been contact persons confirmed or reside areas where has reported (2). Although most cases United States mild, 2%–5% infected required hospitalization Immunosuppressed persons, elderly, underlying lung cardiac disease, pregnant women, diabetes, obese children <5 years age at increased risk for this disease (4). We report pneumonia associated which resulted renal failure death, 39-year-old HIV-positive woman. She had type 1 diabetes AIDS 7 ago received highly active antiretroviral therapy. also an ill child home influenza-like illness. Her medical history included pleuropericardial Nocardia spp. infection, recurrent pleural effusions requiring thoracentesis, hepatomegaly unknown cause. Her recent CD4 cell count 166 cells/μL undetectable viral load month before admission. Medications prescribed combivir, efavirenz, trimethoprim/sulfamethoxazole but she noncompliant. 2008–09 vaccine pneumococcal vaccine. The patient admitted Winthrop-University Hospital (Mineola, NY, USA) on 5, community-acquired pneumonia. empiric moxifloxacin atovaquone. Because concern persistent treated doxycycline. The result rapid test (QuickVue; Quidel, San Diego, CA, negative nasal swab specimen day hospitalization. Over next 48 hours, her clinical status deteriorated, experienced worsening hypotension distress. On admission, fever (101°F) 3 days, pulse rate 109 beats/min, blood pressure 86/52 mm Hg, 22 breaths/min (oxygen saturation 88% room air), generalized weakness, nonproductive increasing shortness breath. alert oriented. Physical examination showed decreased breath sounds bases, hepatomegaly, bilateral edema lower extremities. Laboratory tests 3,000 leukocytes/mm3 (93% neutrophils, 2% bands, 3% lymphocytes), hemoglobin level 12.7 g/dL, 118,000 platelets/mm3. Other laboratory values urea nitrogen 66 mg/dL, creatinine 2.9 phosphokinase 2,276 IU/L, lactic acid 3.6 mmol/L (anion gap 13). chest radiograph moderate effusion right retrocardiac air space disease. Test results virus, fluorescent antibodies (D3 Ultra DFA Respiratory Virus Screening Infectious Disease Kit; Diagnostic Hybrids, Inc., Athens, OH, USA), culture negative. The transferred intensive care unit intubation, pressor support, continuous venovenous hemofiltration fluid removal. Empiric oseltamivir (150 mg 2×/d) started hospital 3; moxifloxicin discontinued, meropenem given (5). Thoracentesis transudative acid-fast bacilli, bacteria, fungi. Results cultures urine analysis Legionella antigen negative. Repeat radiography right-sided pneumothorax airspace tube inserted lung, bronchoscopy performed 5. Results bronchoalveolar lavage Pneumocystis jiroveci, inclusions, fungi, mycobacteria. However, clusters filamentous organisms seen. On second test, antibody nasopharyngeal Diagnosis based positive real-time reverse transcription–PCR (RT-PCR) (New York State Department Health). Despite treatment oseltamivir, died 15, (day 11 hospitalization). Symptoms HIV-infected not known. these higher complications. previous outbreaks, more severe infections mortality rates (6). Although our because child, initially opportunistic infections. Only RT-PCR positive. No other pathogens detected blood, urine, sputum, lavage, thoracenthesis fluid. Empiric seeking symptoms, especially setting sick contacts illnesses. Rapid tests, may provide diagnosis. An needed