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Volume 17, Number 8—August 2011
Dispatch

Predictors of Pneumococcal Co-infection for Patients with Pandemic (H1N1) 2009

Mar Masiá, Sergio Padilla, Pedro Antequera, José Manuel Ramos, Montserrat Ruiz, and Félix GutiérrezComments to Author 
Author affiliations: Author affiliations: Hospital Universitario de Elche, Elche, Spain (M. Masiá, S. Padilla, J.M. Ramos, M. Ruiz, F. Gutiérrez); University Miguel Hernández, Elche (F. Gutiérrez); Hospital Universitario de San Juan, Alicante, Spain (P. Antequera)

Main Article

Table

Demographic and clinical data of patients with pandemic (H1N1) 2009 virus, by pneumococcal co-infection status, Spain, July 2009–March 2010*

Variable
 Influenza plus pneumococcal disease, n = 14
 Influenza without pneumococcal disease, n = 86
 p value†
 Influenza plus pneumococcal pneumonia, n = 9
 Influenza plus nonpneumococcal pneumonia, n = 15
 p value†
Female sex 8 (57.1) 41 (47.7) 0.511 6 (66.7) 7 (46.7) 0.341
Age, y
 42.1 (35.7–57.0)
 39.2 (27.3–52.1)
 0.371
 39.7 (31.1–63.1)
 43.6 (31.7–51.3)
 0.788
Concurrent conditions‡ 10 (71.4) 71 (82.6) 0.325 7 (77.8) 11 (73.3) 0.808
Pregnancy 1 (7.1) 1 (1.1) 0.188 1 (11.1) 0 0.261
Decompensated concurrent condition 3 (21.4) 15 (17.4) 0.628 2 (22.2) 5 (33.3) 0.604
HIV infection 0 (0) 8 (9.3) 0.303 0 2 (13.3) 0.280
Smoker 3 (21.4) 21 (24.4) 0.908 2 (22.2) 3 (20.0) 0.782
Alcoholism
 2 (14.2)
 6 (6.9)
 0.293
 1 (11.1)
 1 (6.66)
 0.674
Hospital admission 12 (85.7) 21 (24.4) 0.000 9 (100) 11 (73.3) 0.090
ICU admission
 2 (14.3)
 2 (2.3)
 0.034
 2 (22.2)
 1 (6.7)
 0.265
Pneumonia 9 (64.3) 15 (17.4) 0.000 9 (100) 15 (100) NA
Pneumococcal bacteremia
 2 (14.2)
 NA
 NA
 1 (11.1)
 0
 0.303
Oliguria/anuria 0 (0) 1 (1.1) 0.694 0 0 NA
O2 saturation <94% 3 (21.4) 12 (13.9) 0.403 2 (22.2) 7 (46.7) 0.311
Axillary temperature, °C 38.1 (37.5–38.9) 36.8 (36.4–37.8) 0.009 37.7 (37.5–38.8) 36.5 (35.9–37.8) 0.679
O2 saturation, %
 95 (85.2–95.5)
 96.3 (94–98)
 0.006
 93 (72–95)
 93 (78–110)
 0.308
CURB-65 score 0 (0–2) 0 (0–1) 0.201 2 (0–2.5) 0 (0–1) 0.156
Confusion 4 (28.6) 1 (1.2) 0.000 4 (44.4) 0 0.005
BUN level >20 mg/dL 2 (14.3) 4 (4.7) 0.628 2 (22.2) 4 (26.7) 0.808
Respiratory rate >30 breaths/min 3 (21.4) 3 (3.5) 0.009 3 (33.3) 1 (6.7) 0.090
BP <90/60 mm Hg 2 (14.3) 2 (2.3) 0.034 2 (22.2) 2 (13.3) 0.572
Age >65 y 2 (14.3) 4 (4.7) 0.159 2 (22.2) 1 (6.7) 0.265
CURB-65 score >1 9 (64.3) 62 (72.1) 0.550 5 (55.5) 7 (46.7) 0.673
CURB-65 score >2
 5 (35.7)
 3 (3.5)
 0.000
 5 (55.5)
 1 (6.7)
 0.007
C-reactive protein, mg/L 190.7 (74.0–190.7) 26.6 (11.80–79.35) 0.000 255 (134–320) 89 (60–162) 0.008
Procalcitonin, ng/mL§
 1.25 (0.12–26.00),
n = 6
 0.5 (0.1–0.5),
n = 19
 0.198
 13.5 (0.59–27.70),
n = 4
 0.5 (0.08–6.03),
n = 3
 0.289
Death 0 0 NA 0 0 NA

*All values are number (%) for categorical variables and median (interquartile range) for continuous variables. NA, not applicable; ICU, intensive care unit; CURB-65, confusion of new onset, urea greater than 7 mmol/L (blood urea nitrogen [BUN] >19), respiratory rate >30 breaths/min, systolic blood pressure (BP) <90 mm Hg or diastolic blood pressure <60 mm Hg, age >65 (10).
†The χ2 or Fisher exact test was used for categorical variables and the Mann-Whitney test for continuous variables.
‡Asthma, chronic lung disease, heart disease, neurologic and neurodevelopmental conditions, blood disorders, endocrine disorders (such as diabetes mellitus), kidney disorders, liver disorders, metabolic disorders, weakened immune system, people <19 y of age who are receiving long-term aspirin therapy, people who are morbidly obese (body mass index >40).
§Measured in patients with signs of sepsis; n values as shown.

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References
  1. Bisno  AL, Griffin  JPP, Van Epps  KA, Niell  HB, Rytel  MS. Pneumonia and Hong Kong influenza: a prospective study of the 1968–1969 epidemic. Am J Med Sci. 1971;261:251–63. DOIPubMedGoogle Scholar
  2. Schwarzmann  SW, Adler  JL, Sullivan  RJ, Marine  WM. Bacterial pneumonia during the Hong Kong influenza epidemic of 1968–1969. Arch Intern Med. 1971;127:1037–41. DOIPubMedGoogle Scholar
  3. Morens  DM, Taubenberger  JK, Fauci  AS. Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness. J Infect Dis. 2008;198:962–70. DOIPubMedGoogle Scholar
  4. Jansen  AG, Sanders  EA, Van Der Ende  A, Van Loon  AM, Hoes  AW, Hak  E. Invasive pneumococcal and meningococcal disease: association with influenza virus and respiratory syncytial virus activity? Epidemiol Infect. 2008;136:1448–54. DOIPubMedGoogle Scholar
  5. Walter  ND, Taylor  TH, Shay  DK, Thompson  WW, Brammer  L, Dowell  SF, Influenza circulation and the burden of invasive pneumococcal pneumonia during a non-pandemic period in the United States. Clin Infect Dis. 2010;50:175–83. DOIPubMedGoogle Scholar
  6. Murdoch  DR, Jennings  LC. Association of respiratory virus activity and environmental factors with the incidence of invasive pneumococcal disease. J Infect. 2009;58:37–46. DOIPubMedGoogle Scholar
  7. McCullers  JA, McAuley  JL, Browall  S, Iverson  AR, Boyd  KL, Henriques Normark  B. Influenza enhances susceptibility to natural acquisition of and disease due to Streptococcus pneumoniae in ferrets. J Infect Dis. 2010;202:1287–95. DOIPubMedGoogle Scholar
  8. McCullers  JA, Rehg  JE. Lethal synergism between influenza virus and Streptococcus pneumoniae: characterization of a mouse model and the role of platelet-activating factor receptor. J Infect Dis. 2002;186:341–50. DOIPubMedGoogle Scholar
  9. Ortiz de la Tabla  VO, Antequera  P, Masiá  M, Ros  P, Martin  C, Gazquez  G, Clinical evaluation of rapid point-of-care testing for detection of novel influenza A (H1N1) virus in a population-based study in Spain. Clin Microbiol Infect. 2010;16:1358–61. DOIPubMedGoogle Scholar
  10. British Thoracic Society. BTS guidelines for the management of community acquired pneumonia in adults: update 2009 [cited 2011 May 17]. http://www.brit-thoracic.org.uk/Portals/0/Clinical%20Information/Pneumonia/Guidelines/CAPGuideline-full.pdf
  11. Gutiérrez  F, Masiá  M, Rodríguez  JC, Ayelo  A, Soldán  B, Cebrián  L, Evaluation of the immunochromatographic BinaxNOW assay for detection of Streptococcus pneumoniae urinary antigen in a prospective study of community-acquired pneumonia in Spain. Clin Infect Dis. 2003;36:286–92. DOIPubMedGoogle Scholar
  12. Palacios  G, Hornig  M, Cisterna  D, Savji  N, Bussetti  AV, Kapoor  V, Streptococcus pneumoniae coinfection is correlated with the severity of H1N1 pandemic influenza. PLoS ONE. 2009;4:e8540. DOIPubMedGoogle Scholar
  13. Na  S, Chong  YP, Kim  MN, Kim  WY, Kim  W, Hong  SB, Duration of viral shedding in patients admitted to hospital with pandemic influenza A/H1N1 2009 infection. J Med Virol. 2011;83:5–9. DOIPubMedGoogle Scholar

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Page created: August 15, 2011
Page updated: August 15, 2011
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