Radiological and Clinical Characteristics of a Military Outbreak of Pandemic H1N1 2009 Influenza Virus Infection

Abstract

Objective: To describe detailed clinical and radiological features of the pandemic H1N1 2009 influenza viral infection among healthy young males in a semi-closed institutionalized setting. Materials and Methods: A total of 18 patients confirmed with the pandemic H1N1 2009 influenza virus infection from July 18 to July 30, 2009 were enrolled in this study. Each patient underwent an evaluation to determine detailed clinical and radiological features. Results: All patients presented with high fever (> 38.0 degrees C), with accompanying symptoms of cough, rhinorrhea, sore throat, myalgia and diarrhea, and increased C-reactive protein (CRP) values with no leukocytosis nor elevated erythrocyte sedimentation rate (ESR). All patients, including one patient who progressed into acute respiratory distress syndrome, were treated with oseltamivir phosphate and quickly recovered from their symptoms. Chest radiographs showed abnormalities of small nodules and lobar consolidation in only two out of 18 patients. However, six of 12 patients who underwent thin-section CT examinations showed abnormal findings for small ground-glass opacities (GGOs) in addition to poorly-defined nodules with upper lobe predominance. Conclusion: In a population of healthy young adults, elevated CRP with normal ESR and white blood cell levels combined with GGOs and nodules on thin-section CT scans may indicate early signs of infection by the pandemic H1N1 2009 influenza virus. ; Agarwal PP, 2009, AM J ROENTGENOL, V193, P1488, DOI 10.2214/AJR.09.3599 ; Ajlan AM, 2009, AM J ROENTGENOL, V193, P1494, DOI 10.2214/AJR.09.3625 ; Lee CW, 2009, KOREAN J RADIOL, V10, P531, DOI 10.3348/kjr.2009.10.6.531 ; Chowell G, 2009, NEW ENGL J MED, V361, P674, DOI 10.1056/NEJMoa0904023 ; Perez-Padilla R, 2009, NEW ENGL J MED, V361, P680, DOI 10.1056/NEJMoa0904252 ; Dawood FS, 2009, NEW ENGL J MED, V360, P2605, DOI 10.1056/NEJMoa0903810 ; Shinde V, 2009, NEW ENGL J MED, V360, P2616, DOI 10.1056/NEJMoa0903812 ; Belshe RB, 2009, NEW ENGL J MED, V360, P2667, DOI 10.1056/NEJMe0903995 ; 2009, MMWR MORB MORTAL WKL, V58, P536 ; *WHO, 2009, WKLY EPIDEMIOL REC, V84, P185 ; *US CDCP, 2009, INT WHO GUID SURV HU ; Hansell DM, 2008, RADIOLOGY, V246, P697 ; DOLIN R, 2008, HARRISONS PRINCIPLES, P1127 ; Grinblat L, 2003, RADIOLOGY, V228, P802, DOI 10.1148/radiol.2283030671 ; Wong KT, 2003, RADIOLOGY, V228, P395, DOI 10.1148/radiol.2283030541 ; *WHO, WORLD NOW START 2009 ; *WHO, INFL A H1N1 UPD 68 ; 3