Life-threatening Respiratory Failure from H1N1 Influenza: Lessons from the Southern Cone Outbreak

  • C. M. Luna
  • R. Valentini
  • O. Rizzo
Conference paper


A sharp increase in the hospitalization rate for pneumonia, particularly among adults between 20 and 40 years old, and an unusual series of deaths, coincident with an increase in laboratory-confirmed influenza cases, were reported in the spring of 2009 in Mexico. This outbreak appeared after the end of influenza season, and was associated with mortality in a younger age-group than the pattern observed in temperate areas in the northern hemisphere [1]. The concurrent finding of a novel, swine-origin influenza A virus (so called pandemic influenza [H1Nl] 2009) from infected children in the United States [2] completed the picture.


Acute Respiratory Distress Syndrome Severe Acute Respiratory Syndrome Severe Acute Respiratory Syndrome Recruitment Maneuver Pneumonia Severity Index 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Chowell G, Bertozzi SM, Colchero MA, et al (2009) Severe respiratory disease concurrent with the circulation of H1N1 influenza. N Engl J Med 361: 674–679CrossRefPubMedGoogle Scholar
  2. 2.
    Centers for Disease Control and Prevention (2009) Swine influenza A (H1N1) infection in two children — Southern California, March–April 2009. MMWR Morb Mortal Wkly Rep 58: 400–402Google Scholar
  3. 3.
    Dolin R, Mark EJ (2005). Influenza. In: Braunwald E, Kasper DL, Fauci A, Hauser SL, Longo DL, Jameson JL (eds) Harrison’s Principles of Internal Medicine E. McGraw-Hill, New York pp 1066–1070Google Scholar
  4. 4.
    Khan K, Arino J, Hu W, et al (2009) Spread of a novel influenza A (H1N1) virus via global airline transportation. N Engl J Med 361: 212–214CrossRefPubMedGoogle Scholar
  5. 5.
    Baker MG, Wilson N, Huang QS, et al (2009) Pandemic influenza A(H1N1)v in New Zealand: the experience from April to August 2009. Euro Surveill 14: pii19319PubMedGoogle Scholar
  6. 6.
    Centers for Disease Control and Prevention (CDC) (2009) Intensive-care patients with severe novel influenza A (H1N1) virus infection — Michigan, June 2009. MMWR Morb Mortal Wkly Rep 57: 749–752Google Scholar
  7. 7.
    Comisión para la Contingencia de Influenza A (H1N1), Hospital Nacional Profesor Alejandro Posadas (2009). Influenza A(H1N1) epidemic in Argentina. Experience in a National General Hospital (Hospital Nacional Profesor Alejandro Posadas) Medicina (Buenos Aires) 69: 393–423Google Scholar
  8. 8.
    Smith AG, Sheridan PA, Harp JB, et al (2007) Diet-induced obese mice have increased mortality and altered immune responses when infected with influenza virus. J Nutr 137: 1236–1243PubMedGoogle Scholar
  9. 9.
    The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342: 1301–1308CrossRefGoogle Scholar
  10. 10.
    Mercat A, Richard JC, Vielle B, et al (2008) Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 299: 646–655CrossRefPubMedGoogle Scholar
  11. 11.
    Aquino Esperanza J, Raimondi A, et al (2009) [Severe pneumonia due to H1N1-2009 influenza A virus: facts in patients requiring mechanical ventilation]. Rev Amer Med Respir 2009 9 (suppl): (abst, in press)Google Scholar
  12. 12.
    Martinez M, Diaz E, Joseph D, et al (1999) Improvement in oxygenation by prone position and nitric oxide in patients with acute respiratory distress syndrome. Intensive Care Med 25: 29–36CrossRefPubMedGoogle Scholar
  13. 13.
    Cheung TM, Yam LY, So LK, et al (2004) Effectiveness of noninvasive positive pressure ventilation in the treatment of acute respiratory failure in severe acute respiratory syndrome. Chest 126: 845–850CrossRefPubMedGoogle Scholar
  14. 14.
    Monto AS, Gravenstein S, Elliott M, et al (2000) Clinical signs and symptoms predicting influenza infection. Arch Intern Med 160: 3243–3247CrossRefPubMedGoogle Scholar
  15. 15.
    Aoki FY, Macleod MD, Paggiaro P, et al (2003) Early administration of oral oseltamivir increases the benefits of influenza treatment. J Antimicrob Chemother 51: 123–129CrossRefPubMedGoogle Scholar
  16. 16.
    Kaiser L, Wat C, Mills T, et al (2003) Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations. Arch Intern Med 163: 1667–1672CrossRefPubMedGoogle Scholar
  17. 17.
    McGeer A, Green KA, Plevneshi A, et al (2007) Antiviral therapy and outcomes of influenza requiring hospitalization in Ontario, Canada. Clin Infect Dis 45: 1568–1575CrossRefPubMedGoogle Scholar
  18. 18.
    Ison MG, Hayden FG (2002) Viral infections in immunocompromised patients: what’s new with respiratory viruses? Curr Opin Infect Dis 15: 355–367PubMedGoogle Scholar
  19. 19.
    Nichols WG, Guthrie KA, Corey L, Boeckh M (2004) Influenza infections after hematopoietic stem cell transplantation: risk factors, mortality, and the effect of antiviral therapy. Clin Infect Dis 39: 1300–1306.CrossRefPubMedGoogle Scholar
  20. 20.
    Ison MG, Gubareva LV, Atmar RL, et al (2006) Recovery of drug-resistant influenza virus from immunocompromised patients: a case series. J Infect Dis 193: 760–764CrossRefPubMedGoogle Scholar
  21. 21.
    Li CY, Yu Q, Ye ZQ, et al (2007) A nonsynonymous SNP in human cytosolic sialidase in a small Asian population results in reduced enzyme activity: potential link with severe adverse reactions to oseltamivir. Cell Res 17: 357–362CrossRefPubMedGoogle Scholar
  22. 22.
    Mandell LA, Wunderink RG, Anzueto A, et al (2007) Infectious Diseases Society of America/ American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 44 (Suppl 2): S27–72CrossRefGoogle Scholar
  23. 23.
    Writing Committee of the Second World Health Organization Consultation on Clinical Aspects of Human Infection with Avian Influenza A (H5N 1) Virus 2008 Update on avian influenza A (H5Nl) virus infection in humans. N Engl J Med 358: 261–273Google Scholar
  24. 24.
    Mandell GL (2000) Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Disease. Churchill Livingstone, New YorkGoogle Scholar
  25. 25.
    de Roux A, Marcos MA, Garcia E, et al (2004) Viral community-acquired pneumonia in nonimmunocompromised adults. Chest 124: 1343–1351CrossRefGoogle Scholar
  26. 26.
    Oliveira EC, Marik PE, Colice G (2001) Influenza pneumonia: a descriptive study. Chest 119: 1717–1723CrossRefPubMedGoogle Scholar
  27. 27.
    van Wissen M, Keller TT, Ronkes B, et al (2007) Influenza infection and risk of acute pulmonary embolism. Thromb J 5:16CrossRefPubMedGoogle Scholar
  28. 28.
    Idell S (2001) Anticoagulants for acute respiratory distress syndrome: can they work? Am J Respir Crit Care Med 164: 517–520PubMedGoogle Scholar
  29. 29.
    Munster VJ, de Wit E, van den Brand JM, et al (2009) Pathogenesis and transmission of swine-origin 2009 A(HINl) influenza virus in ferrets. Science 325: 481–483PubMedGoogle Scholar
  30. 30.
    Greaves K, Oxford JS, Price CP, et al (2003) The prevalence of myocarditis and skeletal muscle injury during acute viral infection in adults: measurement of cardiac troponins I and T in 152 patients with acute influenza infection. Arch Intern Med 163: 165–168CrossRefPubMedGoogle Scholar
  31. 31.
    Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, et al (2009) Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med 361: 680–689CrossRefPubMedGoogle Scholar
  32. 32.
    Dolin R, Mark EJ (2001) Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 36–2001. Acute febrile respiratory illness in a 57-year-old man with recurrent pulmonary disorders. N Engl J Med 345: 1558–1565CrossRefGoogle Scholar
  33. 33.
    Ho YC, Wang JL, Wang JT, et al (2009) Prognostic factors for fatal adult influenza pneumonia. J Infect 58: 439–445CrossRefPubMedGoogle Scholar
  34. 34.
    Li G, Yilmaz M, Kojicic M, et al (2009) Outcome of critically ill patients with influenza virus infection. J Clin Virol 46: 275–278CrossRefPubMedGoogle Scholar
  35. 35.
    Kelly H, Grant K (2009) Interim analysis of pandemic influenza (HINl) 2009 in Australia: surveillance trends, age of infection and effectiveness of seasonal vaccination. Euro Surveill 14: pii19288PubMedGoogle Scholar
  36. 36.
    Giovini V, Castillo DJ, Fescina P, et al (2009) [Severe pneumonia requiring mechanical ventilation, coincident with the influenza H1N1 2009 pandemic, experience in a teaching hospital]. Rev Amer Med Respir 9 (suppl): (abst, in press).Google Scholar

Copyright information

© Springer Science + Business Media Inc. 2010

Authors and Affiliations

  • C. M. Luna
    • 1
  • R. Valentini
    • 2
  • O. Rizzo
    • 3
  1. 1.Universidad de Buenos AiresHospital de ClínicasBuenos AiresArgentina
  2. 2.Intensive Care Service Centro de Educaion Medica eInvestigaciones ClinicasBuenos AiresArgentina
  3. 3.Hospital de Rehabilitacion RespiratoriaMaria FerrerBarracas, Capital FederalArgentina

Personalised recommendations