International Medical Journal, Vol. 21., Iss. 4, 2015, P. 72−77.
CLINICAL ANALYSIS OF FATAL OUTCOME DUE TO INFLUENZA A (H1N1)PDM COMPLICATED BY PNEUMONIA CAUSED BY KLEBSIELLA PNEUMONIAE IN THE POST-PANDEMIC PERIOD DURING EXTRACORPOREAL MEMBRANE OXYGENATION
Kharkiv National Medical University, Ukraine
Kharkiv Regional Clinical Hospital − Center of Emergency Medical Care and Disaster Medicine, Ukraine
Kharkiv City Hospital No. 13
Regional Clinical Hospital of Infectious Diseases, Kharkiv, Ukraine
The article describes a case of influenza A (H1N1) pdm in adult complicated by pneumonia possibly caused by hypervirulent strain of Klebsiella pneumoniae (hvKP) in the post−pandemic period, ECMO. The clinical data, instrumental and laboratory investigation, especially pathological changes were studied, the effectiveness of antibiotic therapy and ECMO was assessed. To assess the prospects for the survival of the patient Cox regression method was used. Influenza A (H1N1) pdm developed in a patient of middle age without underlying risk factors of death. Antibiotic therapy, administered in accordance with the protocol of providing clinical care, proved to be ineffective. Analysis of the probability of nosocomial pneumonia, including with the criteria of CPIS scale, was done. The authors suggest the development of community−acquired pneumonia against a background of influenza A (H1N1) pdm possibly caused by hypervirulent strain Klebsiella pneumoniae (hvKP). There is special anxiety about the resistance of the strain to carbapenems and linezolid. Differential diagnosis with nosocomial pneumonia and ARDS was considered. Pathologic changes in the lungs and other organs were examined. Pathogenetic model of destruction of the respiratory system in case of pneumonia caused by hypervirulent strain Klebsiella pneumoniae (hvKP) was suggested. The pathogenic properties of influenza A (H1N1) pdm virus in the post−pandemic period are responsible for severe course of the disease, including in the patients without underlying risk factors of death. The analysis of the clinical observation suggests that pneumonia complicating influenza could develop like сommunity−acquired pneumonia due to strain Klebsiella pneumoniae possibly by (hvKp) which is characterized by a high degree of resistance to antibiotics. There is special alarm about the resistance of the strain to carbapenems and linezolid. ECMO procedure does not allow to restore the basic functions of lung parenchyma fast enough.
Key words: influenza A (H1N1)pdm, fetal outcome, post−pandemic period, pneumonia, Klebsiella pneumoniae (hvKP), clinical analysis, pathogenetic model of pneumonia development, extracorporeal membrane oxygenation.