CLINICAL PROFILE OF PATIENTS WITH INFLUENZA LIKE ILLNESS.

Corresponding Author:
Lydia Solomon,
Department of Medicine,
Christian Medical College and Hospital,
Brown Road, Ludhiana-141008, Punjab, India.
E-mail: lydiasolomon777@gmail.com

ABSTRACT

BACKGROUND

Respiratory infections caused by seasonal influenza is associated with significant morbidity and mortality. The objective of our study was to analyse the clinical profile, complications and outcome of patients admitted with Influenza like illness during the epidemic of H1N1.

MATERIALS AND METHODS

Patients admitted with a diagnosis of suspected H1N1 were included in the study. Test for H1N1 by PCR was done only in WHO category C cases. Others were diagnosed on the basis of clinical criteria. Based on the results, patients were divided into 3 groups, H1N1 positive (Group 1), H1N1 negative (Group 2) and H1N1 untested group (Group 3). The 3 groups were compared and analysed based on their clinical profile, laboratory investigations, complications and their outcome.

RESULTS

A total of 155 patients formed our study group. All belonged to category C and were treated with Oseltamivir. 87 patients could be tested for H1N1, 38 of whom were positive. Based on test results, the patients were divided into 3 groups, namely group 1 (tested positive), group 2 (tested negative) and group 3 (Could not be tested). There were females more than males in all 3 groups (87 and 68 respectively). Majority, 74 (47.7%) of patients were between 40 – 59 years of age. Most of the patients 96 (61.9%) presented within 7 days of illness. Diabetes mellitus was the most common co morbidity observed in 63 patients (40.6%) and 16 (10.3%) patients had an underlying lung disease. 8 (5.2%) were on steroids. Fever and cough were the first noticed symptoms in 75 (48.4%) and 45 (29%) patients respectively. Nasal catarrh and sore throat were seen as the first symptom only in 15 (9.7%) and 5(3.2%) patients respectively. Moderate ARDS was seen in 91 (58.7%) patients and severe ARDS was seen in 22 (14.2%) patients. 26 (68.4%) patients in group 1 required mechanical ventilation compared to group 2, and group 3 i.e. 17 (34.7%) and 10 (14.7%) respectively. 22 (44.9%) patients in group 2 could be managed on non-invasive ventilation. Other complications noticed were Cardiovascular in 18 (11.6%) patients, (STEMI, NSTEMI, Myocarditis, Atrial fibrillation), Acute Kidney Injury in 18 (11.6%) and neurological in 8 (5.2%) Critical illness neuropathy, dysautonomia, infarcts (Pontine, multicerebral), polyneuropathy, intracerebral haemorrhage. There was a total of 56 (36.1%) deaths, majority of them, 30 (53.6%) had moderate ARDS. There was 100% mortality in patients with severe ARDS in group 1. 55 patients (35.4%) had AKI, out of which 63.6% expired. Patients who presented with hypotension, 8 (66.6%) also had high mortality rate.

CONCLUSION

Severe ARDS at presentation could be used as a predictor for mortality. However, despite the early presentation, severity of the disease was unaltered.

KEYWORDS

Influenza; Clinical Profile: Varied Complications.