Clinical, laboratory and radiologic characteristics of 2009 pandemic influenza A/H1N1 pneumonia: Primary influenza pneumonia versus concomitant/secondary bacterial pneumonia

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Background Although influenza virus usually involves the upper respiratory tract, pneumonia was seen more frequently with the 2009 pandemic influenza A/H1N1 than with seasonal influenza. Methods From September 1, 2009, to January 31, 2010, a specialized clinic for patients (aged ≥15years) with ILI was operated in Korea University Guro Hospital. RT-PCR assay was performed to diagnose 2009 pandemic influenza A/H1N1. A retrospective case-case-control study was performed to determine the predictive factors for influenza pneumonia and to discriminate concomitant/secondary bacterial pneumonia from primary influenza pneumonia during the 2009-2010 pandemic. Results During the study period, the proportions of fatal cases and pneumonia development were 0·12% and 1·59%, respectively. Patients with pneumonic influenza were less likely to have nasal symptoms and extra-pulmonary symptoms (myalgia, headache, and diarrhea) compared to patients with non-pneumonic influenza. Crackle was audible in just about half of the patients with pneumonic influenza (38·5% of patients with primary influenza pneumonia and 53·3% of patients with concomitant/secondary bacterial pneumonia). Procalcitonin, C-reactive protein (CRP), and lactate dehydrogenase were markedly increased in patients with influenza pneumonia. Furthermore, procalcitonin (cutoff value 0·35ng/ml, sensitivity 81·8%, and specificity 66·7%) and CRP (cutoff value 86·5mg/IU, sensitivity 81·8%, and specificity 59·3%) were discriminative between patients with concomitant/secondary bacterial pneumonia and patients with primary influenza pneumonia. Conclusions Considering the subtle manifestations of 2009 pandemic influenza A/H1N1 pneumonia in the early stage, high clinical suspicion is required to detect this condition. Both procalcitonin and CRP would be helpful to differentiate primary influenza pneumonia from concomitant/secondary bacterial pneumonia.

Original languageEnglish
JournalInfluenza and other Respiratory Viruses
Issue number6
Publication statusPublished - 2011 Nov 1



  • 2009 H1N1
  • C-reactive protein
  • Influenza
  • Pneumonia
  • Procalcitonin

ASJC Scopus subject areas

  • Infectious Diseases
  • Pulmonary and Respiratory Medicine
  • Public Health, Environmental and Occupational Health
  • Epidemiology

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