孩童的嚴重H1N1感染與氣喘及其他疾病有關


  September 17, 2009 (加州舊金山) — 根據加拿大研究者在第49屆抗微生物製劑與化學治療跨領域研討會中指出,雖然多數的H1N1流感案例是輕微且屬自限性疾病,出現在孩童的重症相當可能與氣喘等潛在疾病有關。
  
  這項回溯回顧分析了因為H1N1住院之89名孩童的紀錄,魁北克蒙特婁大學附設CHU Sainte-Justine醫院小兒科感染症小組的Bruce Tapiero醫師表示,研究者發現,有不少孩童因為嚴重併發症而需要住進加護病房(ICU)。
  
  該研究中,研究者檢視了PCR檢測陽性確認H1N1感染而住進Sainte-Justine醫院之80名孩童的資料。
  
  多數住院孩童的年紀在6歲以上,許多都是學齡孩童。Tapiero醫師表示,我們希望釐清孩童的病況有多嚴重,以及哪些人屬於重症。
  
  66%的孩童有一種或一種以上的既有疾病,最常見的是氣喘、鎌刀型貧血症、腦病變;其他既有狀況包括肺炎與先天性心臟病。
  
  雖然多數孩童出現一般的H1N1特徵—發燒、咳嗽與喉嚨發炎,但也有不少人(49%)出現胃腸症狀。事實上,H1N1發生的1個死亡案例就是因為胃腸併發症、原本的肺部疾病以及腦病變所致。
  
  多數孩童都有發燒,疾病的神經特徵也常見,7個小孩發生熱痙攣。此外,35%小孩的氧氣飽和度低於95%,有4名病童需要機械式輔助呼吸。
  
  其中有13名孩童(16%)需要住進ICU,這些人大多都有既有的疾病。Tapiero醫師表示,這表示這些孩童的感染特別嚴重。但是他們住在ICU的天數短,事實上,多數孩童的住院天數並不久,平均住院天數為4天。
  
  Tapiero醫師指出,從蒙特婁的研究中可以知道幾件事情。他表示,多數感染H1N1的小孩,即使已經住院,病況都屬中等。但是感染H1N1的小孩,有些發生過胃腸道症狀與熱痙攣,因此,醫師在評估H1N1病童時必須注意這些症狀,以改善診斷和治療。
  
  該報告發表時的小組主持人、日內瓦瑞士大學醫院的Laurent Kaiser醫師表示,這是一個描述性研究,所以有其研究限制。但是它顯示出重症病童一些值得注意的特徵。
  
  Kaiser醫師表示,同時,我們實際上並沒有此一疾病在孩童身上傳染狀況的文獻。他解釋,這類資訊只能仰賴大型的全國研究。我們現在所見的只是冰山一角,加上這是個新疾病,我們根本不知道這座冰山有多大。
  
  Tapiero醫師與 Kaiser醫師都宣告沒有相關財務關係。
  
  第49屆抗微生物製劑與化學治療跨領域研討會(ICAAC):發表場次編號V-1269d。發表於2009年9月14日。
  

Severe H1N1 Infection in Children Linked to Asthma and Other Diseases

By Barbara Boughton
Medscape Medical News

September 17, 2009 (San Francisco, California) — Although most cases of H1N1 influenza are mild and self-limited, severe disease in children is most likely linked to underlying conditions such as asthma, according to Canadian research presented here at the 49th Interscience Conference on Antimicrobial Agents and Chemotherapy.

In the retrospective review, the case records of 89 children hospitalized with H1N1 were analyzed, and the researchers found that a "disturbing" number of children had serious complications requiring a stay in the intensive-care unit (ICU), said Bruce Tapiero, MD, from the Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine in Montreal, Quebec.

In the study, researchers identified 80 children admitted to Sainte-Justine Hospital with confirmed H1N1, as defined by a positive PCR test.

Most of the children hospitalized were older than 6 years, and many were school-aged. "We wanted to find out how severe the disease is in children and who had the most severe disease," Dr. Tapiero said.

One or more underlying medical conditions was found in 66% of the children, with the most common being asthma, sickle cell disease, and encephalopathy. Other underlying conditions were pneumonia and congenital heart disease.

Although most of the children displayed the usual features of H1N1 —fever, cough, and sore throat — a striking number also had gastrointestinal symptoms (49%). In fact, the 1 death that occurred from H1N1 was attributed to gastrointestinal complications, underlying lung disease, and encephalopathy.

Fever was seen in most of the children, and neurological features of the disease were common, with 7 children experiencing febrile seizures. In addition, 35% of the children had oxygen-saturation levels below 95%, and 4 of the sickest patients required mechanical ventilation.

Thirteen of the children (16%) required admission to the ICU, and most of those children had underlying comorbidities. "This suggests that the infection may be particularly severe in these children," Dr. Tapiero said. "But their length of stay in the ICU was brief." In fact, most of the children did not have extended stays in the hospital. The mean hospitalization for the group was 4 days.

Dr. Tapiero noted that some lessons could be drawn from the Montreal study. "Many children with H1N1, even those who are hospitalized, have moderate disease," he said. "But [gastrointestinal] symptoms and febrile seizures are being described in children with H1N1." Thus, it is important that clinicians pay attention to these symptoms when evaluating children for H1N1 to improve diagnosis and treatment, he added.

"This was a descriptive study, so it had some limitations," said Laurent Kaiser, MD, from University Hospital of Switzerland in Geneva, who moderated the session at which the study was presented. "But it shows us some interesting features of children with the most severe disease," he said.

"At the same time, we don't really have documentation about how widespread the disease is in children," Dr. Kaiser said. That kind of information can only come from large national studies, he explained. "What we're seeing here is the tip of the iceberg, but we don't really know the size of the iceberg yet because it's such a new disease."

Dr. Tapiero and Dr. Kaiser have disclosed no relevant financial relationships.

49th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC): Presentation V-1269d. Presented September 14, 2009.

    
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