Abstract
Conditions characterized by immunosuppression have been recently reported as risk factors for severe novel swine-origin influenza A (H1N1) virus (S-OIV) infection during the current 2009 pandemic. We report clinical and virological findings, antiviral therapy, and post-mortem study of S-OIV in an adult bone marrow transplant recipient. The viral genome was amplified by real time reverse transcriptase polymerase chain reaction (RT-PCR) from a nasopharyngeal swab specimen. The patient developed acute respiratory distress syndrome, septic shock, and eventually succumbed with a severe pulmonary haemorrhage. To the best of our knowledge, the entire clinical/therapy management and pathological examination in a transplant recipient infected with the S-OIV has not been previously documented. The fatal ending in this bone marrow transplant recipient supports recommendations that call for education measures, S-OIV vaccination, early diagnosis and aggressive treatment in the transplant population.
Highlights
The 2009 pandemic caused by the novel swineorigin influenza A (H1N1) virus (S-OIV) emerged in Mexico in March 2009 during the influenza season in the northern hemisphere
A number of viruses cause increased morbidity and mortality in transplant patients [14,15,16,17]; for example, we recently described the first report of herpes simplex virus and Norwegian scabies in a fatal renal transplant recipient [18]
S-OIV infection has been reported in recipients of allogeneic hematopoietic cells [9,10,11], in addition to those who have undergone lung [20], kidney [21], heart [22,23] and liver transplantation [8]
Summary
The 2009 pandemic caused by the novel swineorigin influenza A (H1N1) virus (S-OIV) emerged in Mexico in March 2009 during the influenza season in the northern hemisphere. Lung tissue studies from fatal S-OIV cases have been performed in Mexico [12], the United States [2] and Brazil [5]. This study indicates that immunosuppressed transplant recipients may have a higher risk of severe S-OIV disease despite early and aggressive anti-viral therapy S-OIV should be included among the potential pathogens in the transplant population. During the sixth day of hospitalization there was mild recovery in hemodynamic, oxygenation and renal function; a sudden and severe pulmonary haemorrhage associated with cardiac arrest eventually precipitated the patient’s death. Pulmonary tissue sections evaluated by hematoxylin-eosin stain revealed severe diffuse alveolar damage, extensive intraalveolar haemorrhage, formation of hyaline membranes, and cytopathic effect in alveolar epithelial cells that was comprised of hyperplasia of pneumocytes and viral-like intranuclear inclusion bodies (Figure 2 C, D). The patient was not an obese subject considering the body-mass index of 24.5 (the weight in kilograms divided by the square of the height in meters) when obesity is defined as a body-mass index greater than 30 in adults
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