Pharyngeal Hyperemia Research Articles

First Case Mild Symptoms COVID-19 in Rural Central Java Area: Case Report of an Indonesian Patient

Background: SARS-CoV-2 virus infection is a pandemic that began to emerge in December 2019 in various countries with high death rates of 4-9% until now. In March 2020, Indonesia found its first case where the condition of the infection kept spreading to various regions in Indonesia. Different regional conditions in Indonesia make it difficult to manage this virus infection. The capability of the regional hospitals to detect this virus infection with their facilities and infrastructure is required.
 Case presentation: A 17-year-old man came to the Ajibarang Regional Hospital with complaints of coughs and colds felt for four days and fever for two days. Physical examination found a good general condition, moderate pain, the temperature of 38.8°C, pharyngeal hyperemia, and minimal lung crackles sound. Laboratory tests showed normal leukocytes, platelet, and hemoglobin levels. Chest radiograph was suggestive of bronchitis. The patient was hospitalized for approximately four days until the fever resolved and was discharged. Five days after the patient was discharged from the hospital, the results of the viral load examination using RT-PCR confirmed positive for COVID-19.
 Conclusion: This case showed unusual conditions of a mild clinical COVID-19 infection, laboratory results that did not support viral infections, as well as radiology examination of only bronchitis. The viral load test was found to be positive. Therefore, the diagnosis of the COVID-19 infection requires a comprehensive interpretation of complete history taking, clinical examination, laboratory and radiology examinations for clinicians working with limited hospital facilities and infrastructures.

Comparative characteristics of clinical, laboratory and instrumental indicators in children with seasonal influenza depending on the virus strain

Introduction. According to the literature, it is known that clinical signs and symptoms of influenza may differ depending on age, the state of the human immune system, the serotype of the virus and its virulence. Intoxication, catarrhal and hyperthermia are main symptoms of influenza, but the disease does not always proceed classically, it may hide under the mask of other infections. The aim was to conduct a comparative analysis of clinical, laboratory and instrumental parameters in children with influenza A(H1N1) and A(H3N2). Materials and methods. A single-stage retrospective comparative study was carried out with the participation of 96 children from 1 month of age up to 13 years old with a diagnosis of influenza, who were hospitalized at the Irkutsk Regional Infectious Clinical Hospital from December 2018 to January 2019. Clinical and laboratory features of the course of influenza in children were determined depending on a viral strain. Results. The structure of morbidity: influenza A(H1N1) – 70 people (73 %), influenza A(H3N2) – 20 children (21 %), influenza A clinically unvaccinated – in 3 people (3 %), mixed viral infection influenza H1N1 + adenovirus infection – 2 cases (2 %), mixed viral infection H1N1 flu + RS-virus – 1 case (1 %). In the clinic of both strains of the virus, symptoms prevailed: runny nose, dry cough, fever, intoxication. Muscle pain and pharyngeal hyperemia were significantly more common in influenza A(H1N1), the duration of symptoms did not differ. Lymphocytosis was more often observed in influenza A(H1N1), monocytosis – in influenza A(H3N2) (р < 0.05). In 64 % of cases, patients with influenza A(H1N1) had a high leukocyte index of intoxication (odds ratio – 2.2). Conclusion. The symptoms of different influenza A viral strains virus in children are the same, however, muscle pain and hyperemia of the pharynx prevails in children with influenza A(H1N1).

Clinical Study of Human Coronavirus NL63, OC43, 229E, HKU1 Infentions in Hospitalized Children from 2015 to 2020.

ObjectiveThis study aims to analyze the clinical characteristics of hospitalized children infected with HCoV-NL63, OC43, 229E, HKU1 and provide the basis for disease diagnosis and treatment.MethodsA retrospective analysis was conducted on clinical manifestations, imaging data, and treatment measures of hospitalized children with positive HCoV-NL63, OC43, 229E, HKU1 from 2015 to 2020.ResultsA total of 1062 children aged 33 days to 12 years were analyzed, including 879 (82.77%) between 33 days to three years. Lower respiratory tract infections were the most common in 698 children positive for HCoVs (65.72%). The incidences of runny nose, cough, pharyngeal hyperemia, and fine crackles in the mild case group (n = 894, 84.18%) were significantly higher than in the severe case group, and the differences were statistically significant (P < 0.01). The incidences of gasp, stridor, and convulsions, the proportion of underlying diseases, such as congenital heart disease, laryngomalacia, and general developmental disorders, anemia, and abnormal liver function, and mixed infections in the severe group (n = 168, 15.82%) were significantly higher than in the mild group, and the differences were statistically significant (P < 0.01 or P < 0.05). Imaging manifestations differed. Pleural effusion and atelectasis occurred in the severe cases. After treatment, patients fully recovered or improved and were discharged from the hospital. There were no deaths.ConclusionHCoV-NL63, OC43, 229E, HKU1 infection is most common in children under three years old, and the infection site is mainly the lower respiratory tract. The main clinical manifestations include fever, cough, and runny nose. Inspiratory three concave signs, respiratory failure, and heart failure occurred in the severe cases, with pleural effusion and atelectasis possibly occurring at the same time. Severe cases should be identified early so that they may be given comprehensive treatment in time to improve the prognosis.

Сравнительные результаты лечения ОРВИ препаратами меглюмина акридонацетат и имидазолилэтанамид пентандиовой кислоты в эпидемическом периоде COVID-19 в условиях поликлиники

This study compared the efficacy of different therapies for ARVI during the COVID-19 pandemic. Objective. To compare clinical efficacy of Cycloferon and Ingavirin in children aged 4–17 years treated in outpatient facilities during the epidemic season of СOVID-19. Patients and methods. This study included 101 patients who provided 143 oro- and nasopharyngeal swabs tested using certified PCR tests. Of them, 128 samples (89.5%) were positive, whereas 15 samples (10.5%) were negative. We identified the most common viruses circulating in January–May 2021, including (seasonal) coronaviruses (35.9%), rhinoviruses (20.3%), and other viruses. We also analyzed respiratory viruses that have circulated in Moscow during the last 6 years and found higher levels of seasonal coronaviruses. The most common ARVI symptoms in 2021 were fever, rhinitis, pharyngeal hyperemia, and fatigue. Fewer children had headache, cough, and enlarged lymph nodes. Results. We compared ARVI treatment with broad-spectrum antivirals in children aged between 4 and 17 years. Children in group 1 (n = 51) received Cycloferon®, while children in Group (n = 50) received Ingavirin®. Study participants were diagnosed with ARVI and moderate nasopharyngitis. Children from the Cycloferon group demonstrated a more significant dynamics of such clinical symptoms as headache (p &lt; 0.05), cough (p &lt; 0.01), rhinitis (p &lt; 0.01), abundant mucus (p &lt; 0.001), and enlarged lymph nodes (p &lt; 0.001) than children from the Ingavirin group (there was a significant difference in the duration of these symptoms). Only 2 children from group 1 required antibiotics (3.4%), whereas in group 2, 11 children needed antibacterial therapy (22%). Key words: children, acute respiratory viral diseases (ARVI), COVID-19, PCR diagnostics, clinical manifestations, Cycloferon, Ingavirin

Clinical and Laboratory Comparison of Covid-19 and Influenza A/B in Children.

The clinical picture of COVID-19 shows significant similarity with influenza. In this study, it was aimed to compare the clinical and laboratory findings between pediatric patients diagnosed with COVID-19 and those with influenza A or B, and to obtain data on the differential diagnosis of COVID-19 from influenza in children. The study included 104 patients with COVID-19, 140 patients with influenza A and 135 patients with in-fluenza B (379 patients in total) who were admitted to our tertiary hospital with symptoms of acute respiratory tract infection. Fever, cough, runny nose, and pharyngeal hyperemia rates were significantly lower in patients with COVID-19 than in those with influenza A/B. The highest leukocytosis and lymphocytosis rates were seen in influenza A patients. Eosinophil levels were found significantly lower in the influenza A/B patients compared to the COVID-19 group. C-reactive protein levels were significantly higher in the influenza A/B group when compared with the COVID-19 group. The mean PDW value was significantly higher in the COVID-19 patients compared to influenza A/B. Our study data show that low body temperature and loss of taste and smell support the diagnosis of COVID-19, and fever, cough, pharyngeal hyperemia, and runny nose support the diagnosis of influenza. While leukocytosis and increased C-reactive protein suggest influenza, high PDW and eosinophil levels support COVID-19.

Assessment of Children Exposed to Maras Powder Intoxication.

A smokeless tobacco known as Maras powder (MP) is commonly consumed in the southern region of Turkey. To the extent of our knowledge, no previous study in literature has reported acute MP intoxication in children. Our aim was to determine the clinical effects and treatment strategies of MP poisoning in children.Materials and methods: We retrospectively reviewed the medical records of children <18 years of age with MP intoxication who were followed up in the Intensive Care Unit between January 2016 and April 2018 in our center. Forty-one patients (M/F= 25/16) were included in this study. The mean age was 13.2±22.4 months (age range: 7 to 30 months). The patients presented with vomiting (n=23, 56%), cough (n=17, 41.5%), loss of consciousness (n=11, 26.8%), respiratory distress (n=6, 14.6%), convulsion (n=7, 17%), cyanosis (n=1, 2.4%), and abdominal pain (n=1, 2.4%) following oral ingestion of the substance. On their physical examination all patients with convulsion were in a comatose state. Thirty-two patients (78%) had tachycardia; 15 patients (36.5%) had pharyngeal hyperemia; and three (7.3%) had hiccups. Although the female patients had a lesser rate of symptoms than male patients, the difference was not statistically significant. Our aim was to inform the doctors about the clinical picture that develops after taking this substance and contribute to the understanding of the treatment approach.

COVID-19 у детей в мегаполисе: клинико-эпидемиологические и терапевтические аспекты

The pandemic of a new coronavirus infection in the world, including in Russia, was the basis for a detailed analysis of the disease features in children hospitalized in the only specialized hospital in Saint Petersburg. The purpose — is to analyze clinical and epidemiological data and approaches to the treatment of COVID-19 in children based on the functioning of the specialized infectious hospital, which was the first in such a megalopolis as Saint Petersburg to be deployed to work with the new coronavirus infection from January 2020 to the present. Material and methods. Based on a retrospective continuous single-center study, we analyzed 206 medical records of inpatient children aged 0 to 18 years who were treated in the Infectious Department № 7 of the Filatov municipal hospital № 5 in Saint Petersburg with a diagnosis of COVID-19 from March to June 2020. The mandatory selection criterion was laboratory confirmation of the COVID-19 diagnosis — a positive result of PCR of SARS-Cov-2 RNA in nasopharyngeal and oropharyngeal smears. The article is descriptive in nature. Results. It was found that children older than 3 years prevailed among the patients (71,5%, n = 147). Family contact with adults prevailed (54,9%, n = 113). COVID-19-ARVI was diagnosed in 81,4% (n = 168) of children, pneumonia was diagnosed in 18,6% (n = 38) of cases, and in 1,9% (n = 4) of cases it was asymptomatic. Mild forms of the disease prevailed (76,2%, n = 157), severe ones occurred only in 1,9% (n = 4) of patients. In 30,7% (n = 63) of cases, patients were admitted to a hospital late (in the second week of the disease). It was found that the clinical picture was dominated by fever (78,6%, n = 162), which lasted more than 5 days in 22,3% (n = 46) of cases, pharyngeal hyperemia — 84,5% (n = 174), cough — 51,2% (n = 105), symptoms of intestinal dysfunction — 19,4% (n = 40), anosmia — 9,9% (n = 20), exanthema — 7,8% (n = 16), sternal pain — 9,9% (n = 20). Recombinant interferon alpha-2b, umifenovir, lopinavir/ritonavir, anticoagulants, macrolides, and cephalosporins were used in the treatment of children. All patients showed positive dynamics with favorable outcome after treatment. All patients were discharged with clinical recovery. In 84,4% (n = 174) of patients sanation of nasopharynx и and fauces took place in hospital, in 62,1% (n = 128) of cases virus discharge took place on the 10–12 day, in other cases after 2–4 weeks. Conclusion. COVID-19 in children in a megalopolis has specific features compared with other ARVIs, but therapy principles are similar, implying taking into account the disease severity and early start of etiotropic treatment with the whole range of available antivirus drugs allowed for children and having an evidential basis, which was confirmed in the present research.

A survey of clinical and laboratory characteristics of dengue fever epidemic from 2014 to 2018 in Guangzhou, China.

In 2014, a serious dengue outbreak occurred in Guangzhou, South China. In this study, the clinical and laboratory characteristics of dengue fever (DF) group and other febrile illnesses (OFI) group in Guangzhou were described. Clinical and laboratory data collected by studying 1,792 patients from Nanfang Hospital, Southern Medical University during 2014 and 2018. Laboratory data was analyzed by SPSS 22.0 statistical software including Full blood counts (SYSMEX XE-5000), Laboratory Biochemical tests (Roche Cobas 8000), Dengue virus RNA (RT-PCR-Fluorescence Probing) and Dengue IgG/IgM Antibody (Colloidal Gold), Dengue Virus NS1 (ELISA). In the DF group and OFI group, gender ratios were 1.08:1 (male/female, P>0.05) and 1.45:1 (male/female, P<0.05). Adults aged 25-34 years old (29.4%) with the main peak appeared in the DF group, and the same main peak appeared in the OFI group: 25-34 years old (25.13%). Patients were from Medical emergency (41.2% DF group, 29.4% OFI group). The distribution of fever days before treatment was mainly focused within 5 days, with a main peak in the 2 fever days before treatment (24.6%) in the DF group and the main peak in 1 fever day before treatment (46.9%) in OFI group. The major symptoms of the DF group were presented with were fever (100%), myalgia (34.77%), pharyngeal hyperemia (31.33%), headache (25.65%), adenoids (19.62%), and rash (13.25%). In the OFI group, Pharyngeal hyperemia was the most common clinical symptom, accounting for 27.24%, and the next symptom was adenoids (21.26%). The sensitivity and specificity of DV RNA were 61.54%, 100%, respectively, compared to the DF Nonstructural protein 1 (NS1). Dengue virus (DENV) Immunoglobulin M (IgM) IgM in both groups was statistically significant, with DENV-IgM in the DF group were stronger (Z=-7.863, P<0.001), and DENV immunoglobulin G (IgG) were no statistically significant (Z=-1.212, P=0.226). In DF group, 37.14% of serum samples had elevated Alanine transaminase (ALT) levels, 76.85% of them had elevated aspartate aminotransferase (AST) levels, 32.08% of them had elevated creatine kinase (CK) levels, and 2.67% of them had elevated C-reaction protein (CRP) levels, compared with 13.51% of them had elevated ALT levels, 30.65% of them had elevated AST levels, 6.06% of them had elevated CK levels and 69.35% of them had elevated CRP levels of the OFI patients. The prominent manifestations were thrombocytopenia (occurring in 28.07% of the DF group, compared to 5.18% of OFI group) and leucopenia (occurring in 43.27% of DF group and 3.63% of OFI group). The DF incidence of all fever cases was 49.0% within three months in 2014, compared with 1.4% in 2015, 0% in 2016, 0.9% in 2017 and 6.4% in 2018 (P<0.001). DF and OFI can occur in any age and sex. DF occurred in the young and the old, OFI occurred in children and youth. The clinical symptoms of myalgia, headache, rash, weak, Chills, follicular hyperplasia in both groups were statistically significant (P<0.001). IgM can be easily recognized for early diagnoses, DENV-RNA had lower sensitivity and higher specificity, and DF NS1 enzyme-linked immunosorbent assay (ELISA) has a higher sensitive and specificity. DF is a serious public health problem and an emerging continuous threat in Guangzhou. In high-prevalence areas, effective epidemic monitoring and prevention measures need to be undertaken. After the unprecedented outbreak in 2014, on account of the government and citizen paying more attention to the DF epidemic, the cases of DF were decreased significantly from 2015 to 2018.

Clinical and epidemiological characteristics of 245 cases of influenza A (H3N2)

Objective: To investigate the clinical and epidemiological characteristics of influenza A (H3N2) infected patients in Jinhua area, and therefore to improve the understanding of infection with H3N2 influenza virus. Methods: The pharynx swab specimens for pathogenic detection were collected from acute respiratory infection (ARI) cases in the fever clinic of the sentinel hospital in Jinhua area from 2014 to 2017. Descriptive statistics method was used to analyze the clinical features and pathogenics characteristics of the patients infected with H3N2 influenza virus. The t test or χ(2) test of independent samples were used for comparison between groups. Results: A total of 3 803 cases of acute respiratory infection (ARI) were reported in the sentinel hospital in Jinhua area from 2014 to 2017. Among them, 245 cases (6.4%) of H3N2 influenza were diagnosed, including 153 males (62.4%) and 92 females (37.6%), aged from 0.5 to 95 years, with an average age of (50.1+15.7) years. They were divided into 5 age groups, with 107 (43.7%) patients aged 60 years and older. The incidence of major diseases was 43.7%. There was no significant difference in the gender in different age groups (χ(2)=4.581, P=0.333). The seasonal peak of H3N2 influenza A virus infection was mainly in summer (In June-September), but was also seen in other months. In the 4 years from 2014 to 2017, there were a total of 4 peaks, which occurred in July-September, July-August, June-August, and June-August. The body temperature of most patients (73.1%) was between 38.0 and 38.9 ℃. The main positive signs of H3N2 influenza A virus infection were different degrees of pharyngeal hyperemia and tonsillar enlargement. Fever (>38 ℃), cough, dizziness, fatigue, sore throat, headache, chills, shortness of breath, runny nose, myalgia, expectoration, nasal congestion were the main symptoms of H3N2 cases. The proportion of abnormal X-ray/CT manifestations in H3N2 influenza A virus infection cases was lower than that of other influenza viruses. 89.8% of the patients were positive for H3N2 influenza A. The average lymphocyte count was (1.1±0.5) × 10(9)/L, total platelet count (157±39) × 10(9)/L in H3N2 influenza A infection group, which were lower than those in other influenza positive patients [(1.2±0.6)×10(9)/L and (165±42) × 10(9)/L], while the neutrophil count (3.6±0.8) × 10(9)/L was higher than that in other influenza positive patients (3.4±1.0) × 10(9)/L(all P<0.05). Conclusions: Patients with H3N2 influenza A in Jinhua mostly presented with throat congestion and tonsillar enlargement in varying degrees, fever (>38 ℃), cough and sputum production. The seasonal peak of influenza A was in summer (June-September). Elderly aged 60 years or older were the susceptible group.

Acute intoxication and poisoning in children: the experience of a tertiary-care hospital from 2001-2012

The frequency and distribution of acute intoxications and poisoning from non-pharmacological substances in children was evaluated in this observational-descriptive study. This was done by analyzing all admissions to the Emergency Room of our University in Rome during theperiod 1st January 2001 to 31st December 2012. We found 249 patients aged 0-14 years: 147 males and 102 females. The highest incidence occurred in the first 4 years of life: 44.2% in the 1-2 year age-group. Cases were mostly related to solvents (44.6%), natural products (17.7%), agricultural products (12.9%), corrosive acids and alkaline caustics(14.8%). Most admissions occurred during the time slot 18:00 to 21:00 (23.7%). No clinical symptoms were observed in 116 children (46.6% of the total), and physical examination was unrevealing. The remaining 133 displayed nausea/vomiting (22%) and pharyngeal hyperemia (18.8%). Laboratory tests and imaging studies were only performed in selected cases. In terms of consulting requests, the Poisons Center was contacted 156 times (62.6% of cases), the Pediatric Intensive Care Unit 38 times(15.2%), and the surgeon-endoscopist 18 times (7.2%). A short period of observation and monitoring in the Emergency Room was warranted in 106 children (42.5%). Gastroprotective drugs were used in 75 cases(30.1%) and activated charcoal in 18 (7.2%). Nintey-five children (38.2%) were admitted to the pediatric department , but no complications occurred. Targeted information programs in schools and during pediatric check-ups should decrease the risk of ingestion of non-pharmacological substances in children, and the costs of its management.

ABSTRACT 746

Background and aims: Acute generalized exanthematous pustulosis (AGEP) is characterized acute onset of widespread pustule eruption. Fever and leukocytosis may frequently accompany the disease but rapid spontaneous recovery is typical. This disease resembles pustular psoriasis clinically. Two pediatric patients with AGEP have been presented. Methods: CASE-1: A 10-year old male complaining of skin eruption for two days was brought to emergency department. He received anonymous cold medicine for sore throat two days ago. There were diffuse numerous small, primarily non-follicular pustules on a background of edematous erythema. White blood cell count (WBC) was 16500/µL (80% neutrophils). Punch biopsy results were consistent with AGEP. Supported treatment with analgesic and antihistaminic drugs was given. CASE-2: A 7-year old male patient was admitted to emergency department for diffuse redness. According to his history, sore throat and rashes started 3 days ago and then increased gradually. There were pharyngeal hyperemia and small vesiculopustular lesions on neck, axilla and genital area. WBC was 12300/µL (70% neutrophils). Antibiotics, antihistamines and topical steroids were started. On follow-up, reduction in lesions was observed and Group A Streptococcus was detected in throat culture. Conclusions: The patients were diagnosed with AGEP because of throat infection and suspected drug intake, presence of typical clinical findings and rapid improvement on follow-up. Differential diagnoses are important for treatment methods. If clinical improvement is not enough with supportive treatment, pustular psoriasis may be kept in mind. These cases were presented to avoid unnecessary treatment in AGEP which is seen rarely and has good prognosis in childhood.

Testicular involvement during Toscana virus infection: an unusual manifestation?

Toscana virus (TOSV), transmitted by the Phlebotomus genera, is the most common cause of viral meningitis in the Mediterranean area during summer [1]. Generally, the disease is benign and self-limited, although severe complications such as encephalitis and cerebral ischemia are described [2]. Asymptomatic infections and clinical manifestations in the absence of central nervous system involvement are also documented [3, 4]. We describe an unusual manifestation of TOSV infection in a patient residing in central Italy (Siena district, Tuscany). On 4 September 2012, a 29-year-old previously healthy man was admitted to hospital for fever and severe headache lasting 3 days; testicular pain and diarrhea were also reported. On admission, the patient was suffering and alert with an axillary temperature of 37.3 C, pulse rate of 80 beats/min, respiratory rate of 20 breaths/min, and blood pressure of 110/80 mmHg. Physical examination revealed signs of meningeal irritation, in the absence of focal neurological deficits, tenuous maculopapular rash in the trunk and upper limbs, pharyngeal hyperemia, and swelling and tenderness of the right testicle with no other genital abnormalities. The laboratory tests showed a C-reactive protein level of 1.78 mg/dL (normal value \0.5), white blood cell (WBC) count 11,200/mm (neutrophils 70.4 %), aspartate aminotransferase (AST) 24 U/l, alanine aminotransferase (ALT) 44 U/l, and IgG 582 mg/dL. The erythrocyte sedimentation rate, hemoglobin, platelet count, procalcitonin, renal function, amylase, electrolytes, lactate dehydrogenase, creatine phosphokinase, C3, C4, IgA, IgM, and bilirubin were all within the normal limits. Computed tomography (CT) scan of the brain without contrast medium, chest X-ray, and electrocardiography (ECG) were negative. The testicular ultrasound showed minimal right hydrocele. Cerebrospinal fluid (CSF) examination revealed normal glucose level, increased protein levels (161 mg/dL), and pleocytosis (1,745 cells/mm, 61.7 % lymphocytes). The patient was treated with an empirical therapy based on ceftriaxone and intravenous acyclovir. TOSV was detected by specific nested reverse transcription polymerase chain reaction (RT-PCR) in CSF, while bacterial and fungal cultures, as well as results of PCR for picornavirus, HSV-1 and HSV-2, and Mycobacterium tuberculosis were negative in the same specimen. Blood cultures were negative and serology against TOSV showed positivity for IgM and IgG; antibodies against mumps virus were compatible with past infection. The patient gradually improved, with rapid disappearance of the rash and testicular pain; after 7 days, he was discharged in good condition. This case underlines that, in addition to the typical neurological manifestations, TOSV infection may involve other organs [1]. Although cutaneous rash has been reported several times, testicular involvement, as in the patient described here, has only been documented in a single previous report [3]. From a pathogenetic point of view, the concomitance and the rapid disappearance of genital symptoms during the infection seem to suggest, in the absence of other obvious causes, a direct relationship with viral replication.

Genetic Detection of Dobrava/Belgrade Virus, Bulgaria

Genetic Detection of Dobrava/Belgrade Virus, Bulgaria

Analysis of 113 hospitalized patients with confirmed 2009 influenza A (H1N1) virus infection

To evaluate the demographic characteristics, clinical and laboratory features, underlying medical conditions, treatment, and outcome of hospitalized patients with laboratory-confirmed infection due to the 2009 influenza A(H1N1) virus. Materials and methods: This prospective study was performed between October and December 2009. The hospitalized patients with laboratory-confirmed diagnosis of 2009 influenza A(H1N1) virus infection were included in the study. The diagnosis was confirmed with detection of the virus in nasal and nasopharyngeal swabs by RT-PCR assay. Demographic and epidemiological characteristics, clinical features, treatment, and outcome of the patients were recorded on the individual forms. A comparison was made between patients with and without pneumonia. Results: From October to December 2009, 113 confirmed patients with 2009 influenza A(H1N1) virus infection were hospitalized in our clinic. The ages of the patients were between 17 and 77 years (mean age 35.7 ± 15.8 years) and 73 (64.6%) were female. Cough (92.9%), fever (85.8%), malaise (85.8%), headache (80.5%), and muscle aches (85.0%) were the most common presenting symptoms. The time from symptom onset to hospital admission was 1-15 days (mean time 3.8 ± 3 days). On physical examination, fever (74.3%), pharyngeal hyperemia (66.4%), rales (43.4%), dyspnea (29.2%), and cyanosis (4.4%) were the presenting clinical findings. Of the patients, 64 (56.6%) had at least 1 underlying medical condition. The most common underlying disease was chronic pulmonary disease (14.5%). A total of 25 patients were pregnant. On admission to hospital, 25 patients (22.1%) had leukopenia, 12 patients (10.6%) had leukocytosis, and 29 patients (25.7%) had thrombocytopenia. Pulmonary infiltrates consistent with pneumonia were detected on chest radiography in 47 (41.6%) patients.Of these patients, 98 (86.7%) received oseltamivir treatment on admission. Six patients (5.3%) were admitted to the ICU because of acute respiratory failure and 4 of them (3.5%) required mechanical ventilation. Among these patients, 3 (2.7%) died. A comparison between the patients with and without pneumonia was performed statistically. Age older than 40 years old, time from onset of symptoms to admission longer than 3 days, leukocytosis, ALT/AST elevation, and hyperglycemia were significantly higher in patients with pneumonia. Conclusion: Although the 2009 influenza A(H1N1) virus causes severe illness including pneumonia and death, the mortality rate is not very high. The characteristics of the disease are similar to those of seasonal influenza. Young adults were the most affected persons and most of the patients had underlying medical conditions.

An Outbreak of Oropharyngeal Tularemia with Cervical Adenopathy Predominantly in the Left Side

PurposeWe describe the epidemiological and clinical characteristics and the efficacy of a delayed initiation to therapy in an oropharyngeal tularemia outbreak in Duzce, Turkey.Materials and MethodsBetween March and June 2000, 22 patients with tularemia were diagnosed by microagglutination tests.ResultsOropharyngeal and ulceroglandular forms of the disease were discovered. Most of the cases were oropharyngeal (19 cases). The most common symptoms were sore throat (95.4%) and fever (90.9%). Lymphadenopathy (95.4%) and pharyngeal hyperemia (81.8%) were usually observed signs. The lymphadenopathies were localized especially in the left cervical region (66.7%), a finding that has not been previously reported in the literature. The time between the onset of the symptoms and diagnosis was 40.7 ± 22.8 (10 - 90) days. The patients were treated with streptomycin plus doxycycline and ciprofloxacin. The patients' recoveries took up to 120 days.ConclusionThis report describes the first outbreak of tularemia in northwest Turkey. Tularemia may occur in any region where appropriate epidemiological conditions are found and should be kept in mind for differential diagnosis in oropharyngeal symptoms. Late initiation of therapy may delay complete recovery. In this outbreak, cervical lymph nodes predominantly localized on the 1eft side were found, which had not been previously reported.

Initial otolaryngological manifestations of severe acute respiratory syndrome in Taiwan.

To provide a clue for screening severe acute respiratory syndrome (SARS), a highly transmissible disease with health care workers at particular risk, in the early stage from an otolaryngological perspective. Prospective study. Community hospital. Between April 17 and April 26, 2003, 32 consecutive patients with SARS were encountered. Investigation consisted of local examination of ear, nose, and throat fields; palpation of the nuchal areas; and plain chest radiography. Analyses of throat swab samples using reverse transcription-polymerase chain reaction were conducted. Clinical manifestations included fever in 31 patients (97%), followed by cough, dyspnea, chill, headache, sore throat, diarrhea, rhinorrhea, and otalgia. Neither the pharyngeal wall nor the tonsillar area demonstrated hyperemia. There was no lymphadenopathy in the neck. Plain chest radiographs revealed consolidation in 25 (78%) of 32 patients. Results of reverse transcription-polymerase chain reaction analysis targeting the novel coronavirus present in throat swab samples were positive in 19 (66%) of 29 patients tested. Twenty-eight patients required supplemental oxygen, and 14 patients were intubated with mechanical ventilation. Twenty-eight patients survived and 4 patients died. When presented with a patient with flulike symptoms such as fever and/or cough, but no pharyngeal hyperemia or neck lymphadenopathy, physicians should be alerted to the possibility of SARS. In contrast, evidence of inflammatory signs in the otolaryngological field may explain the flulike symptoms, and serve as a differential diagnostic tool between influenza and SARS.