Influenza A In Patients With Hematologic Diseases

Objective:To describe the clinical features of respiratory infection caused by influenza A virus, including seasonal A (H3N2), A (H1N1) pdm09, and A (H7N9), in patients with hematologic diseases, those who were admitted in our hospital from December2013to March2014.Methods:Information of the patients with hematologic diseases who were diagnosed as influenza A in our hospital from December2013to March2014, including clinical manifestations, laboratory examination, radiologic features, treatment and outcome, were collected and analyzed retrospectively, to find some factors associated with the outcome of patients.From December2013to March2014,36patients with hematologic disease acquired influenza A in our department, including8A (H3N2),26A (H1N1) pdm09, and2A (H7N9) cases, with a median age of55years(range25-65),54years(range25-79), and58years(range57-59), respectively, including27males and9females. The basic Hematologic Diseases are mainly hematological malignancies. In H3N2and H1N1patients, more suffered an onset of influenza in hospital than outside the hospital; while, both H7N9patients suffered influenza outside the hospital. Fever (especially high fever) and cough were the most common symptoms. Laboratory test showed lymphopenia and thrombocytopenia in over90%of patients, and level of C-reactive protein(CRP) was elevated in most patients. Two cases of H3N2had bacteremia due to Pseudomonas aeruginosa and E.coli respectively. One H1N1patient and One H7N9patient had bacteremia of sphingosine Aeromonas and Klebsiella pneumoniae respectively. Chest radiograph or computed tomography scans most often showed bilateral ground-glass opacities and consolidation, which are typical of viral pneumonia. A (H3N2), A (H1N1) and A (H7N9) were diagnosed, respectively, in the median onset of7.5days (range3-33),5.0days (range1-20),7.5days (range7-8). All patients with confirmed influenza A virus infection were transferred to isolation wards and received antiviral therapy, such as oseltamivir, one kind of Neuraminidase inhibitor. The mortality of H3N2was25.0%(2of8cases), which was11.5%(3of26cases) in H1N1, and there’s no statistical difference between the both. Both two H7N9patients were died finally. Univariate analyses showed that H7N9infection, state of relapse of the hematologic disease, bacteremia, thrombocytopenia, elevated CRP level were associated with death. Multivariate analysis showed that the only independent risk factor for death is the level of CRP.Conclusion:1. No significant differences were found in clinical characteristics between patients infected by A(H3N2) or A(H1N1)pdm09with hematologic diseases.2. Influenza A could lead to severe outcomes in patients with hematologic diseases. During an epidemic of influenza A, the virus should be tested for routinely by RT-PCR or viral culture in suspected cases, and antiviral therapy and other supportive therapy should be initiated as soon as possible.3. Univariate analyses showed that H7N9infection, state of relapse of the hematologic disease, bacteremia, thrombocytopenia, elevated CRP level were associated with death.4. Multivariate analysis showed that the only independent risk factor for death is the level of CRP, which means that the higher the CRP level is, the greater the risk of death is.