EPIDEMIJA INFLUENZE A H1N1 2019. GODINE U ZLATIBORSKOM OKRUGU. (Croatian)

Introduction: Influenza A H1N1 occurs worldwide sporadically or epidemically. There have been several epidemics of this disease in recent decades. Millions of people fell ill and hundreds of thousands died. The clinical picture varies from asymptomatic to lethal outcome. Older age, male gender and obesity are the most common risk factors for adverse disease. The aim of the research was to examine the clinical course and outcome of the disease of patients with pneumonia during the epidemic of influenza A H1N1 in 2019 in the Zlatibor district. Methods: Epidemiological, clinical, microbiological and radiographic data of patients with influenza A H1N1 treated at the Department of Infectious and Tropical Diseases and the Intensive Care Unit of the General Hospital of Uzice were retrogradely collected and analyzed. Virological and serological analyzes were performed at the Institute of Immunology and Virology “Torlak” in Belgrade. The diagnosis of acute respiratory distress syndrome (ARDS) was made according to the Berlin definition. Statistical analysis was performed using the Statistical Package for Social Sciences SPSS (version 16.0). Results: Out of a total of 274 patients, women accounted for 52.9%. The most common age was 61 to 70 years. 55.4% of patients had comorbidities, 61.8% of that had cardiovascular disease. C reactive protein was elevated in 79.2% of patients. Pneumonia confirmed by radiographic findings was present in 82.8% of patients, 51.5% of that had bilateral pneumonia. Four patients were pregnant, GML 5–9. Two of them had a mild clinical course of infection, one moderate with unilateral pneumonia. All three had a favorable disease outcome. A fourth pregnant woman was admitted in a severe clinical condition and was immediately referred to a tertiary health institution where the disease ended in death. 10.2% of patients were treated in the intensive care unit. Complications occurred in 23.7% of patients, ARDS in 52.3% of that. 55.9% of patients with ARDS were aged 61 to 70 years, and 58.8% were male. Among patients with ARDS, 94.1% had associated diseases, most often CVD (85.3%). C reactive protein was elevated in 85.3% of patients with ARDS. In 8.4% of patients, the disease had an unfavorable course and ended in death. Among these patients, 65.2% were women, and 73.9% were over 65 years of age. Associated diseases were present in 95.6% of these patients, cardiovascular diseases was present in 87% of that. Conclusion: During the influenza epidemic in 2019 in the Zlatibor district, pneumonia, most often bilateral, was most often in patients aged 61–70 with associated cardiovascular diseases. These were also the main risk factors for complications and adverse disease outcome. ARDS was the most common comlication and risk factor for the lethal outcome of the diseases. [ABSTRACT FROM AUTHOR]

Uvod: Influenza A H1N1 se širom sveta javlja sporadično ili epidemijski. Poslednjih decenija je bilo nekoliko pandemija ove bolesti sa milionima obolelih i više stotina hiljada umrlih. Klinička slika varira od asimptomatske do letalnog ishoda. Česte su pojave komplikacija od kojih je najteži akutni respiratorni distres sindrom. Pored komplikacija, na nepovoljan ishod bolesti utiče stariji uzrast, muški pol i udružena gojaznost. Cilj istraživanja je bio da se ispita klinički tok i ishod bolesti bolesnika sa upalom pluća tokom epidemije influenze A H1N1 2019. godine u Zlatiborskom okrugu. Metodi istraživanja: Retrogradno su prikupljeni i analizirani epidemiološki, klinički, mikrobiološki i radiografski podaci pacijenata sa influenzom A H1N1 lečenih na Odeljenju za infektivne i tropske bolesti i Jedinici intenzivne nege OB Užice. Virusološke i serološke analize su rađene na Institutu za imunologiju i virusologiju „Torlak“ u Beogradu. Dijagnoza akutnog respiratornog distres sindroma (ARDS) postavljena je prema berlinskoj definiciji. Statistička analiza obavljena je korišćenjem Statističkog paketa za društvene nauke SPSS (verzija 16.0). Rezultati: Od ukupno 274 bolesnika, žene su činile 52,9%. Najčešći uzrast bio je od 61 do 70 godina. Komorbiditete je imalo 55,4% bolesnika, od čega 61,8% kardiovaskularne bolesti. C reaktivni protein bio je povišen kod 79,2% bolesnika. Upalu pluća potvrdjenu radiografskim nalazom imalo je 82,8% bolesnika, od toga 51,5% obostranu. Četiri bolesnice su bile trudne, GML 5–9. Dve od njih su imale lakši klinički tok infekcije, jedna srednje težak, sa jednostranom upalom pluća. Sve tri su imale povoljan ishod bolesti. Četvrta trudnica je primljena u teškom kliničkom stanju i odmah upućena u tercijernu zdravstvenu ustanovu gde se bolest završila letalnim ishodom. U jedinici intenzivne nege lečeno je 10,2% bolesnika. Komplikacije su nastale kod 23,7% bolesnika, od toga ARDS kod 52,3%. 55,9% bolesnika sa ARDS-om je bilo uzrasta od 61 do 70 godina, a 58,8% je bilo muškog pola. Među bolesnicima sa ARDS-om njih 94,1% je imalo udružene bolesti, najčešće KVB (85,3%). CRP je bio povišen kod 85,3% bolesnika sa ARDS-om. Kod 8,4% bolesnika bolest je imala nepovoljan tok i završila se letalnim ishodom. Među ovim bolesnicima, 65,2% su bile žene, a uzrast preko 65 godina imalo je 73,9%. Kod 95,6% ovih bolesnika bile su prisutne udružene bolesti, od kojih KVB kod 87%. Zaključak: Tokom epidemije influenze 2019. godine u Zlatiborskom okrugu, upalu pluća, najčešće obostranu, imali su najčešće bolesnici uzrasta 61–70 godina sa udruženim kardiovaskularnim bolestima. Isti faktori rizika su uslovljavali nastanak komplikacija i nepovoljan ishod bolesti. Najčešća komplikacija i faktor rizika za letalni ishod bolesti bio je ARDS. [ABSTRACT FROM AUTHOR]

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