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Bronchial casts and pandemic (H1N1) 2009 virus infection.

Hasegawa M, Inamo Y, Fuchigami T, Hashimoto K, Morozumi M, Ubukata K, Watanabe H, Takahashi T - Emerging Infect. Dis. (2010)

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Patient specimens were sent to CDC for real-time reverse transcription–PCR (RT-PCR) testing, and from April 15 through May 5, 2009, a total of 642 infections with the virus, now called pandemic (H1N1) 2009 virus, were confirmed... Children and adults with preexisting underlying respiratory conditions, such as asthma, are at increased risk for complications from infection with pandemic (H1N1) 2009 virus... One possible complication is plastic bronchitis, a rare respiratory illness characterized by formation of large gelatinous or rigid branching airway casts... Plastic bronchitis is a potentially fatal condition induced by bronchial obstruction from mucus accumulation resulting from infection, inflammation, or vascular stasis... We report a case of bronchial casts that caused atelectasis of the right lung of a child infected with influenza A pandemic (H1N1) 2009 virus... A 6-year-old boy with asthma and a 1-day history of fever and cough was referred to a hospital pediatrics department because of dyspnea... Clinical examination at hospital admission found respiratory distress, as shown by tachypnea (respiratory rate 66 breaths/min) and inspiratory retraction, deficient vesicular sounds over the right lung field, elevated blood levels of immunoglobulin E (1,770 IU/mL) and a reduced number of lymphocytes (483 cells/μL), and radiographic evidence of atelectasis of the right lung and hyperinflation of the left lung without air leakage (Figure, panel A)... A histologic examination of casts (MayGiemsa stain; Figure, panel D) indicated a mucoid substance containing a predominantly eosinophilic infiltrate (>90% of cells)... The patient’s respiratory condition during 11 days of oxygen supplementation gradually improved, and he was discharged on hospital day 18... Pandemic (H1N1) 2009 can produce similar airway cast formation in humans; severe respiratory distress reflects extensive obstruction of the respiratory system... Healthcare providers should be aware of the possibility of bronchial casts when examining children with influenza (H1N1) infection accompanied by atelectasis... Steroids can be administered early in infection to avoid cast formation, and antiviral drug therapy and respiratory support can be used for influenza (H1N1)–infected children in whom airway casts have developed.

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A) Chest radiograph obtained at hospital admission from a child infected with influenza subtype H1N1 virus. The image shows atelectasis of the right lung and hyperinflation of the left lung; arrows indicate obstruction of the right main bronchus. B) Macroscopic bronchial casts extracted by intratracheal suction. C) Chest radiograph obtained on hospital day 2, indicating partial resolution of atelectasis of the right lower lobe. D) Light micrograph of casts, characterized by predominant eosinophil infiltration (>90% of cells) (May-Giemsa stain, original magnification ×1,000). Arrows indicate typical eosinophil granules.
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Figure 1: A) Chest radiograph obtained at hospital admission from a child infected with influenza subtype H1N1 virus. The image shows atelectasis of the right lung and hyperinflation of the left lung; arrows indicate obstruction of the right main bronchus. B) Macroscopic bronchial casts extracted by intratracheal suction. C) Chest radiograph obtained on hospital day 2, indicating partial resolution of atelectasis of the right lower lobe. D) Light micrograph of casts, characterized by predominant eosinophil infiltration (>90% of cells) (May-Giemsa stain, original magnification ×1,000). Arrows indicate typical eosinophil granules.

Mentions: A 6-year-old boy with asthma and a 1-day history of fever and cough was referred to a hospital pediatrics department because of dyspnea. Clinical examination at hospital admission found respiratory distress, as shown by tachypnea (respiratory rate 66 breaths/min) and inspiratory retraction, deficient vesicular sounds over the right lung field, elevated blood levels of immunoglobulin E (1,770 IU/mL) and a reduced number of lymphocytes (483 cells/μL), and radiographic evidence of atelectasis of the right lung and hyperinflation of the left lung without air leakage (Figure, panel A). Pandemic (H1N1) 2009 virus infection was confirmed by real-time RT-PCR, as described (5), of an endotracheal aspirate. Real-time PCR ruled out Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Legionella pneumophila, Chlamydophila pneumoniae, S. pyogenes, respiratory syncytial viruses A and B, seasonal influenza viruses A and B, parainfluenza viruses 1–3, rhinovirus, enterovirus, human metapneumovirus, human bocavirus, and adenovirus (6). While the patient was breathing room air, his percutaneously monitored oxygen saturation was 86%; respiratory support by mechanical ventilation was then initiated. Mucus casts were extracted by intratracheal suction (Figure, panel B). The patient was treated with an inhaled bronchodilator, intravenous methylprednisolone (20–60 mg/day for 7 days), and antiviral (oseltamivir) and antimicrobial (ampicillin/sulbactam) drugs.


Bronchial casts and pandemic (H1N1) 2009 virus infection.

Hasegawa M, Inamo Y, Fuchigami T, Hashimoto K, Morozumi M, Ubukata K, Watanabe H, Takahashi T - Emerging Infect. Dis. (2010)

A) Chest radiograph obtained at hospital admission from a child infected with influenza subtype H1N1 virus. The image shows atelectasis of the right lung and hyperinflation of the left lung; arrows indicate obstruction of the right main bronchus. B) Macroscopic bronchial casts extracted by intratracheal suction. C) Chest radiograph obtained on hospital day 2, indicating partial resolution of atelectasis of the right lower lobe. D) Light micrograph of casts, characterized by predominant eosinophil infiltration (>90% of cells) (May-Giemsa stain, original magnification ×1,000). Arrows indicate typical eosinophil granules.
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Related In: Results  -  Collection

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Figure 1: A) Chest radiograph obtained at hospital admission from a child infected with influenza subtype H1N1 virus. The image shows atelectasis of the right lung and hyperinflation of the left lung; arrows indicate obstruction of the right main bronchus. B) Macroscopic bronchial casts extracted by intratracheal suction. C) Chest radiograph obtained on hospital day 2, indicating partial resolution of atelectasis of the right lower lobe. D) Light micrograph of casts, characterized by predominant eosinophil infiltration (>90% of cells) (May-Giemsa stain, original magnification ×1,000). Arrows indicate typical eosinophil granules.
Mentions: A 6-year-old boy with asthma and a 1-day history of fever and cough was referred to a hospital pediatrics department because of dyspnea. Clinical examination at hospital admission found respiratory distress, as shown by tachypnea (respiratory rate 66 breaths/min) and inspiratory retraction, deficient vesicular sounds over the right lung field, elevated blood levels of immunoglobulin E (1,770 IU/mL) and a reduced number of lymphocytes (483 cells/μL), and radiographic evidence of atelectasis of the right lung and hyperinflation of the left lung without air leakage (Figure, panel A). Pandemic (H1N1) 2009 virus infection was confirmed by real-time RT-PCR, as described (5), of an endotracheal aspirate. Real-time PCR ruled out Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Legionella pneumophila, Chlamydophila pneumoniae, S. pyogenes, respiratory syncytial viruses A and B, seasonal influenza viruses A and B, parainfluenza viruses 1–3, rhinovirus, enterovirus, human metapneumovirus, human bocavirus, and adenovirus (6). While the patient was breathing room air, his percutaneously monitored oxygen saturation was 86%; respiratory support by mechanical ventilation was then initiated. Mucus casts were extracted by intratracheal suction (Figure, panel B). The patient was treated with an inhaled bronchodilator, intravenous methylprednisolone (20–60 mg/day for 7 days), and antiviral (oseltamivir) and antimicrobial (ampicillin/sulbactam) drugs.

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Patient specimens were sent to CDC for real-time reverse transcription–PCR (RT-PCR) testing, and from April 15 through May 5, 2009, a total of 642 infections with the virus, now called pandemic (H1N1) 2009 virus, were confirmed... Children and adults with preexisting underlying respiratory conditions, such as asthma, are at increased risk for complications from infection with pandemic (H1N1) 2009 virus... One possible complication is plastic bronchitis, a rare respiratory illness characterized by formation of large gelatinous or rigid branching airway casts... Plastic bronchitis is a potentially fatal condition induced by bronchial obstruction from mucus accumulation resulting from infection, inflammation, or vascular stasis... We report a case of bronchial casts that caused atelectasis of the right lung of a child infected with influenza A pandemic (H1N1) 2009 virus... A 6-year-old boy with asthma and a 1-day history of fever and cough was referred to a hospital pediatrics department because of dyspnea... Clinical examination at hospital admission found respiratory distress, as shown by tachypnea (respiratory rate 66 breaths/min) and inspiratory retraction, deficient vesicular sounds over the right lung field, elevated blood levels of immunoglobulin E (1,770 IU/mL) and a reduced number of lymphocytes (483 cells/μL), and radiographic evidence of atelectasis of the right lung and hyperinflation of the left lung without air leakage (Figure, panel A)... A histologic examination of casts (MayGiemsa stain; Figure, panel D) indicated a mucoid substance containing a predominantly eosinophilic infiltrate (>90% of cells)... The patient’s respiratory condition during 11 days of oxygen supplementation gradually improved, and he was discharged on hospital day 18... Pandemic (H1N1) 2009 can produce similar airway cast formation in humans; severe respiratory distress reflects extensive obstruction of the respiratory system... Healthcare providers should be aware of the possibility of bronchial casts when examining children with influenza (H1N1) infection accompanied by atelectasis... Steroids can be administered early in infection to avoid cast formation, and antiviral drug therapy and respiratory support can be used for influenza (H1N1)–infected children in whom airway casts have developed.

Show MeSH
Related in: MedlinePlus