Swine influenza A (H1N1) virus (SIV) infection requiring extracorporeal life support in an immunocompetent adult patient with indirect exposure to pigs, Italy, October 2016

摘要

We describe a case of severe swine influenza A(H1N1) virus infection in an immunocompetent middle-aged man in October 2016 in Italy who had only indirect exposure to pigs. The patient developed a severe acute distress respiratory syndrome which was successfully supported by extracorporeal membrane oxygenation and treated with antiviral therapy. The sole risk factor for influenza was a body mass index?>?30 kg/m~(2). After a month of hospitalisation, the patient was discharged in good health. Keywords: influenza virus, respiratory infection, extracorporeal membrane oxygenationCase descriptionIn early October 2016, a man in his 40s with underlying obesity (body mass index?>?30?kg/m~(2)) presented at the emergency department of our hospital after four days of rhinitis, cough, fever and dyspnoea. The patient was hospitalised due to hypoxaemia (P_(a)O_(2)/F_(I)O_(2)?=?190), hypocapnia, hyperlactataemia (3.6 mmol/L), dyspnoea and bilateral interstitial pneumonia, as shown by chest X-ray and computed tomography (CT) (Figure 1). Open in a separate windowFigure 1 Chest X-ray and computed tomography in a patient with severe swine influenza A(H1N1), Italy, October 2016CT: computed tomography. The X-ray taken on admission (A) showed bilateral opacities. A follow-up chest X-ray performed on day 29 showed almost complete regression of the opacities (B). Chest CT on day 2 after admission (C) showed extensive bilateral consolidation with alveolar parenchymal consolidations and ground-glass opacity (right end). CT on day 12 after admission showed partial regression of consolidation in the right median-lower lobe with residual little areas of ground-glass opacity and improved ventilation of the lower left lobe (D).