• Open Access

Lower respiratory tract hemorrhage associated with 2009 pandemic influenza A (H1N1) virus infection

Authors

  • Erin D. Kennedy,

    1. Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
    2. Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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  • Monika Roy,

    1. Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA.
    2. Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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  • Jeffrey Norris,

    1. The CDC Experience Applied Epidemiology Fellowship, Office of Surveillance, Epidemiology and Laboratory Services, Atlanta, GA, USA.
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  • Alicia M. Fry,

    1. Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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  • Mitul Kanzaria,

    1. Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
    2. Epidemiology Elective Program, Office of Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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  • Dianna M. Blau,

    1. Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens & Pathology, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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  • Wun-Ju Shieh,

    1. Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens & Pathology, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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  • Sherif R. Zaki,

    1. Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens & Pathology, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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  • Kirsten Waller,

    1. Pennsylvania Department of Health, Harrisburg, PA, USA.
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  • Laurie Kamimoto,

    1. Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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  • Lyn Finelli,

    1. Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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  • Michael A. Jhung,

    1. Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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  • for the 2009 Pandemic H1N1 Influenza-Associated Lower Respiratory Tract Hemorrhage Working Group

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    • Members of 2009 Pandemic H1N1 Influenza-Associated Lower Respiratory Tract Hemorrhage Working Group are given in Appendix 1.


Erin D. Kennedy, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. E-mails: EDKennedy@cdc.gov

Abstract

Please cite this paper as: Kennedy et al. for the 2009 Pandemic H1N1 Influenza-Associated Lower Respiratory Tract Hemorrhage Working Group. (2012) Lower respiratory tract hemorrhage associated with 2009 pandemic influenza A (H1N1) virus infection. Influenza and Other Respiratory Viruses DOI: 10.1111/irv.12022.

Background  Influenza-associated lower respiratory tract hemorrhage (LRTH) has been reported in previous pandemics and is a rare complication of seasonal influenza virus infection. We describe patients with LRTH associated with 2009 pandemic influenza A (H1N1) (pH1N1) virus infection identified from April 2009 to April 2010 in the United States.

Methods  We ascertained patients with pH1N1-associated LRTH through state and local surveillance, the Emerging Infections Program, and CDCs Infectious Diseases Pathology Branch. All patients had influenza A, evidence of pneumonia, and evidence of LRTH.

Results  We identified 44 cases; the median number of days from illness onset to clinical signs of LRTH was one. Hemoptysis or respiratory tract bleeding was documented in 40% of pH1N1-associated LRTH cases, often present early during the course of illness. Twenty-one (48%) patients with LRTH had no other hemorrhagic diatheses. Seven (23%) patients with LRTH received antiviral treatment within two days of illness onset.

Conclusions  During influenza season, clinicians should consider influenza infection in the differential diagnosis for patients presenting with hemoptysis or other signs or symptoms of LRTH. While the impact of timing of antiviral therapy on this complication has not been studied, the rapid progression of LRTH may support use of early empiric therapy. Continued investigation is necessary to betterdefine the clinical spectrum of both seasonal influenza- and pH1N1-associated LRTH.

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