The role of corticosteroids in the management of severely ill patients with inlfuenza A (H1N1) viral infection is unclear and controversial. Two critically ill cases with influenza A (H1N1) infections complicated with organizing pneumonia (OP) in 2011 successfully treated with low dose corticosteroids were reported here. After initial clinical improvement, the condition of both patients aggravated 20-23 days after the onset of illness. Chest X-ray and computed tomographies (CT) showed an increment of lung infiltrates. Cultures of blood, pleural lfuid and transbronchial aspirate were negative for bacteria and fungi. Organizing pneumonia was diagnosed clinically and both patients were successfully treated with low-dose corticosteroids. Low-dose corticosteroids initiated during convalescence may be beneficial for severe swine-origin influenza A H1N1 pandemic 2009 virus (S-OIV) infections.
Bin CaoLi GuXiao-min YuYu-Dong YinChen MaYing-mei Liu
China has markedly increased infectious disease surveillance efforts after the outbreak of severe acute respiratory syndrome （SARS） in 2003.＇ When the first pneumonia cases with unknown etiology from Shanghai were reported to the National Health and Family Planning Commission and the China Center of Disease Control and Prevention （CDC） in March 2013, our Chinese doctors and scientists show more confident to face the emerging infectious disease than 10 years ago.
Background It is the first multicenter clinical study in China to investigate zanamivir use among Chinese adolescents and adults with influenza-like illness （ILl） since 2009, when inhaled zanamivir （RELENZA ） was marketed in China. Methods An uncontrolled open-label, multicentre study to evaluate the antiviral activity, and safety of inhaled zanamivir （as Rotadisk via Diskhaler device）; 10 mg administered twice daily for 5 days in subjects≥12 years old with ILl. Patients were enrolled within 48 hours of onset and followed for eight days. Patients were defined as being influenza-positive if the real-time reverse transcriptase-polymerase chain reaction real-time reverse transcriptase-polymerase chain reaction （rRT-PCR） test had positive results. Results A total of 400 patients 〉12 years old were screened from 11 centers in seven provinces from March 2010 to January 2011. Three hundred and ninety-two patients who took at least one dose of zanamivir were entered into the safety analysis. The mean age was 33.8 years and 50% were male. Cardiovascular diseases and diabetes were the most common comorbidities. All the reported adverse events, such as rash, nasal ache, muscle ache, nausea, diarrhea, headache, occurred in less than 1% of subjects. Mild sinus bradycadia or arrhythmia occurred in four subjects （1%）. Most of the adverse events were mild and did not require any change of treatment. No severe adverse events （SAE） or fatal cases were reported. Bronchospasm was found in a 38 years old woman whose symptoms disappeared after stopping zanamivir and without additional treatment. All the 61 influenza virus isolates （43 before enrollment, 18 during treatment） proved to be sensitive to zanamivir. Conclusions Zanamivir is well tolerated by Chinese adolescents and adults with ILls. There is no evidence for the emergence of drug-resistant isolates during treatment with zanamivir. （ChiCTR-TNRC-10000938）
