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2016 ; 19
(ä): 1-4
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Association of influenza with severe pneumonia/empyema in the community,
hospital, and healthcare-associated setting
#MMPMID27330964
Seki M
; Fuke R
; Oikawa N
; Hariu M
; Watanabe Y
Respir Med Case Rep
2016[]; 19
(ä): 1-4
PMID27330964
show ga
We presented three cases of influenza-related severe pneumonia/empyema that
occurred in one season. CASE 1: A 76-year-old diabetic man, developed empyema as
a result of severe community-acquired pneumonia (CAP) secondary to Haemophilus
influenzae, as confirmed on sputum culture. Nasal swab was positive for influenza
A antigen. After drainage of empyema, intravenous peramivir and
piperacillin/tazobactam were administered for 3 days and 2 weeks, respectively,
followed by oral levofloxacin for 2 weeks. Eventually, he recovered. In this
case, the isolated H. influenzae was non-typeable and negative for
beta-lactamase. CASE 2: A 55-year-old man with suspected cerebral infarction and
diabetes mellitus (DM) developed severe pneumonia/empyema as result of
hospital-acquired pneumonia (HAP). Although influenza A antigen was detected, no
bacterium was isolated from the sputum, blood, or pleural effusion. He showed
severe hypoxia, but recovered after administration of peramivir and levofloxacin
with prednisolone for 5 days and 2 weeks, respectively. CASE 3: A 76-year-old
woman with heart failure and DM was followed-up on an outpatient basis and was
under nursing home care for four months. Subsequently, she developed pneumonia
and was admitted to our hospital; influenza antigen was isolated from nasal swab.
Healthcare-associated pneumonia (HCAP)/empyema were diagnosed and were
effectively treated with peramivir and levofloxacin for 4 days and 1 week,
respectively. In diabetic patients, influenza virus may possibly accelerate
pneumonia/empyema due to bacterial coinfection. Although non-typeable
H. influenzae is a rare causative pathogen of empyema, it can be expected as a
result of "pathogen shift" due to the increased use of the H. influenzae type b
vaccine in Japan.