J Korean Soc Radiol.  2011 Jun;64(6):615-621. 10.3348/jksr.2011.64.6.615.

Chest Radiographic Findings of Novel Swine-Origin Influenza A (H1N1) Virus Infection in Children

• Bae SY
• Hong HS
• Chang YW
• Paik SH
• Park SJ
• Cha JG
• Lee HK

• KMID: 1443514
• DOI: http://doi.org/10.3348/jksr.2011.64.6.615

Abstract

PURPOSE
To analyze chest radiographic findings in children infected with laboratoryconfirmed novel swine-origin influenza A (H1N1) virus.
MATERIALS AND METHODS
Three hundred seventy-two out of 2,014 children with laboratory confirmed H1N1 infection and who also underwent a chest radiograph from September to November 2009 were enrolled in this study. Patients were divided into in-patients, out-patients, and patients with co-infections and further subdivided into with underlying disease and without underlying disease as well as age (<2 years old, 2-5 years, 5-10 years, 10-18 years old). The initial radiographs were evaluated for radiographic findings and the anatomic distribution of abnormalities.
RESULTS
The initial radiographs were abnormal in 154 (41.39%) patients. The predominant radiographic findings were peribronchial wall opacity found in 85 (22.84%) patients and hyperinflation observed in 69 (18.54%) patients. Further, 75 (71.42%) patients exhibited central predominance and the right lower lung zone was also commonly involved. There were statistically significant differences in the radiological findings between in-patient and out-patient groups. However, there were no significant differences in the radiographic findings between in-patients and the co-infection group with respect the presence of underlying disease and age.
CONCLUSION
Initial radiographs of children with laboratory confirmed H1N1 virus were abnormal in 41.39% of cases. The common radiographic findings included peribronchial opacities, hyperinflation, lower lung zonal distribution, and central predominance.

MeSH Terms

Child
Coinfection
Fluconazole
Humans
Influenza A Virus, H1N1 Subtype
Influenza, Human
Lung
Outpatients
Pneumonia
Radiography, Thoracic
Thorax
Viruses
Fluconazole

Figure

• 

  Fig. 1 A 10-year-old boy with laboratory confirmed S-OIV (H1N1) who presented with coughing. Chest PA (A), right lateral view (B) on hospital admission showed peribronchial opacities in the RLL and RML. The distribution showed a central predominance as well as a presence in the lower and middle lung zone.

• 

  Fig. 2 A 7-year-old boy who presented with dyspnea and had a history of allergic rhinitis. Chest PA (A), right lateral (B) and right decubitus view (C) on hospital admission showed consolidation with air-bronchogram in the BLL, RUL and increased peribronchial opacities in the right perihilar region, pneumomediastinum, subcutaneous emphysema, as well as fluid shifting in the dependent portion. The distribution of the lesion showed central predominance as well as diffuse involvement of the right lung.

Reference

1. Smith TF, Burgert EO Jr, Dowdle WR, Noble GR, Campbell RJ, Van Scoy RE. Isolation of swine influenza virus from autopsy lung tissue of man. N Engl J Med. 1976; 294:708–710.

2. Ito T, Couceiro JN, Kelm S, Baum LG, Krauss S, Castrucci MR, et al. Molecular basis for the generation in pigs of influenza A viruses with pandemic potential. J Virol. 1998; 72:7367–7373.

3. De Jong JC, Paccaud MF, de Ronde-Verloop FM, Huffels NH, Verwei C, Weijers FF, et al. Isolation of swine-like influenza A (H1N1) viruses from man in switzerland and the netherlands. Ann Inst Pasteur Virol. 1988; 139:429–437.

4. Goldfield M, Bartley JD, Pizutti W, Black HC, Altman R, Halperin WE. Influenza in New Jersey in 1976: isolations of influenza A/New Jersey/76 virus at Fort Dix. J Infect Dis. 1977; 136:Suppl. S347–S355.

5. Rota PA, Rocha EP, Harmon MW, Hinshaw VS, Sheerar MG, Kawaoka Y, et al. Laboratory characterization of a swine influenza virus isolated from a fatal case of human influenza. J Clin Microbiol. 1989; 27:1413–1416.

6. Wells DL, Hopfensperger DJ, Arden NH. Swine influenza virus infections: transmission from ill pigs to humans at a wisconsin agricultural fair and subsequent probable person-person transmission. JAMA. 1991; 265:478–481.

7. Wentworth DE, Thompson BL, Xu X, Regnery HL, Cooley AJ, McGregor MW, et al. An influenza A (H1N1) virus, closely related to swine influenza virus, responsible for a fatal case of human influenza. J Virol. 1994; 68:2051–2058.

8. Gregory V, Bennett1 M, Thomas Y, Kaiser L, Wunderli W, Matter H, et al. Human infection by a swine influenza A (H1N1) virus in Switzerland Brief Report. Arch Virol. 2003; 148:793–802.

9. Top FH, Russell PK. Swine influenza at Fort Dix, New Jersey (January-Febuary 1976). IV. Summary and speculation. J Infect Dis. 1977; 136:Suppl. S376–S380.

10. Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, Hernandez M, Quinones-Falconi F, Bautista E, et al. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med. 2009; 361:680–689.

11. Agarwal PP, Cinti S, Kazerooni EA. Chest radiographic and CT findings in novel swine-origin influenza A (H1N1) virus (S-OIV) infection. AJR Am J Roentgenol. 2009; 193:1488–1493.

12. Ajlan AM, Quiney B, Nicolaou S, Muller NL. Swine-Origin Influenza A (H1N1) Viral Infection: radiographic and CT findings. AJR Am J Roentgenol. 2009; 193:1494–1499.

13. Lee EY, McAdam AJ, Chaudry G, Fishman MP, Zurakowski D, Boiselle PM. Swine-Origin Influenza A (H1N1) viral infection in children: initial chest radiographic findings. Radiology. 2010; 254:934–941.

14. Webster RG, Bean WJ, Gorman OT, Chambers TM, Kawaoka Y. Evolution and ecology of influenza A viruses. Microbiol Rev. 1992; 56:152–179.

15. Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team. Dawood FS, Jain S, Finelli L, Shaw MW, Lindstrom S, et al. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med. 2009; 360:2605–2615.

16. Condon VR. Pneumonia in children. J Thorac Imaging. 1991; 6:31–44.

17. Wildin SR, Chonmaitree T, Swischuk LE. Roentgenographic features of common pediatric viral respiratory tract infections. Am J Dis Child. 1998; 142:43–46.

18. Griscom NT. Pneumonia in children and some of its variants. Radiology. 1988; 167:297–302.

19. Donnelly LF. Imaging in Immunocompetent children who have pneumonia. Radiol Clin N Am. 2005; 43:253–265.

20. Bramson RT, Griscom NT, Cleveland RH. Interpretation of chest radiographs in infants with cough and fever. Radiology. 2005; 236:22–29.

21. Aherne W, Bird T, Court SDM, Gardner PA, McQillin J. Pathological changes in virus infections of the lower respiratory tract in children. J Clin Path. 1970; 23:7–18.

22. Broughton RA. Infections due to Mycoplasma pneumonia in childhood. Pediatr Infect Dis. 1986; 5:71–85.

23. McCullers JA. Insights into the Interaction between influenza virus and pneumococcus. Clin Microbiol Rev. 2006; 19:571–582.