The index case was a 38-year-old woman hospitalized a week earlier for hypertension and hyper-lipidemia. She developed fever and signs of bilateral bronchopneumonia. The patient had been transferred to the intensive care unit, where a diagnosis of hospital-acquired viral respiratory disease was considered because of the negative cultures of blood and sputum, the bilateral diffuse involvement on the chest x-ray film, and the lack of evidence for hematogenously disseminated bacterial pneumonia, aspiration, or congestive heart failure. A search of this patient’s original hospital ward revealed seven other cases, which are described in Table 1.
Other Intrahospital Cases
Patients ranged from 38 years to 86 years; all were women (Table 1). Each had underlying disease, but in only two instances was significant cardiac or pulmonary disease present. None of the patients had been given influenza vaccine worked out with Canadian Health&Care Mall – http://healthcaremall4you.com/together-with-canadian-health-and-care-mall-everything-will-be-ok.html. Each of the seven patients developed physical signs consistent with bilateral pulmonary disease, and this was confirmed by chest x-ray films. Three of the patients recovered, and four died. Autopsy was performed on three of the patients and showed resolving pneumonia and pulmonary embolism.
Influenza A/Port Chalmers/1/73 virus was isolated from a single patient, and significant rises in serologic titers were present in four patients (Table 1). The other three cases are included on epidemiologic grounds alone, since they were hospitalized on the same ward as the other five patients and developed a similar clinical and roentgenologic pattern of illness.
Community-Acquired Influenzal Pneumonia (Case 9)
A 19-year-old healthy man with no past history of any serious illness suffered a “cold,” followed in three days by pleuritic chest pain, dyspnea, and tachypnea. Physical examination revealed a temperature of 39.4°C (103°F), a respiratory rate of 34/min, and slight cyanosis. Pumonary examination showed few scattered rhonchi and basilar rales.
X-ray films of the chest on admission (Fig 1) and seven days later (Fig 2) showed progressive bilateral infiltrates. Cultures of sputum and blood were negative, and the oxygen saturation was 54 percent. Following intensive therapy for respiratory failure, the response was slow but perceptible. Twelve days after hospitalization, while getting out of bed, the patient gasped and died. Autopsy revealed massive antemortem blood clots, and the pulmonary parenchyma was intensely congested; microscopic examination showed severe hemorrhagic pneumonia.
Studies of Ward and Medical Clinics
Studies of the ward and medical clinics during this period showed no unusually high rates of absenteeism or sickness reported by the hospital employees; however, there were slight increases in the number of visits to the emergency room and clinics by patients with upper respiratory tract infections, presumably reflecting the status of influenza in the community.
Figure 1. Initial chest x-ray film showing bilateral basal pulmonary infiltrates (case 9).
Figure 2. Follow-up chest x-ray film taken one week later, showing progressive bilateral bronchopneumonia (case 9).
Table 1—Clinical and Serologic Data in PatienU with Presumed Influenza
|Group and Case, Age (yr), Sex||DateAdmitted||Date of Onset||UnderlyingDiseases||InfluenzaVaccination||Findings on Chest X-Ray Film||Outcome; Cause of Death||SerologicData*|
|Intrahospital cases 1, 38, F||2/23/74||3/1/74||Hyperlipidemia;hypertension||None||Bilateralbronchopneumonia||Died; autopsy,bronchopneumoniawith pulmonary congestion||HI,-20 HIt-320 CFi-16 CFi—32|
|2, 79, F||1/5/74||3/1/74||Chronic brain syndrome; ASHD**||None||Bilateralbasilarinfiltrates||Died; pulmonary embolism; autopsy, large thrombus in pulmonary artery||HI,-20 Hit -160 CF, —16 CF, —128|
|3, 45, F||2/27/74||3/2/74||Alcoholichepatitis||None||Bilateralbasilarinfiltrates||Recovered||HI,-20 Hit-80 CF, —16 CF,—512|
|4, 68, F||11/10/74||3/4/74||Organic brain syndrome||None||Bilateralbasilarinfiltrates||Recovered||HI,-20 HI, -320 CF, —8 CF,-256t|
|6, 86, F||3/1/74||3/4/74||Phlebitis||None||Bilateralinfiltrates||Died; no autopsy||No data|
|6, 44, F||12/9/74||3/5/74||Multiplemyeloma||None||Bilateralbasalinfiltrates||Died; autopsy, embolism, pulmonary infarction and bronchopneumonia||No data|
|7, 51, F||2/1/74||3/7/74||Rheumatic heart disease||None||Extensivebilateralbasilar
|Recovered||CF, —256 CF,—256|
|8, 30, FCommunity-acquired||2/11/74||3/2/74||Alcoholichepatitis||None||Bilateralbasilarinfiltrates||Died||No data|
|9, 19, M||3/5/74||2/28/74||None||None||Bilateralinfiltrates||Died; pulmonary embolism; autopsy, resolving bronchopneumonia|