Pandemic influenza A (H1N1) 2009: chest radiographic findings from 147 proven cases in the Montreal area

Abstract

Objective: To describe chest radiographic findings in patients with isolated and complicated acute novel influenza A (H1N1) virus infection.

Methods: Retrospective study of 147 patients (64 men, mean age 41) with reverse-transcriptase polymerase chain reaction confirmed acute influenza A (H1N1) infection, who also had a chest radiograph <72 hours of viral specimen collection. Radiographs were analysed for acute findings. A correlation with bacterial cultures results was performed. The unpaired 2-sample equal-variance Student t test was applied to continuous variables and the Pearson χ(2) test of association to discrete variables.

Results: In 71% of cases, chest radiograph was normal. The presence of acute imaging findings was associated with older age (P < .05), increased number of comorbidities (most commonly, chronic obstructive pulmonary disease, diabetes, asthma) (P < .05), higher rate of hospitalization (P < .05) and intensive care unit admission, and increased mortality. Predominant acute radiographic finding in isolated influenza A (H1N1) was alveolar opacity (88%), either unifocal or multifocal, most often in the lower lobes. In the subgroup of patients with positive imaging findings and for whom nonviral microbiologic data was available, 62% had superimposed bacterial or fungal infection.

Conclusion: In the majority of patients with acute influenza A (H1N1) infection, the chest radiograph is normal. Acute imaging findings are associated with older age, an increased number of comorbidities, and a higher rate of complications and mortality. The predominant radiographic finding of isolated primary influenza A (H1N1) infection is alveolar opacity. Superimposed bacterial infection is frequent and must be excluded in patients with abnormal imaging.