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521 Unusual Presentation of Disseminated Pandemic Influenza a (H1N1) 2009 in an Infant
  1. P Suandork1,
  2. D Aranwutikul1,
  3. S Chaisuparassameekul1,
  4. A Thitithanyanont2,
  5. S Wiboon-ut2,
  6. P Kanrai2,
  7. S Worapongpaiboon3,
  8. S Hongeng4
  1. 1Department of Pediatrics, Bangkok Hospital, Bangkok Hospital Group
  2. 2Department of Microbiology, Faculty of Science, Mahidol University
  3. 3Department of Pathology, Samitivej Hospital
  4. 4Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand


Background Children are the risk group for severe disease of Pandemic influenza A (H1N1) 2009 infection. A case of disseminated manifestation of pandemic H1N1 influenza has been rarely reported.

Methods We present a case of a-3-month-old male infant who manifested with clinical sepsis and can be demonstrated the evidence of disseminated pandemic H1N1 influenza in bone marrow prior having respiratory symptoms.

Results The patient presented with high fever for 1 day. The initial diagnosis was sepsis but he had persisted fever with hepatosplenomegaly. Complete blood count persistently showed pancytopenia. Bone marrow aspiration and biopsy on day 8 showed predominant population of maturing myeloid precursors. In contrast, erythroid precursors were virtually absent. PCR tested in serum was negative for Epstein-Barr virus, cytomegalovirus, dengue virus and parvovirus. On day 11, he developed respiratory distress and required ventilator support. Bronchoalveolar lavage was positive for pandemic H1N1 influenza by both RT-PCR and viral culture. The staining marrow specimens performed on day 8 with immunofluorescence technique to detect nucleoprotein (NP) antigens and RT-PCR were positive for pandemic H1N1 influenza. The virus antigen was also detected by flow cytometry using monoclonal antibody specific for NP labeled with fluorescein isothiocyanate (FITC). Interestingly, most of positive cells were CD14+ cells and the amounts of positive cells were 10% of total marrow cells. His immunological profiles were normal.

Conclusion This infant demonstrated the evidence of disseminated pandemic H1N1 influenza prior having pneumonic symptoms. Infant is more susceptible to have disseminated manifestation and can present initially as clinical sepsis.

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