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In previous influenza pandemics, studies of autopsy specimens have shown that most deaths attributed to influenza A virus infection occurred concurrently with bacterial pneumonia (1), but such evidence has been lacking for 2009 pandemic influenza A (H1N1). CDC receives tissue specimens routinely from patients with confirmed or suspected infectious diseases and provides histopathologic, immunohistochemical, and molecular evaluations. Specimens were received from 77 patients who had 2009 pandemic influenza A (H1N1) virus infection confirmed before death (N = 41) or after death (N = 36). Of the 77 confirmed cases evaluated, 22 had histopathologic, immnohistochemical, and molecular evidence of coinfection with an identified bacteria, including 10 cases with S. Although the findings in this report confirm the presence of bacterial lung coinfection, the results cannot be used to assess the prevalence of bacterial pneumonia among patients who have died from pandemic H1N1. Medical examiners and coroners have an important role in the surveillance of deaths caused by the 2009 pandemic influenza A (H1N1) virus (8). The findings in this report also underscore the importance of managing patients with influenza who also might have bacterial pneumonia with both empiric antibacterial therapy and antiviral medications.†† In addition, public health departments should encourage the use of pneumococcal vaccine, seasonal influenza vaccine, and, when the vaccine becomes available, pandemic influenza A (H1N1) 2009 monovalent vaccine.
Alternative Text: The Figure above consists of two slides showing Streptococcus pneumoniae infection in a patient with confirmed pandemic H1N1 virus infection. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S.
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An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. El uso de esta pagina web esta sujeto a nuestras Condiciones de uso y las compras a nuestras Condiciones de venta. We have the largest print-on-demand fulfillment network in the world with 15 manufacturing centers in five different countries. If you can't find the answers to your question on our FAQ page, please submit a support ticket, and our staff will respond to your question(s) right away. Known as Burkholderia cenocepacia, the bacterium is resistant to nearly all known antibiotics and can contribute to lung infection in cystic fibrosis patients. The researchers found that a drug known as rapamycin can help cell survival in mice with cystic fibrosis, uncovering a possible treatment for the bacterial infection in cystic fibrosis patients. During the testing, the drug rapamycin did not have any effect on mice without cystic fibrosis, as they were capable of fighting off the infection on their own, but health improvements were seen in the mice with cystic fibrosis.
Antibiotics are the most common form of lung infection treatment in cystic fibrosis, either taken intravenously or in pill form. Nutrition and physiotherapy may also be utilized during treatment to improve overall health.
The key to successful treatment is early detection, so see your doctor right away if changes occur in your condition – or someone you know with cystic fibrosis.
Cystic fibrosis (CF) patients suffer from infection and inflammation, but exercise has been shown to help enhance quality of life. On any matter relating to your health or well-being, please check with an appropriate health professional. To help determine the role of bacterial coinfection in the current influenza pandemic, CDC examined postmortem lung specimens from patients with fatal cases of 2009 pandemic influenza A (H1N1) for bacterial causes of pneumonia. Fourteen of 18 patients with information available sought medical care while ill, and eight were hospitalized.

The cases in this report do not come from a systematic sample and might not be representative of all pandemic H1N1 deaths or all pandemic H1N1 deaths associated with bacterial pneumonia. Histopathologic techniques can assist with postmortem diagnosis of coinfections in patients in whom culture, antemortem or postmortem, does not detect bacteria.
Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness. Usefulness of immunohistochemical diagnosis of Streptococcus pneumoniae in formalin-fixed, paraffin-embedded specimens compared with culture and gram stain techniques. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009.
Hospitalized patients with novel influenza A (H1N1) virus infection---California, April--May, 2009.
Intensive-care patients with severe novel influenza A (H1N1) virus infection---Michigan, June 2009. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices (ACIP). Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). Histochemical and immunohistochemical diagnosis of Streptococcus pneumoniae infection in a patient with confirmed 2009 pandemic influenza A (H1N1). The bacterial infection can affect anyone, though it’s virtually harmless in the general population.
Cystic fibrosis (CF) is a condition that causes a buildup of mucus in lungs – as well as other parts of the body – making it difficult for a person to breathe. Lung infection treatment in cystic fibrosis is important to reduce the risk of mortality or any complication that may occur.
There are numerous benefits from exercise for overall good health, but more so for those with cystic fibrosis. Cystic fibrosis is a hereditary disease that causes the body to produce thick and sticky mucus that can clog the lungs and obstruct the pancreas. No statement herein is to be construed as a diagnosis, treatment, preventative, or cure for any disease, disorder or abnormal physical state.
During May 1--August 20, 2009, medical examiners and local and state health departments submitted specimens to CDC from 77 U.S.
All specimens were examined using hematoxylin and eosin stain, Lillie-Twort tissue Gram stain, and Warthin-Starry silver stain (Figure).
Of the seven hospitalized patients with information available, all required mechanical ventilation. Systematic research is needed to determine the incidence and outcome of bacterial lung coinfections among patients with pandemic H1N1 virus infection and to quantify the role of these infections in fatal cases. When autopsies are performed for patients with confirmed or suspected influenza who die after acute respiratory disease, a pathological evaluation of respiratory tissues should be conducted and should include testing for both viral and bacterial pathogens (8).
But now researchers are closer to understanding why it poses a higher risk in cystic fibrosis patients. The process is stronger in cystic fibrosis patients, leading to more serious complications. The statements herein have not been evaluated by the Foods and Drugs Administration or Health Canada. Tissue specimens also were evaluated by various immunohistochemical assays using antibodies that are specifically reactive with S.

Seven of nine patients with information available on antimicrobial therapy were treated with antibiotics. E Chmara, MD, Northern Region Medical Examiner Office; New Jersey Dept of Health and Senior Svcs. Because medical records and death certificates generally were not available, no conclusion could be drawn about whether the cause of death was influenza, bacterial infection, or both. Although no data were available on the vaccination status of the 22 patients, one patient was aged <5 years and was therefore a candidate for pneumococcal conjugate vaccine, and 15 others had underlying medical conditions that were indications for PPSV23 vaccine (9,10). The disease either progresses with propagation of inflammation and chronic destruction of lung tissue, or acute infection with severe sepsis that occurs very quickly. This report summarizes the demographic and clinical findings from these cases and the laboratory evaluation of the specimens. However, two early reviews of severe cases of 2009 pandemic influenza A (H1N1) showed no evidence of bacterial pneumonia among 30 hospitalized patients with laboratory-confirmed cases in California (5) and 10 intensive-care patients in Michigan (6). Third, because assessments of bacterial coinfections were conducted at autopsy, inadequate sampling, collection of specimens from unaffected portions of the lung, or prolonged illness and treatment before death might have prevented identification of bacteria. Persons at greatest risk for invasive pneumococcal disease include young children, older adults, and persons of any age with certain conditions, including chronic lung or cardiovascular disease and immunosuppressive conditions. Evidence of concurrent bacterial infection was found in specimens from 22 (29%) of the 77 patients, including 10 caused by Streptococcus pneumoniae (pneumococcus). All bacteria were evaluated by a broad-range PCR assay that targets a segment of the 16S ribosomal DNA gene in DNA extracted from formalin-fixed, paraffin-embedded tissue (2).
These reports might have led to a perception that bacterial coinfections are playing a limited role or no role in influenza deaths during the current pandemic. All children aged <5 years should receive pneumococcal conjugate vaccine according to current Advisory Committee on Immunization Practices (ACIP) recommendations (9). The cases were reported from eight states: California, Hawaii, Illinois, New Jersey, New York, Texas, Utah, and Virginia. However, failure to document bacterial lung infections might reflect the difficulty of establishing specific bacterial diagnoses among persons with bacterial coinfections. In addition, PPSV23 is recommended for all persons aged 2--64 years with certain health conditions and all persons aged ?65 years.¶ Available vaccination coverage data indicate that only a small proportion of persons aged 2--64 years in the United States who are recommended by ACIP to receive pneumococcal vaccine have received the vaccine.
Fourteen of 18 patients for whom information was available sought medical care while ill, and eight (44%) were hospitalized. C DiAngelo, MD, Northern District Office of the Chief Medical Examiner, Virginia; Virginia Dept of Health.
Routine clinical tests used to identify bacterial infections among patients with pneumonia do not detect many of these infections. These findings confirm that bacterial lung infections are occurring among patients with fatal cases of 2009 pandemic influenza A (H1N1) and underscore both the importance of pneumococcal vaccination for persons at increased risk for pneumococcal pneumonia and the need for early recognition of bacterial pneumonia in persons with influenza. Histopathologic evaluation and testing of lung tissue, especially using PCR and immunochemistry methods, can detect many bacterial lung infections missed by standard clinical methods (2).
The findings in this report indicate that, as during previous influenza pandemics, bacterial pneumonia is contributing to deaths associated with pandemic H1N1 and that histopathologic methods can be used to identify bacterial coinfections after death.

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