Pandemic Influenza A (H1N1) in Critically Ill Pediatric Patients. Clinician Outreach and Communication Activity (COCA) Conference Call . October 21, 2009. Continuing Education Disclaimer.
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Clinician Outreach and Communication Activity (COCA) Conference Call
October 21, 2009
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H1-N1 influenza virus confirmed by pre- and postmortem PCR Hemorrhagic necrosis involving both lungs, acute inflammation
Focal areas of hyaline membrane, suggestive of ARDS
Scattered basophilic structures suspicious for viral inclusions
MRSA positive in the postmortem lung tissue cultures and premortem blood culture
Aspergillusfumigatus, right lung and left pleural fluid
Bone marrow with rare MRSA
Multi-organ system failure with associated areas of necrosis involving lungs, liver, spleen, and adrenal glands
CDC/HHS-ASPR Clinical Call on Severe Pediatric H1N1 Infections
21 October 2009
9/24 in the evening: not feeling well, only specific complain was sore throat
9/25 at 7am 102.7ºF. Now with cough. Given ibuprofen and cough medication .At 8:30pm abdominal pain. At 10:30pm shaking, fever 104ºF. Vomited 3 times. Unable too walk, and crying with generalized pain. Profuse watery diarrhea. Intermittently unresponsive.
Driscoll Children’s Hospital ER: 104.8ºF, received I.V. boluses. Admitted but shortly after arrival with profuse watery diarrhea in bed. Less responsive.
PICU: Head CT Scan followed by brain MRI and MRA. Required intubation before imaging studies.
Rapid Influenza A test +
Received oseltamivir 75mg q 12h and acyclovir
Past medical history: febrile seizure at 9 months of age and tympanostomy tube placement at 8 years of age. IUTD.
Family history; Mother 39 years old with hypothyroidism and hypertension, father 40 years old an healthy. Brother 18 years old and healthy
Corpus Christi, TX
No recent illness at home
School: 6th grade. Several children sick with ILI.
Played soccer on 9/18. Parents remember there were many mosquitoes that evening
On conventional mechanical ventilation
HR:58, RR 12, O2Sat 100%, BP 106/52
No exanthem or enanthem
Lungs: CTA Heart: RRR
Abdomen: Soft. No visceromagaly
Influenza A antigen +
WBCs:5,400. 4b, 66s, 27 l, HgB:14gm/dl, Plts:213,000
Bun 15mg/dl, Cr1.3 mg/dl
SGOT 79, SGPO 46
T.Protein 5.4 mg/dl, albumin 3,1 gm/dl
PT;16.1secs, PTT 42 secs.
Blood, CSF and Urine cultures, all no growth for bacteria.
Protein: 192 mg/dl
RT-PCR + Influenza A, H1 and H3 negative. (local health department confirmed in second sample swine origin H1N1)
ETT culture: Influenza A and Parainfluenza 3Laboratories
9/28/09 ( 1 day before death)
Continuing Education Credit/Contact Hours for COCA Conference Calls
Continuing Education guidelines require that the attendance of all who participate in COCA Conference Calls be properly documented. ALL Continuing Education credits/contact hours (CME, CNE, CEU and CECH) for COCA Conference Calls are issued online through the CDC Training & Continuing Education Online system http://www2a.cdc.gov/TCEOnline/.
Those who participate in the COCA Conference Calls and who wish to receive CE credit/contact hours and will complete the online evaluation by November 20, 2009 will use the course code EC1265. Those who wish to receive CE credits/contact hours and will complete the online evaluation between November 21, 2009 and October 21, 2010 will use course code WD1265. CE certificates can be printed immediately upon completion of your online evaluation. A cumulative transcript of all CDC/ATSDR CE’s obtained through the CDC Training & Continuing Education Online System will be maintained for each user.