Severe novel influenza A (H1N1) infection in cancer patients

Hajjar, L. A.; Mauad, T.; Galas, F. R. B. G.; Kumar, A.; da Silva, L. F. F.; Dolhnikoff, M.; Trielli, T.; Almeida, J. P.; Borsato, M. R. L.; Abdalla, E.; Pierrot, L.; Kalil Filho, R.; Auler, J. O. C.; Saldiva, P. H. N.; Hoff, P. M.

Kharfan-Dabaja et al. [14] first reported H1N1 infection in two allogeneic hematopoietic cell transplantation recipients. In one case, the patient presented with fever, myalgia, sore throat and diarrhea without evidence of hypoxemia or lung progressive infiltrates. After treatment with oseltamivir, ciprofloxacin and doxycicline, the symptoms resolved without sequelae. In the second case, pulmonary symptomatology continued to deteriorate despite aggressive polymicrobial treatment, requiring mechanical ventilation and ultimately the patient died from respiratory failure [14] . Redelman-Sidi et al. [8] recently described 45 patients with cancer and/or hematological conditions and H1N1 infection at the Memorial Sloan-Kettering Cancer Center, with no reports of mortality or serious morbidities. In this report, only one patient was admitted in the ICU and did not need mechanical ventilation. In these patients with cancer, mortality was very high. The differences in outcomes may be related to specific characteristics of our population, including high prevalence of metastatic disease, comorbidities and high incidence of bacterial coinfection. Differently from the MSKCC experience [8] , most patients in our series initially presented with signs and symptoms of lung disease-hypoxemia, dyspnea and tachypnea-instead of only influenza symptoms.