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1/12. Hemolytic uremic syndrome associated with influenza a virus infection in an adult renal allograft recipient: case report and review of the literature.

    Hemolytic uremic syndrome (HUS) is a rare but serious complication following renal transplantation. It usually develops early after transplantation, and ciclosporin treatment is the most common triggering factor. We report the case of a 35-year-old male with posttransplant HUS which developed 1 year after renal transplantation. He became febrile 4 days before the onset of HUS, and the significant rise in viral titer confirmed the diagnosis of influenza a virus infection. The association of ciclosporin treatment with HUS was unlikely, because of the late onset of HUS and the low ciclosporin trough levels. The patient was treated successfully without a dose reduction of ciclosporin. An etiologic relationship between influenza a virus and HUS was highly probable in our patient. We also review a total of 156 adult cases with HUS after renal transplantation described in the literature. The prognosis of posttransplant HUS differs according to the cause. The advent of ciclosporin has improved the graft survival rate and mortality of patients with rejection-induced HUS.
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2/12. Influenza-induced rhabdomyolysis after autologous peripheral blood stem cell transplantation for malignant lymphoma.

    We report influenza-induced rhabodmyolysis and congestive heart failure after high-dose therapy and hematopoietic stem cell transplantation for malignant lymphoma. Four months after autologous peripheral blood stem cell transplantation for the treatment of malignant lymphoma, a 65-year-old Japanese man developed acute congestive heart failure requiring artificial ventilation and rahbdomyolysis. Since influenza a virus was documented from his nasal cavity, he was diagnosed as rhabdomyolysis and congestive heart failure induced by influenza A infection. neuraminidase inhibitor (oseltamivir 150 mg/ day for 5 days) was administrated, and heart failure and respiratory status were improved. Our experience suggests that early treatment with neuraminidase inhibitor may improve the clinical outcome of influenza-induced rhabdomyolysis and congestive heart failure.
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3/12. Severe influenza B myocarditis and myositis.

    OBJECTIVE: To report an influenza B infection with associated myocarditis and severe skeletal myositis. DESIGN: Case report. SETTING: Cardiac intensive care unit in a university-affiliated children's hospital. PATIENT: A 4-yr-old girl. RESULTS: The patient was successfully supported with extracorporeal membrane oxygenation for profound myocardial dysfunction and a combination of plasmapheresis and continuous venovenous hemodialysis for rhabdomyolysis and acute renal failure. CONCLUSIONS: This case provides a reminder that patients presenting with viral illness or myoglobinuria accompanied by renal failure, with or without associated myocarditis, may be demonstrating symptoms of influenza B.
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4/12. influenza b virus associated pneumonia: report of one case.

    influenza a virus is a more common cause of pneumonia than influenza b virus. Influenza virus pneumonia complicated with acute respiratory distress syndrome (ARDS) is rare and has a high mortality rate. In addition to pneumonia, influenza occasionally causes neurologic, cardiac, renal, or muscular complications. Hepatic involvement in influenza virus infection has been rarely reported. We reported the case of a 7-year-old girl who was initially treated for upper respiratory tract infection, but she was transferred to the pediatric intensive care unit for intubation and ventilation after her condition deteriorated to lobar pneumonia with ARDS and liver function impairment within 7 days. Influenza B virus infection was confirmed by virus culture and serological study. Respiratory viruses, such as respiratory syncytial virus, adenovirus, influenza virus, and parainfluenza virus, are common causes of pneumonia in children; moreover, they should be considered especially in the presence of persistent leukopenia, low CRP value, lack of growth of bacterial cultures, and poor response to antimicrobial therapy. We should describe its course, diagnosis, and treatments in detail; furthermore, we reported this case to emphasize that influenza b virus may cause transient liver dysfunction and it is an etiology of pneumonia as well as ARDS.
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5/12. Respiratory syncytial virus and heart disease. A report of two cases.

    Two patients had cardiac disease and serological evidence for respiratory syncytial virus (RSV) infection. The first patient had myocarditis and complete atrioventricular heart block with repeated syncopal episodes two weeks following infection. The second patient had alcoholic cardiomyopathy and worsening congestive heart failure associated with RSV infection. The significance of RSV infection in these two patients may bear a significant relationship to sudden infant death syndrome, chronic cardiomyopathy, and alcohol-related heart disease. Cardiac disease secondary to RSV infection may be more prevalent than is presently recognized.
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6/12. swine influenza virus infections. Transmission from ill pigs to humans at a wisconsin agricultural fair and subsequent probable person-to-person transmission.

    In September 1988, a previously healthy 32-year-old pregnant woman was hospitalized for pneumonia and died 8 days later. The only pathogen detected was an influenza virus antigenically related to the swine influenza virus (SIV). Four days before illness onset, the patient visited a county fair swine exhibition where there was widespread influenzalike illness among the swine. To detect other persons who were possibly infected by contact with the ill swine, we measured serum SIV hemagglutination-inhibition antibody titer in 25 swine exhibitors who were 9 to 19 years old. Nineteen (76%) had SIV hemagglutination-inhibition titers of 20 or greater. Antibody was undetectable in serum samples from 25 swine exhibitors from a neighboring county. Additional studies suggest that one to three health care personnel who had contact with the patient developed influenzalike illnesses with laboratory evidence of SIV infection. An outbreak of apparent SIV infection in swine resulted in multiple human infections, and, although no recognized community outbreak resulted, there was evidence of virus transmission from the patient to health care personnel.
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7/12. Fatal swine influenza pneumonia during late pregnancy.

    Serious morbidity or death from swine influenza infection is unusual in the immunocompetent host. We present a fatal case of pneumonia caused by this virus in a previously healthy 32-year-old woman during her third trimester of pregnancy, and review all published case reports of swine influenza in united states civilians. pregnancy may be a predisposing factor to fulminant infection with swine influenza virus.
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8/12. Influenza A and rhabdomyolysis.

    A case of influenza A H3N2 resulting in unusually severe rhabdomyolysis and myoglobinuria is described. Although a rare complication of viral infection, prompt treatment with intravenous fluids can prevent the serious complications which may follow.
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9/12. influenza a virus associated with acute encephalopathy.

    During the period of February 1972 until February 1976, we documented six cases of influenza A-associated acute encephalopathy. The illnesses occurred during periods of influenza A activity in our community. The encephalopathy was invariably preceded by an upper respiratory tract infection, and, thereafter, patients soon became confused, vomited, and showed noticeable restlessness. patients then followed either of two courses, some becoming comatose within 24 hours and others improving rapidly within three days or less. None of these patients exhibited the hepatic and biochemical abnormalities associated with Reye's syndrome. All patients survived but some had sequelae. The syndrome of influenza-associated acute encephalopathy deserves wider recognition.
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10/12. Sporadic occurrence of zoonotic swine influenza virus infections.

    Two infections by swine influenza virus, antigenically similar to A/new jersey/76 (H1N1) virus, were detected during community epidemics with other influenza viruses. The swinelike viruses were obtained during virological surveillance of acute respiratory illnesses, and the clinical symptoms of these two patients were similar to those caused by other respiratory viruses. Both patients reported contact with swine a few days before onset of illness, but in one case it was brief. Serological studies suggested that one patient may have transmitted the virus to his roommate, but spread into the community was not indicated.
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