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The value of radiographic findings for the progression of pandemic 2009 influenza A/H1N1 virus infection

Takanori Funaki12, Kensuke Shoji2, Nobuyuki Yotani1, Tomohiro Katsuta24, Osamu Miyazaki3, Shunsuke Nosaka3, Hidekazu Masaki3 and Akihiko Saitoh25*

Author Affiliations

1 Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan

2 Department of Medical Subspecialties, Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan

3 Department of Radiology, National Center for Child Health and Development, Tokyo, Japan

4 Current address: Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa, Japan

5 Current address: Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

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BMC Infectious Diseases 2013, 13:516  doi:10.1186/1471-2334-13-516

Published: 4 November 2013



Most illnesses caused by pandemic influenza A (H1N1) pdm09 virus (A/H1N1) infection are acute and self-limiting among children. However, in some children, disease progression is rapid and may require hospitalization and transfer to a pediatric intensive care unit (PICU). We investigated factors associated with rapid disease progression among children admitted to hospital for A/H1N1 infection, particularly findings on initial chest radiographs.


In this retrospective study, we investigated the records of children who had received a laboratory or clinical diagnosis of A/H1N1 infection and were admitted to the largest children’s hospital in Japan between May 2009 and March 2010. The medical records were reviewed for age, underlying diseases, vital signs on admission, initial chest radiographic findings, and clinical outcomes. According to chest radiographic findings, patients were classified into 4 groups, as follows: [1] normal (n = 46), [2] hilar and/or peribronchial markings alone (n = 64), [3] consolidation (n = 64), and [4] other findings (n = 29). Factors associated with clinical outcomes were analyzed using logistic regression.


Two hundreds and three patients (median 6.8 years) were enrolled in this study. Fifteen percent (31/203) of patients were admitted to PICU. Among 31 patients, 39% (12/31) of patients required mechanical ventilation (MV). When the initial chest radiographic findings were compared between patients with consolidation (n = 64) and those without consolidation (n = 139), a higher percentage of patients with consolidation were admitted to PICU (29.7% vs.8.6%, P < 0.001) and required MV (17.2% vs. 0.7%, P < 0.001). These findings remain significant when the data were analyzed with the logistic regression (P < 0.001, P < 0.001, respectively).


Consolidation on initial chest radiographs was the most significant factor to predict clinical course of hospitalized children with the 2009 A/H1N1 infection.

Influenza; Chest; Children; Outcome