NFLUENZA A H1N1PDM WITH PNEUMONIA IN ELDERLY PERSONS
Research objective is to study clinical progression of inﬂ uenza A (H1N1), inﬂ uenzal pneumonia, pathomorphological pulmonary changes in the lungs in elderly persons. There were 36 patients with inﬂ uenza A (H1N1) aged 60-84 years (24 men, women-12) under observation. Inﬂ uenza with pneumonia was diagnosed in 24 diseased (66.7 %). In 33.3 % the diagnosis of inﬂ uenza А (H1N1) was conﬁ rmed with viral serology testing (hemagglutination-inhibition test), in 63.9 % - with polymerase chain reaction diagnostics, including in 87.5 % of deceased patients. During 5 years prior to the disease there was no history of inﬂ uenza vaccination in all patients. On the 5th-9th sick day 66.7 % of the diseased were hospitalized, 1 female patient (2.8 %) was admitted to the department in 2 week after the disease onset. Apparent intoxication syndrome was observed from the ﬁ rst day of the disease in 41.7% of patients with uncomplicated inﬂ uenza. The duration of fever was 8.7±2.6 days. All elderly patients with uncomplicated inﬂ uenza recovered. Inﬂ uenza complicated by pneumonia was diagnosed in 24 diseased (66.7 %). In 36.1 % of patients pneumonia was total or subtotal, complicated by respiratory failure of II-III degree of severity. Patients suffering from inﬂ uenza and inﬂ uenzal pneumonia did not receive antiviral treatment with oseltamyvirum (Tamiﬂ u) due to the lack of this medicinal product in the pharmacy network under the conditions of the local armed conﬂ ict. Antibacterial therapy included intravenous administration of meropenum, protected 3rd generation cephalosporins, respiratory ﬂ uoroquinolones, macrolides in usual dosages. Oxygen therapy was an indispensable condition for the complex treatment of patients with inﬂ uenzal pneumonia via a facemask, airtight reservoir bag mask, airtight positive end-expiratory pressure support mask («PEEP»), non-invasive ventilation. Pathogenetic therapy included a restrictive type of infusion therapy, focused on relief of pulmonary edema and respiratory distress syndrome, correction of anemia, blood pressure and glucose levels, and administration of bronchial mucolytics. Sixteen of 36 elderly patients with inﬂ uenzal pneumonia died (case fatality rate made 44.4 %). Inﬂ uenzal pneumonia mortality in elderly persons within the area of the local armed conﬂ ict was characterized by a high rate due to late presentation, as well as the presence of severe chronic background diseases.