Study on the pulmonary microvascular thromboembolism associated with severe influenza virus infection in the elderly

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Influenza has been a significant and highly contagious disease of global importance for a long time. We recruited 18 elderly patients (mean age, 78.6, range 69-91 years) with high grade fever (more than 38.5℃) general fatigue and hypoxemia during flu seasons from January 2001 to March 2003 in our university hospital. Among those subjects. 11 patients (7 male) were dignosed as having influenza A (H3N2) virus infection by influenza diagnosing kit. In 5 out of 11 influenza patients, serum D-dimer (mean. 482 ng/ml vs 215 ng/ml) and exaled CO concentrations (mean. 7.2 ppm vs 1.6 ppm) were significantly higher compared with the remained 6 patients, respectively. In 4 out of 5 patients, pulmonary perfusion scan revealed multiple nodular defects in the bilateral lungs (figure). Pulmonary microvascular thromboembolism was diagnosed and three patients who agreed to receive heparin and urokinase therapy survived finally. However, one patient who disagreed to anti-coagulant therapy died with acute severe respiratory fai lure. These results suggest that pulmonary microthromboemboli is an important complication of influenza A virus infection and prompt diagnosis is essential to save the patients from acute death associated with influenza.