Co-infection of Influenza B and Streptococci causing severe pneumonia and septic shock in healthy women

BMC Infectious Diseases

Table 1 Characteristics of three previously healthy patients with primary Influenza B infection, severe bacterial pneumonia and septic shock

Characteristic	Patient 1	Patient 2	Patient 3
Date of admission	February 2008	March 2008	March 2008
Days of hospitalization	56	18	26
Age (years)	40	27	61
Co-morbidities	None	None	Osteoporosis
Septic shock *
Tachycardia (beats/min)	160	120	110
Tachypnoea (rate/min)	40	45	30
Hypotension	Yes	Yes	Yes
Fever (°C)	40	39	39
Leukocyte count (×10S9/l)	2.96	12.4	14.2
Microbiology
Initially isolated bacteria	S. pyogenes^†	S. pyogenes^†	S. pneumoniae^‡
Influenza B RT-PCR ^§	Positive	Positive	Positive
Influenza A RT-PCR ^§	Negative	Negative	Negative
Initial therapy	Piperacillin/Tazobactam	Amoxicillin/clavulanic acid plus Clarithromycin	Ceftriaxon plus Clarithromycin
Final therapy	Penicllin plus	Penicillin plus	Vancomycin plus
	Oseltamivir	Oseltamivir	Oseltamivir
Laboratory findings ^\|\|
CRP (mg/l)	507	445	329
PCT (ng/ml)	203	113	3.71
Arterial blood gas ^\|\|
pH	7.19	7.28	7.45
paO2 (kPa)	8.7	9.72	6.59
paCO2 (kPa)	8.9	4.84	4.95
BE	-4.6	-8.8	2.5
Lactate (mmol/l)	1.4	5.1	2.5
Death on day	-	18	-

* Defined as patients showing all of following abnormal findings: tachycardia, tachypnoe, fever, leukocytosis or -penia and hypotension. Data printed are from the time of admission.
^† Results from bronchoalveolar lavage and blood cultures.
^‡ Result from urine pneumococcal antigen test.
^§ Real-time quantitative PCR from tracheal aspirate detecting Influenza A and B in separate reactions confirmed in at least two separate exams.
^|| Values showing the greatest deviation from normal during the first two days after admission. All blood gas data were obtained while applying high flow oxygen through a non re-breathing mask.

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