Source: Annual Congress 2011 - The new clinical spectrum of lung diseases: from bronchi to pleura

Abstract

Rationale: myalgia and weakness are complications in H1N1 Influenza severe pneumonia (H1N1 ISP). Myopathy and polyneuropathy has been described only in Influenza B. Muscle damage in H1N1 ISP, has not been studied yet.
Objetive: To evaluate physiological, morphological and metabolic characteristics in muscle biopsies from patients with severe muscular weakness after a H1N1 ISP
Case Report: After signed consent form 14 subjects with H1N1 ISP and muscular weakness were enrolled. Bilateral muscular strength (biceps and Quadriceps measured by electronic manometer) and electromyography and muscle biopsy (3-5 days after extubation) were performed.
Results:

General and Clinical characteristics

Age, years	Gender	CK > 360 UI/L	APACHE II	MV	Muscular Strengh, %p	EMG	Biopsy Alterations
37	M	Yes	10	Yes	38	SMP	M/N
25	M	Yes	16	Yes	0	SMP	M/N
28	F	No	11	Yes	0	SMP	M/N
51	F	Yes	14	Yes	0	MMN	M/N
52	F	No	14	Yes	0		M/N
39	F	Yes	22	Yes	0		M
39	M	Yes	9	Yes	56	SMP
40	F	No	11	Yes	0	SMP	M/N
56	M	No	17	Yes	0	SMP	M/N
55	M	Yes	20	Yes	0	SMP
54	F	No	13	Yes	0	SMP	M
30	F	Yes	15	No	109	SMP	M
72	F	Yes	19	Yes	0	SMP	M
34	M	No	11	Yes			M

M=male, F=female, CK=creatin kinase, APACHE=Acute Physiology and Chronic Health Evaluation, MV=mechanical ventilation, %p percentage predicted average of 4 muscles, EMG=electromyography, SMP=sensoriomotor polyneuropathy, MMN=multiple mononeuropathy, M/N=mixed pattern myopathy and neuropathy, M= myopathy (metabolic)

Conclusions: All patients with H1N1 ISP presented metabolic and physiological muscular alterations compatible with myopathy or myopathy/neuropathy. This findings explain the severe muscle symptoms and the low recovering even after discharge. An early physical rehabilitation program must be recommended.

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M. E. Dominguez Flores, M. Velazquez, R. J. Hernandez-Zenteno, F. Fernandez Valverde, S. Vargas Cañas, A. Ramirez-Venegas, J. L. Tellez Becerra, L. E. Payro, O. Baños, M. E. Vazquez, P. Ledezma (Mexico City, Mexico). Findings in peripheral biopsy muscle in severe pneumonia due to H1N1 influenza. Eur Respir J 2011; 38: Suppl. 55, 494

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