Otolaryngological Complications in Patients Infected with the Influenza A (H1N1) Virus

Objective. To describe bacterial upper respiratory infections in patients with influenza A (H1N1) virus during the 2009 pandemic. Study Design. Case series with chart review. Setting. May 17 to July 17, 2009, Clinica Las Condes, Santiago, Chile. Subjects and Methods. Patients with clinical and/or laboratory diagnosis of influenza A (H1N1) who presented to the emergency department or other medical specialists with bacterial upper respiratory infection requiring antibiotic treatment within 2 months of influenza diagnosis. Results. A total of 10,048 cases of influenza A (H1N1) were identified by the emergency department. All patients received oseltamivir. Fifty-four patients (0.55%) who presented with bacterial upper respiratory infection within 2 months after the diagnosis of influenza were selected. The median time to presentation with bacterial respiratory infection was 12 days. Median age was 12 years, and 51.8% were male. The most common bacterial upper respiratory infections were acute rhinosinusitis (46.4%; median age, 17 years), acute otitis media (33.9%; median age, 5 years), and pharyngotonsillitis (14.3%; median age, 17 years). Four patients were hospitalized: 3 with streptococcal tonsillitis with prolonged fever and 1 with acute otitis media who later developed pansinusitis and otomastoiditis. There were no deaths in this group of patients. Conclusion. There were few bacterial upper respiratory infections associated with influenza A (H1N1) (0.55%). The most common infections were acute otitis media in young children and acute rhinosinusitis and pharyngotonsillitis in young adults. These complications were more often seen during the 2 months following the influenza infection than at the time of diagnosis with influenza. Outcome was favorable for all patients.