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It is worth emphasizing the importance of obtaining a broncho-
alveolar sample when testing patients with suspected swine flu on the
Intensive Care Unit. A 41 year old man was admitted to our Intensive Care
Unit with pneumonia following a 10 day history of worsening respiratory
symptoms. He had a background history of asthma. Nose and throat swabs for
H1N1v PCR taken on day of admission to the unit were negative.
Oseltamivir, which had been started on the day of admission, was then
stopped. A blind broncho-alveolar lavage taken the day after admission
subsequently came back positive for H1N1v by PCR and oseltamivir was
restarted. Broncho-alveolar lavage was repeated 9 days after admission and
was still positive for H1N1v RNA by PCR. A negative sample was eventually
obtained 15 days after admission to the Intensive Care Unit.
If you have a patient who requires ventilation for suspected swine
flu get a deep sample from the lungs and don't rely on the routine nose
and throat PCR swabs to rule out the diagnosis.
No competing interests
09 November 2009
Consultant in Anaesthesia and Intensive Care Medicine