• Raluca Vasilica MIHAI Infectious Diseases Clinical Hospital, Constanta, Romania
  • Diana BADIU Infectious Diseases Clinical Hospital, Constanta, Romania
  • L.C. PETCU “Ovidius” University, Constanta, Romania
  • Ema GHEORGHE “Ovidius” University, Constanta, Romania
  • Paraschiva POSTOLACHE “Grigore T. Popa” University of Medicine and Pharmacy Iasi


The objective of this study was to identify clinical and paraclinical characteristics along with risk factors in patients with influenza A and B virus infection. Material and methods: This retrospective study included children diagnosed with influenza, admitted to the pediatric department of Constanta Infectious Diseases Clinical Hospital, from Romania, during the 2015-2019 influenza cold seasons. Data regarding clinical characteristics, laboratory tests (fibrinogen, white blood cells (WBC), hemoglobin (Hb), platelets (PLT), erythrocyte sedimentation rate (ESR), creatine-kinase (CK), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and C-reactive protein (CRP), and management were collected. Results: Over the study period, 265 patients with influenza A and 83 patients with influenza B were investigated. The mean age of patients with influenza A was higher than of patients with influenza B (6.48 vs 5.9 years). It has been showed that cough was statistically different in both types (p=0.0094). The same statistically significant values were seen for rhinorrhea (p=0.0035), vomiting/nausea (p=0.0362), dyspnea (p=0.0449), myalgias (p=0.0412) and pneumonia (p=0.0077). At admission, the laboratory tests showed higher values of fibrinogen in A influenza and higher values of WBCs in B influenza. Hemoglobin, PLT, CK, and AST shows a significant difference for B influenza (p<0.001). In contrast, CRP shows significant differences of values for A influenza (p=0.001). Moreover, the early antiviral treatment was almost similar for both influenzas early from the onset (p=0.0418). Conclusions: Although we have found the predominance of clinical characteristics and non-specific inflammation markers as risk factors in patients with influenza A virus, the predisposing to influenza B should be paid also attention. This information’s should be used in order to optimize its utilization for early effective and preventive management strategies in pediatric population.

Author Biographies

L.C. PETCU, “Ovidius” University, Constanta, Romania

Faculty of Dentistry
Biostatistics Department

Ema GHEORGHE, “Ovidius” University, Constanta, Romania

Faculty of Dentistry
Department 2, Preclinical Disciplines II

Paraschiva POSTOLACHE, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (I)
Clinical Rehabilitation Hospital, Pulmonary Rehabilitation Clinic, Iasi


1. Bouvier NM, Palese P. The Biology of influenza viruses. Vaccine 2008; 28(4): D49-D53.
2. Taubenberger JK, Morens DM. The Pathology of Influenza Virus Infections. Annu Rev Pathol 2008; 3: 499-522.
3. Taubenberger JK, Kash JC, Morens DM. The 1918 influenza pandemic: 100 years of questions answered and unanswered, Science Translational Medicine 2019; 11(502): Article ID eaau5485.
4. Paules C, Dubbarao K. Influenza. Lancet 2017; 390(10095): 697-708.
5. Ruf BR, Knuf M. The burden of seasonal and pandemic influenza in infants and children. Eur J Pediatr 2014; 173: 265-276.
6. Fraaij PL, Heillinen T. Seasonal influenza: the burden of disease in children. Vaccine 2011; 29: 7524-7528.
7. Taubenberger JK, Morens DM. The pathology of influenza virus infections. Annual Review of Pathology: Mechanisms of Disease 2008; 3(1): 499-522.
8. Simmerman JM, Chittaganpitch M, Levy J, et al. Incidence, seasonality and mortality associated with influenza pneumonia in Thailand: 2005-2008. PloS One 2009; 4(11): Article ID e7776.
9. Dawwod FS, Fiore A, Kamimoto L, et al. Burden of seasonal influenza hospitalization in children, United States, 2003 to 2008, The Journal of Pediatrics 2010; 157(5): 808-814.
10. Silvennoinen H, Peltola V, Lehtinen P, Vainionpaa R, Heikkinen T. Clinical presentation of influenza in unselected children treated as outpatients. Pediatr Infect Dis J 2009; 28(5): 372-375.
11. Kim HW, Brandt CD, Arrobio JO, Murphy B, Chanock RM, Parrott RH. Influenza A and B virus infection in infants and young children during the years 1957-1976. Am J Epidemiol 1979; 109(4): 464-479.
12. Silvennoinen H, Huusko T, Vuorinen T, Keikkinen T. Comparative burden of influenza A/H1N1, A/H3N2 and B infections in children treated as outpatients. Pediatr Infect Dis J 2015; 34(10): 1081-1085.
13. Mosnier A, Caini S, Daviaud I, et al. Clinical characteristics are similar across type A and B influenza virus infections. PLoS One 2015; 10(9): e0136186.
14. Tran D, Vaudry W, Moore D, et al. Hospitalization for influenza A versus B. Pediatrics 2016; 138(3): e20154643.
15. Centers for Disease Control and Prevention. People at high risk for flu complications. Available from: http://www.cdc.gov/flu/highrisk/index.htm.
16. Cambrea S, Iancu A, Postolache P, Arghir O. Outbreaks of A H1N1 virus infection during two influenza consecutive seasonal epidemics in children from South-Eastern part of Romania: 2014-2016. CHEST 2016; 150(4), Supplement (S): 967A-967A.
17. Cambrea SC, Halichidis S, Mihai CM, Carp DS, Stoicescu RM, Arghir OC. Environmental risk factors for Influenza AH1N1 among children in South-East Romania. J Environ Prot Ecol 2013; 14(3): 1132-1139.
18. Cambrea SC, Petcu CL, Iliescu DM. Relations of environmental factors and evolution of Bou-tonneusse fever in the county of Constanta - Romania. J Environ Prot Ecol 2018; 19(2): 914-922.
19. Chaves SS, Aragon D, Bennett N, et al. Patients hospitalized with laboratory-confirmed influenza during the 2010- 2011 influenza season: exploring disease severity by virus type and subtype. J Infect Dis 2013; 208(8): 1305-1314.
20. Paul Glezen W, Schmier JK, Kuehn CM, Ryan KJ. Oxford J. The burden of influenza B: a structured literature review. Am J Public Health 2013; 103(3): e43-51.
21. Chen R, Holmes EC. The evolutionary dynamics of human influenza B virus. J Mol Evol 2008; 66(6): 655-663.
22. Shang M, Blanton L, Brammer L, et al. Influenza-associated pediatric deaths in the United States, 2010-2016. Pediatrics 2018; 141(4): pii: e20172918.
23. Halichidis S., Balasa AL, Ionescu EV, Iliescu MG, Cambrea SC, Petcu LC, Mihai CM Evolution of Salmonellosis in Constanta area in correlation with environmental factors. J Environ Prot Ecol 2019; 20(3): 1496-1504.
24. Cambrea SC, Arghir OC, Rascu A, Petcu CL. Biochemical features of an acute viral hepatitis A outbreak. Revista de Chimie 2018; 69(6): 1447.
25. Diaconu S, Cambrea SC, Petcu LC, Rugină S. Aspects of nosocomial gastroenteritis with rotavirus in children hospitalized in Constanta - Romania. Acta Medica Mediterranea 2017; 33(Special Issue 2): 1289-1293.
26. Li-Kim-Moy J, Yin JK, Blyth CC, et al. Influenza hospitalizations in Australian children. Epidemiol Infect 2017; 145: 1451-1460.
27. Bhat N, Wright JG, Broden KR, et al. Influenza-associated deaths among children in the United States, 2003-2004. New Engl J Med 2005; 353: 2559-2567.
28. Wong KK, Jain S, Blanton L, et al. Influenza-associated pediatric deaths in the United States, 2004-2012. Pediatrics 2013; 132: 796-804.
29. Kato S, Fujisawa T, Enomoto N, Inui N, Nahamura Y, Suda T. Severe respiratory failure associated with influenza B virus infection. Respirology Case Reports 2015; 3(2): 61-63.
30. Fildan AP, Toma CL, Tofolean D, et al. Overlapping tuberculosis in a patient with pulmonary alveolar proteinosis. Acta Medica Mediterranea 2016; 32 (5): 1597-1601.
31. Tuta LA, Dantes E, Mihailov IC. Particularities of tuberculosis in predialysis patients from south-eastern Romania. J Environ Prot Ecol 2016; 17(4): 1582-1591.
32. Postolache P, Cojocaru DC, Jimborean G, Ianosi ES. Outcomes of pulmonary rehabilitation in severe pulmonary hypertension-Case Report. Rev Med Chir Soc Med Nat Iasi 2018; 122(1): 67-71.
33. Miron OT, Afrasinei V, Miron L, Petrariu FD. The prognostic value of neutrophil-to-lymphocyte ratio in patients with advances non-small-cell lung cancer and pulmonary comorbidities. Rev Med Chir Soc Med Nat Iasi 2020; 124(2): 215-224.
34. Peltola V, Ziegler T, Ruuskanen O. Influenza A and B virus infections in children. Clin Infect Dis 2003; 36(3): 299-305.
35. Mancinelli L, Onori M, Concato C, et al. Clinical features of children hospitalized with influenza A and B infections during the 2012-2013 influenza season in Italy. BMC Infect Dis 2016; 16: 6 / doi: 10.1186/s12879-015-1333-x.
36. Muthuri SG, Venkatesan S, Myles PR, et al. Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data. The Lancet Respiratory Medicine 2014; 2(5): 395-404.
37. Garten R, Blanton L, Elal AIA, et al. Update: influenza activity in the United States during the 2017-18 season and composition of the 2018-19 influenza vaccine. MMWR. Morbidity and Mortality Weekly Report 2018; 67(22): 634-642.
38. Lungu O, Siriopol IM, Rusu D, Ristescu I, Patrascanu E, Grigoras I. The management of a hospital -acquired influenza AH1N1 outbreak in oncological patients. A case series report. Rev Med Chir Soc Med Nat Iasi 2020; 124(2): 254-261.
39. Torres A, Sibila O, Ferrer M, et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response. JAMA 2015; 313(7): 677-686.
40. Siemieniuk RAC, Meade MO, Alonso-Coello P. et al. Corticosteroid therapy for patients hospitalized with community- acquired pneumonia. Annals of Internal Medicine 2015; 163(7): 519-528.
41. Brun-Buisson C, Richard JC, Mercat A, Thiebaut AC, Brochard L. (REVA-SRLF A/H1N1v 2009 Registry Group). Early corticosteroids in severe influenza A/H1N1 pneumonia and acute respiratory distress syndrome. AJRCCM 2011; 183(9): 1200-1206.
42. Rascu A, Popa DE, Arghir OC, Otelea MR. Effects of corticosteroid treatment on respiratory muscles function in patients with severe obstructive lung disease. Farmacia 2016; 64(6): 819-822.
43. Diaz E, Martin-Loeches I, Canadell L, et al. Corticosteroid therapy in patients with primary viral pneumonia due to pandemic (H1N1) 2009 influenza. Journal of Infection 2012; 64(3): 311-318.