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Abstract
Rhabdomyolysis is characterised by muscle breakdown with release of damaging proteins that can have devastating consequences. Acute influenza infection is being increasingly recognised as an underlying aetiology. We report an unusual case of severe rhabdomyolysis with acute renal failure due to influenza A infection that improved with high-dose oseltamivir and intravenous fluids. In our case, we also noticed a temporal relation between fever spikes and subsequent increase in serum creatine kinase. The precise mechanism between the rise in temperature and creatine kinase is unclear but it could be due to direct viral invasion of myocytes or due to release of new viral progeny following replication in the myocyte.
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Affiliation(s)
- Martin Runnstrom
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Alex M Ebied
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Adonice Paul Khoury
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Raju Reddy
- Department of Pulmonary Disease and Critical Care Medicine, University of Florida, Gainesville, Florida, USA
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Desdouits M, Munier S, Prevost MC, Jeannin P, Butler-Browne G, Ozden S, Gessain A, Van Der Werf S, Naffakh N, Ceccaldi PE. Productive infection of human skeletal muscle cells by pandemic and seasonal influenza A(H1N1) viruses. PLoS One 2013; 8:e79628. [PMID: 24223983 PMCID: PMC3818236 DOI: 10.1371/journal.pone.0079628] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 09/24/2013] [Indexed: 11/19/2022] Open
Abstract
Besides the classical respiratory and systemic symptoms, unusual complications of influenza A infection in humans involve the skeletal muscles. Numerous cases of acute myopathy and/or rhabdomyolysis have been reported, particularly following the outbreak of pandemic influenza A(H1N1) in 2009. The pathogenesis of these influenza-associated myopathies (IAM) remains unkown, although the direct infection of muscle cells is suspected. Here, we studied the susceptibility of cultured human primary muscle cells to a 2009 pandemic and a 2008 seasonal influenza A(H1N1) isolate. Using cells from different donors, we found that differentiated muscle cells (i. e. myotubes) were highly susceptible to infection by both influenza A(H1N1) isolates, whereas undifferentiated cells (i. e. myoblasts) were partially resistant. The receptors for influenza viruses, α2-6 and α2-3 linked sialic acids, were detected on the surface of myotubes and myoblasts. Time line of viral nucleoprotein (NP) expression and nuclear export showed that the first steps of the viral replication cycle could take place in muscle cells. Infected myotubes and myoblasts exhibited budding virions and nuclear inclusions as observed by transmission electron microscopy and correlative light and electron microscopy. Myotubes, but not myoblasts, yielded infectious virus progeny that could further infect naive muscle cells after proteolytic treatment. Infection led to a cytopathic effect with the lysis of muscle cells, as characterized by the release of lactate dehydrogenase. The secretion of proinflammatory cytokines by muscle cells was not affected following infection. Our results are compatible with the hypothesis of a direct muscle infection causing rhabdomyolysis in IAM patients.
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Affiliation(s)
- Marion Desdouits
- Unité Epidémiologie et Physiopathologie des Virus Oncogènes, Institut Pasteur, Paris, France
- UMR 3569, CNRS, Paris, France
- Cellule Pasteur, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Sandie Munier
- Unité de Génétique Moléculaire des Virus ARN, Institut Pasteur, Paris, France
- UMR 3569, CNRS, Paris, France
- EA302, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | | | - Patricia Jeannin
- Unité Epidémiologie et Physiopathologie des Virus Oncogènes, Institut Pasteur, Paris, France
- UMR 3569, CNRS, Paris, France
| | - Gillian Butler-Browne
- UM76, Institut de Myologie, Université Pierre et Marie Curie, Paris, France
- U974, INSERM, Paris France
- UMR7215, CNRS, GH Pitié Salpêtrière, Paris, France
| | - Simona Ozden
- Unité Epidémiologie et Physiopathologie des Virus Oncogènes, Institut Pasteur, Paris, France
- UMR 3569, CNRS, Paris, France
| | - Antoine Gessain
- Unité Epidémiologie et Physiopathologie des Virus Oncogènes, Institut Pasteur, Paris, France
- UMR 3569, CNRS, Paris, France
| | - Sylvie Van Der Werf
- Unité de Génétique Moléculaire des Virus ARN, Institut Pasteur, Paris, France
- UMR 3569, CNRS, Paris, France
- EA302, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Nadia Naffakh
- Unité de Génétique Moléculaire des Virus ARN, Institut Pasteur, Paris, France
- UMR 3569, CNRS, Paris, France
| | - Pierre-Emmanuel Ceccaldi
- Unité Epidémiologie et Physiopathologie des Virus Oncogènes, Institut Pasteur, Paris, France
- UMR 3569, CNRS, Paris, France
- Cellule Pasteur, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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3
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Callado RB, Ponte Carneiro TG, da Cunha Parahyba CC, de Alcantara Lima N, da Silva Junior GB, de Francesco Daher E. Rhabdomyolysis secondary to influenza A H1N1 vaccine resulting in acute kidney injury. Travel Med Infect Dis 2013; 11:130-3. [DOI: 10.1016/j.tmaid.2012.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 10/25/2012] [Accepted: 11/15/2012] [Indexed: 01/04/2023]
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