Here we report a possible case of coinfection with influenza A/H1N1 and varicella in

a young French traveler returning from a rock festival in Hungary. We report a cluster of influenza A/H1N1 cases at this festival. We report the case of a 23-year-old man who was hospitalized 3 days after returning to France from a rock festival in Budapest, Hungary. The rock festival took place in Sziget Island from 11 to 18 August, 2009. On 17 August, he complained of diarrhea and rhinorrhea without fever. The next day, he went back to France and complained of fever (39.5°C), chills, and cough. On 19 August, a vesicular rash appeared. As he returned from a rock festival1 he was referred Decitabine supplier by his doctor to the H1N1 flu consultation at our department. Clinical examination revealed a disseminated vesicular rash predominantly on the trunk, typical of varicella. Pulmonary examination, pulse oxymetry, and the rest of examination revealed no abnormalities. A nasopharyngeal swab specimen was obtained for the diagnosis of A/H1N1 infection. A cutaneous swab and a serology for varicella zoster virus (VZV) were also performed.

The chest radiography was normal. Laboratory parameters were normal. Real-time polymerase chain reaction (PCR) detection of influenza A/H1N1 virus, was positive on the nasopharyngeal sample using two tests.2 Real-time PCR detection of VZV was MG-132 order also positive in both blood and cutaneous specimens. VZV serology showed the presence of specific IgM and IgG through enzyme-linked immunosorbent assay (ELISA) test (Dade Behring) compatible C-X-C chemokine receptor type 7 (CXCR-7) with a primary infection with VZV causing varicella. The patient was hospitalized into an individual room using respiratory

and contact isolation procedures as recommended for influenza A/H1N1 and varicella. Oseltamivir (75 mg, two times per day) and valacyclovir (1 g, three times per day) were prescribed for 5 and 7 days, respectively, with a favorable outcome. Oseltamivir and valacyclovir were concomitantly used because a pulmonary infection by both A/H1N1 and VZV virus was suspected, and in reason of asthma in the past medical history of the patient. Sensitivity of the A/HIN1 virus strain to oseltamivir was not tested. The patient was discharged 3 days later with recommendations to carry on the isolation protections at home. Fifteen days later he was seen as an out-patient and he was well. Follow-up of viral shedding was not done. Some 390,000 young people gathered during the 2009 Sziget festival. In the context of the current swine origin H1N1 flu pandemic, a separate medical tent was dedicated to attend participants showing flu symptoms. Possible cases were referred to Szent Margareta local hospital in a dedicated separate department for further investigation. Overall, during the Sziget event, 14 individuals were admitted to St Margareta Hospital (3.6 per 100,000 individuals). Among these cases, eight (57.1%) tested positive for H1N1 by real-time PCR detection on nasal swab samples.