Egyptian Journal of Chest Diseases and Tuberculosis (2016) 65, 169–171

H O S T E D BY
The Egyptian Society of Chest Diseases and Tuberculosis

Egyptian Journal of Chest Diseases and Tuberculosis

www.elsevier.com/locate/ejcdt
www.sciencedirect.com

REVIEW

Alcoholic consumption behavior and death

due to swine flu
Viroj Wiwanitkit

Hainan Medical University, China

Received 28 May 2015; accepted 14 July 2015

Available online 19 August 2015

KEYWORDS Abstract Swine flu is still an important public health consideration. This respiratory infection can
Alcohol; cause severe illness and death in cases with underlying disease. Alcoholic consumption behavior is
Consumption; an important underlying disease that is widely discussed for its clinical correlation with the disease
Swine flu severity in swine flu. In this brief review, the author summarizes and discusses alcoholic consump-
tion behavior and death due to swine flu.
ª 2015 The Author. Production and hosting by Elsevier B.V. on behalf of The Egyptian Society of Chest
Diseases and Tuberculosis. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).

Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Alcoholic consumption behavior and death due to swine flu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Pathology and pathophysiology due to alcoholic consumption behavior in swine flu . . . . . . . . . . . . . . . . . . . . . . . . . 170
Can alcoholic consumption behavior be problematic toward swine flu management? . . . . . . . . . . . . . . . . . . . . . . . . . 170
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170

Introduction
Swine flu is still an important public health consideration. This
respiratory infection can cause severe illness and death in cases
with underlying disease [1,2]. Peiris et al. concluded that
‘‘many of the complications leading to hospitalization and
mortality occur in those with underlying disease conditions
or pregnancy [2]’’ Zhang et al. found that having an underlying
disease was the main risk factor for developing complications
and death [3]. Alcoholic consumption behavior is an important
underlying disease that is widely discussed forits clinical corre-
lation with the disease severity in swine flu. In this brief review,
the author summarizes and discusses alcoholic consumption
behavior and death due to swine flu.
Alcoholic consumption behavior and death due to swine flu

E-mail address: wviroj@yahoo.com In the early phase of the outbreak of swine flu in 2009, ‘‘alco-
Peer review under responsibility of The Egyptian Society of Chest holic consumption behavior’’ is a topic that is widely
Diseases and Tuberculosis.
http://dx.doi.org/10.1016/j.ejcdt.2015.07.005
0422-7638 ª 2015 The Author. Production and hosting by Elsevier B.V. on behalf of The Egyptian Society of Chest Diseases and Tuberculosis.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
170
discussed. Some death cases due to swine flu have the underly-
ing alcoholic consumption behavior. Based on the recent
report on influenza by Greenbaum et al., ‘‘heavy alcohol use
increased disease severity [4].’’ However, a recent study focus-
ing on swine from China showed that heavy alcohol use was
not a risk [5]. Similar observations are also reported from
USA by Jain et al. [6] and from Mexico by Perez-Padilla
et al. [7]. Nevertheless, Riquelme et al. recently reported an
interesting observation that pneumonia associated with swine
flu was more common among patients with less alcoholism
[8]. Focusing on fatality due to swine flu, Cui et al. performed
a study in China and found that heavy alcohol use was not
related to death in patients with swine flu [9]. Similarly, Lee
et al. performed a study in USA and obtained the same find-
ings [10]. In fact, deaths due to swine flu cases with underlying
alcoholic consumption behavior are sporadically reported as
case reports [11,12]. The relationship between alcoholic con-
sumption behavior and severity/fatality in swine flu infection
is still controversial. Nevertheless, most reports support no
relationship.
Pathology and pathophysiology due to alcoholic consumption
behavior in swine flu
To clarify the effect of alcoholic consumption behavior,
pathology and pathophysiology are required. There are some
reports on pathological findings among the death cases of
swine flu with underlying chronic alcohol use [11].
Mukhopadhyay et al. found that ‘‘the main pathologic abnor-
mality in fatal cases is diffuse alveolar damage [11].’’ The
pathophysiological explanation of this finding is interesting.
In the animal model study, Meyerholz et al. found that
‘‘chronic alcohol consumption may increase the risk of severe
influenza virus infections by altering the pulmonary inflamma-
tory environment and CD8 T cell response [13].’’ Chen et al.
additionally commented that the immunosuppression due to
chronic alcoholism should be an important underlying mecha-
nism inducing severe clinical manifestations [14]. Defective
immune status due to chronic alcoholism is believed to be
the cause of severe influenza [15].
Can alcoholic consumption behavior be problematic toward
swine flu management?
An interesting question is ‘‘can alcoholic consumption
behavior be problematic toward swine flu management?’’ As
previously noted, chronic alcohol might lead to immunosup-
pression and might increase the risk of severe illness.
Nevertheless, the patients with underlying chronic alcohol
use usually have poor self-care. Those patients usually visit
the physician late and this might increase the severity of infec-
tion [16]. In addition, those patients usually neglect proper pre-
ventive immunization [16,17].
Conclusion
Although there are some reports on death swine flu cases with
underlying chronic alcohol use it is still not conclusive on the
effect of chronic alcohol use on severity/fatality of swine flu
infection. Immunosuppression might be a mechanism that
V. Wiwanitkit
results in severe infection in patients with underlying alcohol
use. However, further epidemiological investigation is needed
to reach the final conclusion.
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