The Influenza A (H1N1) CXR findings are similar to those reported for SARS and H5N1. Although imaging will play an important role in detecting lung changes, and to monitor disease progression as well as response to treatment; knowledge of the current epidemic status is essential for correct diagnosis. Noninvasive ventilation in acute respiratory failure due to H1N1 influenza We present a case of severe H1N1 influenza with hypoxemic acute respiratory failure necessitating mechanical ventilation benefited from noninvasive positive pressure ventilation (NIPPV). The NIPPV may be of great use in treating patients with H1N1-related acute respiratory distress syndrome in a resource poor setting or when invasive ventilator is unavailable.  Temporal Anomalies in Immunological Gene Expression in a Time Series of Wild Mice: Signature of an Epidemic? Although the ecological importance of coinfection is increasingly recognized, analyses of microbial pathogen dynamics in wildlife usually focus on an ad hoc subset of the species present due to technological limitations on detection. Here we demonstrate the use of expression profiles for immunological genes (pattern recognition receptors, cytokines and transcription factors) as a means to identify, without preconception, the likelihood of important acute microbial infections in wildlife. Using a wood mouse population in the UK as a model we identified significant temporal clusters of individuals with extreme expression of immunological mediators across multiple loci, typical of an acute microbial infection. These clusters were circumstantially associated with demographic perturbation in the summertime wood mouse population. Animals in one cluster also had significantly higher individual macroparasite burdens than contemporaries with “normal” expression patterns. If the extreme transcriptional profiles observed are induced by an infectious agent then this implicates macroparasites as a possible player in mediating individual susceptibility or resilience to infection. The form of survey described here, combined with next generation nucleic acids sequencing methods for the broad detection of microbial infectious agents in individuals with anomalous immunological transcriptional profiles, could be a powerful tool for revealing unrecognized, ecologically important infectious agents circulating in wildlife populations. The role of infectious agents in the dynamics of natural vertebrate populations has been a growing interest for ecologists. Endemic infections have been shown to have important effects on survival [1, 2] and reproduction [3, 4, 5, 6, 7] and the theoretical potential to regulate populations and drive abundance cycles [8, 9] . At the same time there are many documented instances of epidemics associated with catastrophic mortality in nature [10, 11, 12] , although the observation of such events may often be serendipitous or depend on the focus of the researcher. Increasingly it is also appreciated that co-occurring pathogens should be regarded as a potential community [13, 14] , whose interactions may define the consequences of infection for the individual host and host population [15] . In general, however, ecological studies of microbial infectious disease in nature are constrained to the analysis of a single pathogen or an ad hoc panel of pathogens for which there is a priori knowledge, a preconception of possible importance and specific diagnostic reagents.