Clinical characteristics of 26 human cases of highly pathogenic avian influenza A (H5N1) virus infection in China

• Published in: PloS one 2008-08, Vol.3 (8), p.e2985-e2985
• Main Authors: Yu, Hongjie, Gao, Zhancheng, Feng, Zijian, Shu, Yuelong, Xiang, Nijuan, Zhou, Lei, Huai, Yang, Feng, Luzhao, Peng, Zhibin, Li, Zhongjie, Xu, Cuiling, Li, Junhua, Hu, Chengping, Li, Qun, Xu, Xiaoling, Liu, Xuecheng, Liu, Zigui, Xu, Longshan, Chen, Yusheng, Luo, Huiming, Wei, Liping, Zhang, Xianfeng, Xin, Jianbao, Guo, Junqiao, Wang, Qiuyue, Yuan, Zhengan, Zhou, Longnv, Zhang, Kunzhao, Zhang, Wei, Yang, Jinye, Zhong, Xiaoning, Xia, Shichang, Li, Lanjuan, Cheng, Jinquan, Ma, Erdang, He, Pingping, Lee, Shui Shan, Wang, Yu, Uyeki, Timothy M, Yang, Weizhong
• Format: Article
• Language: English
• Subjects: Adolescent; Adrenal Cortex Hormones - therapeutic use; Adult; Adult respiratory distress syndrome; Anti-Bacterial Agents - therapeutic use; Antiviral agents; Avian flu; Avian influenza; Avian influenza viruses; Blood products; Child; China - epidemiology; Complications; Cough; Cytokines; Development and progression; Disease control; Disease prevention; Disease Progression; Drug Therapy, Combination; Drugs; Dyspnea; Failure; Fever; Heart diseases; Heart failure; Hospitals; Humans; Immunotherapy; Infection; Infections; Infectious diseases; Infectious Diseases/Viral Infections; Influenza; Influenza A; Influenza A Virus, H5N1 Subtype - pathogenicity; Influenza, Human - complications; Influenza, Human - epidemiology; Influenza, Human - mortality; Influenza, Human - virology; Inpatients; Medical laboratories; Medical Records; Medical research; Platelets; Pneumonia; Pneumonia, Viral - diagnostic imaging; Pneumonia, Viral - etiology; Public Health and Epidemiology/Infectious Diseases; Radiography; Renal function; Respiration; Respiratory distress syndrome; Respiratory Distress Syndrome - etiology; Respiratory Distress Syndrome - virology; Respiratory Medicine/Respiratory Infections; Surveillance; Survival Analysis; Survivors; Tachypnea; Virus diseases; Viruses
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0002985

While human cases of highly pathogenic avian influenza A (H5N1) virus infection continue to increase globally, available clinical data on H5N1 cases are limited. We conducted a retrospective study of 26 confirmed human H5N1 cases identified through surveillance in China from October 2005 through April 2008. Data were collected from hospital medical records of H5N1 cases and analyzed. The median age was 29 years (range 6-62) and 58% were female. Many H5N1 cases reported fever (92%) and cough (58%) at illness onset, and had lower respiratory findings of tachypnea and dyspnea at admission. All cases progressed rapidly to bilateral pneumonia. Clinical complications included acute respiratory distress syndrome (ARDS, 81%), cardiac failure (50%), elevated aminotransaminases (43%), and renal dysfunction (17%). Fatal cases had a lower median nadir platelet count (64.5 x 10(9) cells/L vs 93.0 x 10(9) cells/L, p = 0.02), higher median peak lactic dehydrogenase (LDH) level (1982.5 U/L vs 1230.0 U/L, p = 0.001), higher percentage of ARDS (94% [n = 16] vs 56% [n = 5], p = 0.034) and more frequent cardiac failure (71% [n = 12] vs 11% [n = 1], p = 0.011) than nonfatal cases. A higher proportion of patients who received antiviral drugs survived compared to untreated (67% [8/12] vs 7% [1/14], p = 0.003). The clinical course of Chinese H5N1 cases is characterized by fever and cough initially, with rapid progression to lower respiratory disease. Decreased platelet count, elevated LDH level, ARDS and cardiac failure were associated with fatal outcomes. Clinical management of H5N1 cases should be standardized in China to include early antiviral treatment for suspected H5N1 cases.