title: Fatal avian influenza A (H5N1) in a child presenting with diarrhea followed by coma.
abstract: In southern Vietnam, a four-year-old boy presented with severe diarrhea, followed by seizures, coma, and death. The cerebrospinal fluid contained 1 white cell per cubic millimeter, normal glucose levels, and increased levels of protein (0.81 g per liter). The diagnosis of avian influenza A (H5N1) was established by isolation of the virus from cerebrospinal fluid, fecal, throat, and serum specimens. The patient's nine-year-old sister had died from a similar syndrome two weeks earlier. In both siblings, the clinical diagnosis was acute encephalitis. Neither patient had respiratory symptoms at presentation. These cases suggest that the spectrum of influenza H5N1 is wider than previously thought.
authors.affiliation: Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors.forename: Menno D
authors.initials: MD
authors.lastname: de Jong
authors.forename: Van Cam
authors.initials: VC
authors.lastname: Bach
authors.forename: Tu Qui
authors.initials: TQ
authors.lastname: Phan
authors.forename: Minh Hien
authors.initials: MH
authors.lastname: Vo
authors.forename: Tan Thanh
authors.initials: TT
authors.lastname: Tran
authors.forename: Bach Hue
authors.initials: BH
authors.lastname: Nguyen
authors.forename: Marcel
authors.initials: M
authors.lastname: Beld
authors.forename: Thi Phuong
authors.initials: TP
authors.lastname: Le
authors.forename: Huu Khanh
authors.initials: HK
authors.lastname: Truong
authors.forename: Van Vinh Chau
authors.initials: VV
authors.lastname: Nguyen
authors.forename: Tinh Hien
authors.initials: TH
authors.lastname: Tran
authors.forename: Quang Ha
authors.initials: QH
authors.lastname: Do
authors.forename: Jeremy
authors.initials: J
authors.lastname: Farrar
mesh_terms: D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000821:virology*; D003967:Diarrhea / Q000821:virology*; D018792:Encephalitis, Viral / Q000209:etiology* / Q000821:virology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D053124:Influenza A Virus, H5N1 Subtype; D009980:Influenza A virus / Q000235:genetics / Q000302:isolation & purification; D007251:Influenza, Human / Q000150:complications* / Q000175:diagnosis / Q000821:virology; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D011859:Radiography; D012640:Seizures / Q000821:virology