title: Cytotoxic therapy for severe avian influenza A (H5N1) infection.
abstract: The mortality rate in documented avian influenza A virus subtype H5N1 infection is still high, which is currently reported by WHO at about 50%. Post-mortem analyses in affected patients have revealed haemophagocytosis similar to that found in patients with haemophagocytic lymphohistiocytosis (HLH); such haemophagocytosis could be a very prominent post-mortem feature in H5N1 infection. There are also clinical similarities between H5N1 infection and HLH, such as massive hypercytokinaemia, cytopenia, and acute encephalitis. Importantly, patients with another severe viral infection that may be complicated by secondary HLH, severe Epstein-Barr-virus-associated HLH, have significantly better survival if specific HLH therapy (including the cytotoxic and pro-apoptotic drug etoposide) is initiated early, with survival reported to rise from about 50% to 90%. With this notable improvement in survival, specific HLH treatment, including cytotoxic therapy, could be considered in patients with severe avian influenza A infection complicated by secondary HLH.
authors.affiliation: Childhood Cancer Research Unit, Department of Woman and Child Health, Karolinska Institutet, Karolinska University Hospital Q6:05, SE-171 76 Stockholm, Sweden.
authors.forename: Jan-Inge
authors.initials: JI
authors.lastname: Henter
authors.forename: Chun-Bong
authors.initials: CB
authors.lastname: Chow
authors.forename: Chi-Wai
authors.initials: CW
authors.lastname: Leung
authors.forename: Yu-Lung
authors.initials: YL
authors.lastname: Lau
mesh_terms: D000328:Adult; D000818:Animals; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D000998:Antiviral Agents; D002648:Child; D005047:Etoposide / Q000627:therapeutic use; D006801:Humans; D053124:Influenza A Virus, H5N1 Subtype / Q000472:pathogenicity*; D005585:Influenza in Birds / Q000517:prevention & control* / Q000635:transmission; D007251:Influenza, Human / Q000188:drug therapy* / Q000401:mortality; D051359:Lymphohistiocytosis, Hemophagocytic / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D011200:Poultry
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D000998:Antiviral Agents; D005047:Etoposide