Cytotoxic therapy for severe avian influenza A (H5N1) infection.
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.
Henter
Jan-Inge
JI
Childhood Cancer Research Unit, Department of Woman and Child Health, Karolinska Institutet, Karolinska University Hospital Q6:05, SE-171 76 Stockholm, Sweden.
Chow
Chun-Bong
CB
Leung
Chi-Wai
CW
Lau
Yu-Lung
YL
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
D000972:Antineoplastic Agents, Phytogenic; D000998:Antiviral Agents; D005047:Etoposide