[Clinical characteristic analysis of the first human case infected by influenza A (H5N1) in Jiangxi Province].
OBJECTIVE
To describe the clinical, laboratory and radiological presentation of a human case infected by influenza A (H5N1), and to understand its management and prognosis.


METHODS
The clinical and autopsy data of the first human case infected by influenza A (H5N1) in Jiangxi Province were collected and analyzed.


RESULTS
The first case infected by influenza A (H5N1) in Jiangxi Province was confirmed by laboratory findings with reverse transcription-polymerase chain reaction (RT-PCR) and influenza A (H5N1) isolation. The patient had been healthy in the past and exposed to the environment of bird flu before illness. The initial symptoms included high fever with influenza-like symptoms, and then cough and purulent sputum mixed with blood appeared. The clinical situation deteriorated progressively with occurrence of diarrhea and dyspnea. Laboratory abnormalities included decrease of peripheral white blood cells and lymphocytes, urine protein, dramatic increase of enzymes associated with hepatic injury and myocarditis and decrease of serum albumin. Six days later, penicillin-resistant streptococcus pneumoniae was isolated from multiple sputum cultures. With the deterioration of clinical situation, several other bacteria and fungi were found in sputum culture. Pulmonary infiltrates were evident in right middle and lower lobe at day 5 after illness, and rapidly progressed to involve bilateral lungs as acute respiratory distress syndrome (ARDS)-like changes. The patient was treated with antiviral, antibacterial, and antifungal reagents, and corticosteroids and invasive mechanical ventilation were also administered, but without any improvement. The patient died 27 days after the onset of symptoms and an autopsy was performed. Pathologically, the lungs exhibited diffuse alveolar damage. The lymphocytes in the spleen, the lymph nodes and the tonsils were depleted prominently with histiocytic hyperplasia and hemophagocytic phenomena. Edema and degeneration of myocytes in the heart and extensive acute tubular necrosis in the kidney were observed.


CONCLUSIONS
The prognosis was very poor if influenza A (H5N1) infected human cases was developed as ARDS with multiple organ damage or failure.
Zhang
Wei
W
Department of Respiratory Medicine, First Affiliated Hospital, Nanchang University, Nanchang 330006, China.
Wen
Le-ying
LY
Lu
Min
M
Xiong
Yu
Y
Qian
Ke-jian
KJ
Deng
Ai-hua
AH
Guo
Lu-sheng
LS
Xiao
Zu-ke
ZK
Zhao
Xin-sheng
XS
Duan
Shu-min
SM
Xie
Zhi-gang
ZG
Gao
Zi-fen
ZF
Li
Min
M
Shao
Hong-quan
HQ
Wang
Guo-gan
GG
Liu
Da-wei
DW
Gao
Zhan-cheng
ZC
D000328:Adult; D002681:China / Q000453:epidemiology; D006801:Humans; D053124:Influenza A Virus, H5N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology*; D008297:Male; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000209:etiology