title: [Clinical characteristic analysis of the first human case infected by influenza A (H5N1) in Jiangxi Province].
abstract: 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.
authors.affiliation: Department of Respiratory Medicine, First Affiliated Hospital, Nanchang University, Nanchang 330006, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.forename: Le-ying
authors.initials: LY
authors.lastname: Wen
authors.forename: Min
authors.initials: M
authors.lastname: Lu
authors.forename: Yu
authors.initials: Y
authors.lastname: Xiong
authors.forename: Ke-jian
authors.initials: KJ
authors.lastname: Qian
authors.forename: Ai-hua
authors.initials: AH
authors.lastname: Deng
authors.forename: Lu-sheng
authors.initials: LS
authors.lastname: Guo
authors.forename: Zu-ke
authors.initials: ZK
authors.lastname: Xiao
authors.forename: Xin-sheng
authors.initials: XS
authors.lastname: Zhao
authors.forename: Shu-min
authors.initials: SM
authors.lastname: Duan
authors.forename: Zhi-gang
authors.initials: ZG
authors.lastname: Xie
authors.forename: Zi-fen
authors.initials: ZF
authors.lastname: Gao
authors.forename: Min
authors.initials: M
authors.lastname: Li
authors.forename: Hong-quan
authors.initials: HQ
authors.lastname: Shao
authors.forename: Guo-gan
authors.initials: GG
authors.lastname: Wang
authors.forename: Da-wei
authors.initials: DW
authors.lastname: Liu
authors.forename: Zhan-cheng
authors.initials: ZC
authors.lastname: Gao
mesh_terms: 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