[Study on a fatal pregnant woman died from by avian influenza (H5N1)].
OBJECTIVE
To ascertain the causation of a pregnant woman with undefined pneumonia reported from the People's Hospital of Tongling city in Anhui province on November 2005.


METHODS
Epidemiological and clinical information of the case was collected from the keypersons close to the case and referring to the medical record. A medical observation was carried out on the close contacts of the case and sick or dead poultry. Tracheal aspirates being collected were tested by both RT-PCR and real-time PCR to detect viral nucleic acids of A/H5N1, and were inoculated into special pathogen free (SPF) embryonated hens' eggs.


RESULTS
The pregnant woman was found to have been contacted with the sick/dead poultry directly on the 4th day before onset of illness. All the 122 close contacts were healthy after a 10-day medical observation. The major clinical features of the case were viral pneumonia with rapidly developed leukopenia and lymphopenia. The progress to acute respiratory distress syndrome and multiple organ dysfunction syndromes was found at clinical presentation. HA and NA gene of A/H5N1 virus were positive. The 8 gene fragments of A/Anhui/1/2005 (H5N1) isolated from the tracheal aspirates had not carried genes from a human virus through reassortment, and the receptor-binding site of the hemagglutinin was polybasic cleavage site.


CONCLUSIONS
This was the first documented case of H5N1 infection in pregnant woman. The immunotolerant state of pregnancy might have predisposed to the fatal outcome of the patient.
Li
Qun
Q
Anhui Provincial Center for Disease Control and Prevention, Hefei 230061, China.
Lan
Yu
Y
Xu
Cui-ling
CL
Liu
Yan
Y
Wu
Tong-sheng
TS
Wen
Le-ying
LY
Xiang
Ni-juan
NJ
Zhang
Ye
Y
Wu
Jia-bing
JB
Dong
Jie
J
Xiong
Chuan-long
CL
Xu
Xiao-ling
XL
Hu
Wan-fu
WF
Li
Zhong-jie
ZJ
Hu
Dai-lin
DL
Zhou
Lei
L
Ma
Ming-ying
MY
Liu
Zhi-tao
ZT
Liu
Xu-xiang
XX
Liu
Li-ping
LP
Wang
Jun
J
Hu
Shou-kui
SK
He
Jun
J
Wang
Yong
Y
Li
Xian-xiang
XX
Wu
Fu-qing
FQ
Shu
Yue-long
YL
Wang
Mao-wu
MW
Wang
Zi-jun
ZJ
Yang
Wei-zhong
WZ
Wang
Yu
Y
Yu
Hong-jie
HJ
D000328:Adult; D002681:China; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D053124:Influenza A Virus, H5N1 Subtype / Q000235:genetics / Q000302:isolation & purification*; D007251:Influenza, Human / Q000150:complications / Q000473:pathology*; D009102:Multiple Organ Failure; D011014:Pneumonia / Q000821:virology*; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D012128:Respiratory Distress Syndrome; D014132:Trachea / Q000821:virology