title: Influenza A/H5N1 virus infection in humans in Cambodia.
abstract: BACKGROUND
  Between January 2005 and April 2006, six patients of influenza A/H5N1 virus infection were reported in Cambodia, all with fatal outcome.
  
  
  OBJECTIVE
  We describe the virological findings of these six H5N1 patients in association with clinical and epidemiologic findings.
  
  
  METHODS
  Broncho-alveolar lavage, nasopharyngeal, throat and rectal swabs and sera were cultured for virus isolation and viral load quantified in clinical specimens by real-time RT-PCR. We compared sequences obtained from different body sites within the same patient to detect viral quasi-species.
  
  
  RESULTS
  H5N1 virus strains isolated in Cambodia belong to genotype Z, clade 1 viruses. H5N1 viruses were isolated from serum and rectal swab specimens in two patients. The haemagglutinin gene sequences of the virus in different body sites did not differ. Amino acid substitutions known to be associated with a change in virus binding were not observed.
  
  
  CONCLUSIONS
  The high frequency of virus isolation from serum and faecal swabs highlights that H5N1 is likely to be a disseminated infection in humans and this has implications for antiviral treatment, biosafety in clinical laboratories and on risks for nosocomial and human-to-human transmission. There were no tissue-specific adaptive mutations in the HA gene from viruses isolated from different organs.
authors.affiliation: Institut Pasteur in Cambodia, 5 Monivong blvd, P.O. Box 983, Phnom Penh, Cambodia. pbuchy@pasteur-kh.org
authors.forename: Philippe
authors.initials: P
authors.lastname: Buchy
authors.forename: Sek
authors.initials: S
authors.lastname: Mardy
authors.forename: Sirenda
authors.initials: S
authors.lastname: Vong
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Toyoda
authors.forename: Jean-Thierry
authors.initials: JT
authors.lastname: Aubin
authors.forename: Megge
authors.initials: M
authors.lastname: Miller
authors.forename: Sok
authors.initials: S
authors.lastname: Touch
authors.forename: Ly
authors.initials: L
authors.lastname: Sovann
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Dufourcq
authors.forename: Beat
authors.initials: B
authors.lastname: Richner
authors.forename: Phan Van
authors.initials: PV
authors.lastname: Tu
authors.forename: Nguyen Thi Kim
authors.initials: NT
authors.lastname: Tien
authors.forename: Wilina
authors.initials: W
authors.lastname: Lim
authors.forename: J S Malik
authors.initials: JS
authors.lastname: Peiris
authors.forename: Sylvie
authors.initials: S
authors.lastname: Van der Werf
mesh_terms: D000328:Adult; D000818:Animals; D001769:Blood / Q000821:virology; D002160:Cambodia / Q000453:epidemiology; D002460:Cell Line; D002648:Child; D002675:Child, Preschool; D005243:Feces / Q000821:virology; D005260:Female; D005838:Genotype; D006801:Humans; D053124:Influenza A Virus, H5N1 Subtype / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D007251:Influenza, Human / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000821:virology; D008297:Male; D012367:RNA, Viral / Q000032:analysis / Q000302:isolation & purification; D012137:Respiratory System / Q000821:virology; D020133:Reverse Transcriptase Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D014776:Virus Cultivation
chemical_list: D012367:RNA, Viral