Clinical characteristics of 26 human cases of highly pathogenic avian influenza A (H5N1) virus infection in China.
BACKGROUND
While human cases of highly pathogenic avian influenza A (H5N1) virus infection continue to increase globally, available clinical data on H5N1 cases are limited. We conducted a retrospective study of 26 confirmed human H5N1 cases identified through surveillance in China from October 2005 through April 2008.


RESULTS
Data were collected from hospital medical records of H5N1 cases and analyzed. The median age was 29 years (range 6-62) and 58% were female. Many H5N1 cases reported fever (92%) and cough (58%) at illness onset, and had lower respiratory findings of tachypnea and dyspnea at admission. All cases progressed rapidly to bilateral pneumonia. Clinical complications included acute respiratory distress syndrome (ARDS, 81%), cardiac failure (50%), elevated aminotransaminases (43%), and renal dysfunction (17%). Fatal cases had a lower median nadir platelet count (64.5 x 10(9) cells/L vs 93.0 x 10(9) cells/L, p = 0.02), higher median peak lactic dehydrogenase (LDH) level (1982.5 U/L vs 1230.0 U/L, p = 0.001), higher percentage of ARDS (94% [n = 16] vs 56% [n = 5], p = 0.034) and more frequent cardiac failure (71% [n = 12] vs 11% [n = 1], p = 0.011) than nonfatal cases. A higher proportion of patients who received antiviral drugs survived compared to untreated (67% [8/12] vs 7% [1/14], p = 0.003).


CONCLUSIONS
The clinical course of Chinese H5N1 cases is characterized by fever and cough initially, with rapid progression to lower respiratory disease. Decreased platelet count, elevated LDH level, ARDS and cardiac failure were associated with fatal outcomes. Clinical management of H5N1 cases should be standardized in China to include early antiviral treatment for suspected H5N1 cases.
Yu
Hongjie
H
Office for Disease Control and Emergency Response, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China.
Gao
Zhancheng
Z
Feng
Zijian
Z
Shu
Yuelong
Y
Xiang
Nijuan
N
Zhou
Lei
L
Huai
Yang
Y
Feng
Luzhao
L
Peng
Zhibin
Z
Li
Zhongjie
Z
Xu
Cuiling
C
Li
Junhua
J
Hu
Chengping
C
Li
Qun
Q
Xu
Xiaoling
X
Liu
Xuecheng
X
Liu
Zigui
Z
Xu
Longshan
L
Chen
Yusheng
Y
Luo
Huiming
H
Wei
Liping
L
Zhang
Xianfeng
X
Xin
Jianbao
J
Guo
Junqiao
J
Wang
Qiuyue
Q
Yuan
Zhengan
Z
Zhou
Longnv
L
Zhang
Kunzhao
K
Zhang
Wei
W
Yang
Jinye
J
Zhong
Xiaoning
X
Xia
Shichang
S
Li
Lanjuan
L
Cheng
Jinquan
J
Ma
Erdang
E
He
Pingping
P
Lee
Shui Shan
SS
Wang
Yu
Y
Uyeki
Timothy M
TM
Yang
Weizhong
W
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002681:China / Q000453:epidemiology; D018450:Disease Progression; D004359:Drug Therapy, Combination; D006801:Humans; D053124:Influenza A Virus, H5N1 Subtype / Q000472:pathogenicity*; D007251:Influenza, Human / Q000150:complications* / Q000453:epidemiology / Q000401:mortality / Q000821:virology*; D007297:Inpatients; D008499:Medical Records; D011024:Pneumonia, Viral / Q000000981:diagnostic imaging / Q000209:etiology; D011859:Radiography; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000821:virology; D016019:Survival Analysis; D017741:Survivors
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents