title: Clinical characteristics of 26 human cases of highly pathogenic avian influenza A (H5N1) virus infection in China.
abstract: 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.
authors: Office for Disease Control and Emergency Response, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China.
authors: Hongjie
authors: H
authors: Yu
authors: Zhancheng
authors: Z
authors: Gao
authors: Zijian
authors: Z
authors: Feng
authors: Yuelong
authors: Y
authors: Shu
authors: Nijuan
authors: N
authors: Xiang
authors: Lei
authors: L
authors: Zhou
authors: Yang
authors: Y
authors: Huai
authors: Luzhao
authors: L
authors: Feng
authors: Zhibin
authors: Z
authors: Peng
authors: Zhongjie
authors: Z
authors: Li
authors: Cuiling
authors: C
authors: Xu
authors: Junhua
authors: J
authors: Li
authors: Chengping
authors: C
authors: Hu
authors: Qun
authors: Q
authors: Li
authors: Xiaoling
authors: X
authors: Xu
authors: Xuecheng
authors: X
authors: Liu
authors: Zigui
authors: Z
authors: Liu
authors: Longshan
authors: L
authors: Xu
authors: Yusheng
authors: Y
authors: Chen
authors: Huiming
authors: H
authors: Luo
authors: Liping
authors: L
authors: Wei
authors: Xianfeng
authors: X
authors: Zhang
authors: Jianbao
authors: J
authors: Xin
authors: Junqiao
authors: J
authors: Guo
authors: Qiuyue
authors: Q
authors: Wang
authors: Zhengan
authors: Z
authors: Yuan
authors: Longnv
authors: L
authors: Zhou
authors: Kunzhao
authors: K
authors: Zhang
authors: Wei
authors: W
authors: Zhang
authors: Jinye
authors: J
authors: Yang
authors: Xiaoning
authors: X
authors: Zhong
authors: Shichang
authors: S
authors: Xia
authors: Lanjuan
authors: L
authors: Li
authors: Jinquan
authors: J
authors: Cheng
authors: Erdang
authors: E
authors: Ma
authors: Pingping
authors: P
authors: He
authors: Shui Shan
authors: SS
authors: Lee
authors: Yu
authors: Y
authors: Wang
authors: Timothy M
authors: TM
authors: Uyeki
authors: Weizhong
authors: W
authors: Yang
mesh_terms: 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
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents