[Clinical experience of successful management of a child with A/H5N1 infection in Shanxi province].
OBJECTIVE
To explore the clinical features and treatment strategy of human influenza A (H5N1) virus infection.


METHODS
The clinical data from a 2-year-old girl with A/H5N1 infection were collected and analyzed.


RESULTS
The patient had a history of exposure to a living poultry market. A/H5N1 nucleic acid was detected by real-time polymerase chain reaction and reverse-transcription polymerase chain reaction in a nasopharyngeal aspirate. The prominent clinical features included fever, cough and dyspnea. Extensive multiple lobular infiltrates developed quickly, followed by acute respiratory distress syndrome (ARDS) and multi-organ dysfunction. Corticosteroids, oxygen therapy and non-invasive mechanical ventilation were administrated on day 9 after onset of the disease. The patient's condition became stable after the management. After A/H5N1 infection was confirmed, antiviral treatment with oseltamivir and A/H5N1 vaccinated plasma were used on day 11. Oxygenation and serum enzyme levels returned to normal gradually, and most of the lung infiltrates disappeared. The patient was discharged on day 28.


CONCLUSIONS
Human A/H5N1 infection is a severe and rapidly progressive disease mostly manifested as ARDS. Corticosteroids may have some effects on the pulmonary lesions, but oxygen therapy and ventilatory support are the mainstay of the management. A/H5N1 vaccinated plasma may be useful for improving the prognosis.
Department of Respiratory Medical, the Fourth People's Hospital of Taiyuan, Taiyuan 030053, China. luoh1117@sina.com
Hong
H
Luo
Meng-bo
MB
Fan
Bin
B
Cao
Su-yun
SY
Qian
Cheng-ping
CP
Song
Ai-bin
AB
Zhao
Ke-zhan
KZ
Liu
Zhuo-yan
ZY
Zhang
Chao-hai
CH
Wang
Guo-ping
GP
Hao
Hui-jun
HJ
Bi
D002675:Child, Preschool; D002681:China; D005260:Female; D006801:Humans; D007106:Immune Sera; D053124:Influenza A Virus, H5N1 Subtype; D007251:Influenza, Human / Q000628:therapy* / Q000821:virology; D010102:Oxygen Inhalation Therapy; D012121:Respiration, Artificial; D016896:Treatment Outcome
D007106:Immune Sera