[Clinical characteristics and therapeutic experience of case of severe highly pathogenic A/H5N1 avian influenza with bronchopleural fistula].
OBJECTIVE
To summarize the clinical characteristics and therapeutic experience of A/H5N1 infected patient with intractable bronchopleural fistula.


METHODS
The data of a patient with A/H5N1 infection complicated with bronchopleural fistula was collected and analyzed.


RESULTS
A 44-year-old woman with pneuminian was diagnosed as A/H5N1 infection by reverse-transcription polymerase chain reaction (RT-PCR) in laboratory from the sample of secretion of respiratory tracts. She had exposed to sick or dead poultry 3 days before development of illness. She developed acute respiratory distress syndrome 7 days after onset of sickness. After comprehensive management with antiviral agents, antibiotics, convalescent serum and invasive ventilation, her clinical condition improved and turned to stable. However, 16 days after onset of illness, her clinical situation deteriorated due to ventilator-associated pneumonia, bilateral pneumothorax and persistent right bronchopleural fistula. After partly failure of beside assist thoracoscopy to fix the pleural fistula, transbronchoscopic bronchial occlusion by autoblood was explored and the air leakage stopped soon after occlusion. Three days after the autoblood clot was expectorated out and air leak recurred. Then, bronchopleural fistula on the surface of visceral pleura was successfully blocked by biogel and OB gel through pleural cavity by fibrobronchoscopy. The patient was discharged from the hospital 99 days after onset of illness (at the 94th hospital day).


CONCLUSIONS
Bronchopleural fistula was an intractable complication for patient with A/H5N1 infection. Occlusion operation by biogel and OB gel through bronchoscopy might be an alternative choice for fixing the bronchopleural fistula.
Zhang
Hua-ping
HP
The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China. fmuzhp@126.com
Zeng
Yi-ming
YM
Lin
Zhang-shu
ZS
Chen
Wei
W
Liang
Jian-sheng
JS
Zhang
Hong
H
Huang
Wen-rui
WR
D000328:Adult; D001983:Bronchial Fistula / Q000150:complications / Q000628:therapy* / Q000821:virology; D002681:China; D005260:Female; D006801:Humans; D053124:Influenza A Virus, H5N1 Subtype; D007251:Influenza, Human / Q000150:complications / Q000628:therapy* / Q000821:virology; D010995:Pleural Diseases / Q000150:complications / Q000628:therapy* / Q000821:virology; D016896:Treatment Outcome