title: Clinical preparedness for severe pneumonia with highly pathogenic avian influenza A (H5N1): experiences with cases in Vietnam.
abstract: BACKGROUND
  Avian influenza A (H5N1) in human presents a global pandemic threat, and preparedness is urgently required in high-risk countries.
  
  
  METHODS
  A retrospective chart review was conducted on 8 patients with H5N1 infection (aged 2-30 years; 3 fatal) who were hospitalized in Bach Mai Hospital (BMH), Vietnam, or in affiliated hospitals with consultation by physicians in BMH between 2007 and 2010. Demographic background, chest radiographs, and clinical and laboratory data were evaluated to determine the critical issues in relation to clinical outcomes. Treatment of 4 patients with acute respiratory distress syndrome (ARDS) (2 fatal) was assessed for renal replacement therapy using continuous hemodiafiltration (CHDF), polymyxin B-immobilized (PMX) hemoperfusion, or their combination.
  
  
  RESULTS
  Patients had direct contact with dead/sick poultry infected with H5N1 virus or lived in areas where H5N1 poultry outbreaks had been reported at the same time as their illness. Time to initiation of oseltamivir from symptom onset was 2-6 days for survivors and 7-9 days for non-survivors. All patients except one had infiltrative shadows on chest radiographs on admission. Patients with delayed treatment developed ARDS. Renal replacement therapy contributed to patient survival, with improvement of oxygenation and a dramatic decrease in serum cytokine levels if initiated earlier.
  
  
  CONCLUSIONS
  Understanding local H5N1 poultry outbreaks and chest radiography assist early diagnosis and initiation of antiviral treatment. Developing a network among local and tertiary care hospitals can reduce the time to initiation of treatment. CHDF and PMX hemoperfusion are possible candidates for effective treatment of ARDS with H5N1 if applied earlier.
authors.affiliation: National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. kudo@aoni.waseda.jp
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kudo
authors.forename: Nguyen Gia
authors.initials: NG
authors.lastname: Binh
authors.forename: Toshie
authors.initials: T
authors.lastname: Manabe
authors.forename: Dao Xuan
authors.initials: DX
authors.lastname: Co
authors.forename: Nguyen Dang
authors.initials: ND
authors.lastname: Tuan
authors.forename: Shinyu
authors.initials: S
authors.lastname: Izumi
authors.forename: Jin
authors.initials: J
authors.lastname: Takasaki
authors.forename: Dang Hung
authors.initials: DH
authors.lastname: Minh
authors.forename: Pham Thi Phuong
authors.initials: PT
authors.lastname: Thuy
authors.forename: Vu Thi Tuong
authors.initials: VT
authors.lastname: Van
authors.forename: Tran Thuy
authors.initials: TT
authors.lastname: Hanh
authors.forename: Ngo Quy
authors.initials: NQ
authors.lastname: Chau
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001717:Birds; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D053124:Influenza A Virus, H5N1 Subtype; D005585:Influenza in Birds; D007251:Influenza, Human / Q000628:therapy*; D008297:Male; D011024:Pneumonia, Viral / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014744:Vietnam