title: A detailed epidemiological and clinical description of 6 human cases of avian-origin influenza A (H7N9) virus infection in Shanghai.
abstract: BACKGROUND
  The world's first reported patient infected with avian influenza H7N9 was treated at the Fifth People's Hospital of Shanghai. Shortly thereafter, several other cases emerged in the local area. Here, we describe the detailed epidemiological and clinical data of 6 cases of avian influenza H7N9.
  
  
  RESULTS
  We analyzed the epidemiologic and clinical data from clustered patients infected with H7N9 in the Minhang District of Shanghai during a 2-week period. Of the 6 patients, 2 were from a single family. In addition, 3 patients had a history of contact with poultry; however, all 6 patients lived in the proximity of 2 food markets where the H7N9 virus was detected in chickens and pigeons. The main symptoms were fever, cough, and hemoptysis. At onset, a decreased lymphocyte count and elevated creatine kinase, lactate dehydrogenase, procalcitonin, and C-reactive protein levels were observed. As the disease progressed, most patients developed dyspnea and hypoxemia. Imaging studies revealed lung consolidation and multiple ground-glass opacities in the early stage, rapidly extending bilaterally. All patients were treated with oseltamivir tablets beginning on days 3-8 after onset. The main complications were as follows: acute respiratory distress syndrome (ARDS; 83.3%), secondary bacterial infection (66.7%), pleural effusion (50%), left ventricular failure (33.3%), neuropsychiatric symptoms (33.3%), and rhabdomyolysis (16.7%). Of the 6 patients, 4 died of ARDS, with 2 patients recovering from the infection.
  
  
  CONCLUSIONS
  An outbreak of H7N9 infection occurred in the Minhang District of Shanghai that easily progressed to acute respiratory distress syndrome. Two cases showed family aggregation, which led us to identify the H7N9 virus and indicated that human transmission may be involved in the spread of this infection.
authors.affiliation: The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China.
authors.forename: Jindong
authors.initials: J
authors.lastname: Shi
authors.forename: Juan
authors.initials: J
authors.lastname: Xie
authors.forename: Zebao
authors.initials: Z
authors.lastname: He
authors.forename: Yunwen
authors.initials: Y
authors.lastname: Hu
authors.forename: Yanchao
authors.initials: Y
authors.lastname: He
authors.forename: Qihui
authors.initials: Q
authors.lastname: Huang
authors.forename: Beizheng
authors.initials: B
authors.lastname: Leng
authors.forename: Wei
authors.initials: W
authors.lastname: He
authors.forename: Ying
authors.initials: Y
authors.lastname: Sheng
authors.forename: Fangming
authors.initials: F
authors.lastname: Li
authors.forename: Yuanlin
authors.initials: Y
authors.lastname: Song
authors.forename: Chunxue
authors.initials: C
authors.lastname: Bai
authors.forename: Yong
authors.initials: Y
authors.lastname: Gu
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Jie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001717:Birds; D002681:China / Q000453:epidemiology; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006798:Housing; D006801:Humans; D064766:Influenza A Virus, H7N9 Subtype / Q000502:physiology*; D007251:Influenza, Human / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy / Q000635:transmission; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D016896:Treatment Outcome