title: Avian influenza A(H7N9) virus screening in patients with fever and flu-like symptoms in a tertiary hospital in an area with confirmed cases.
abstract: Novel avian influenza A(H7N9) virus was isolated in fatal patients in Yangtze River Delta of China in March 2013. We aimed to screen the virus in febrile patients in a tertiary hospital in an area with confirmed cases. Throat-swab specimens collected from consecutive patients with fever (≥38°C) and flu-like symptoms from April 15 to April 25, 2013 were subjected to detect novel avian influenza A(H7N9) virus with real-time PCR. The clinical outcomes in the patients and close contacts were followed up. Of total 200 patients screened, one (0.5%) was positive for avian influenza A(H7N9) virus and 199 others were negative. The infected patient experienced respiratory failure and had diffuse infiltrates in the right lower lobe in chest CT images. He received symptomatic and antibacterial treatments as well as oseltamivir. His condition was substantially improved within three days after admission; avian influenza A(H7N9) virus was not detected after 5 days' antiviral therapy. The hemagglutinin inhibition test showed that the serum titers against avian influenza A(H7N9) virus increased from <1∶20 at the early phase to 1∶80 at the convalescent phase. Follow-up of 23 close contacts showed that none of them developed fever and other symptoms within two weeks. Our findings suggest that although the infection rate of avian influenza A(H7N9) virus in patients with fever and flu-like symptoms is rare, the screening is valuable to rapidly define the infection, which will be critical to improve the clinical outcomes.
authors.affiliation: Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Wu
authors.affiliation: Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Huang
authors.affiliation: Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, Hubei, China.
authors.forename: Jianjun
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Intensive Care Units, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Gu
authors.affiliation: Department of Radiology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhu
authors.affiliation: Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.
authors.forename: Kui
authors.initials: K
authors.lastname: Zhang
authors.affiliation: Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, Hubei, China.
authors.forename: Quanjiao
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, Hubei, China.
authors.forename: Chaochao
authors.initials: C
authors.lastname: Xiong
authors.affiliation: Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China ; Jiangsu Key Laboratory for Molecular Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Nanjing Municipal Center for Disease Control, Nanjing, Jiangsu, China.
authors.forename: Jiequan
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China ; Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China ; Jiangsu Key Laboratory for Molecular Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.
authors.forename: Yi-Hua
authors.initials: YH
authors.lastname: Zhou
authors.affiliation: Jiangsu Key Laboratory for Molecular Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.
authors.forename: Yitao
authors.initials: Y
authors.lastname: Ding
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D064766:Influenza A Virus, H7N9 Subtype / Q000472:pathogenicity; D009980:Influenza A virus / Q000472:pathogenicity*; D007251:Influenza, Human / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D055815:Young Adult