title: Extra-pulmonary viral shedding in H7N9 Avian Influenza patients.
abstract: BACKGROUND
  The clinical features of avian-origin influenza virus A (H7N9) virus infection have been extensively characterized, but viral RNA detection in extra-pulmonary samples has seldom been studied.
  
  
  OBJECTIVE
  To study shedding of viral RNA in extra pulmonary samples in patients with avian influenza H7N9 infections.
  
  
  METHODS
  A retrospective study of throat swabs, urine, fecal samples and sera collected sequentially from 18 hospitalized patients with H7N9 infections in Shanghai, China, between April and July in 2013 was conducted.
  
  
  RESULTS
  Viral RNA could be detected in urine samples from 17 patients, in fecal samples from 15 and in sera from 14 with a real-time reverse transcription polymerase chain reaction. The median duration of shedding of viral RNA was 19.7 days in throat swabs, 22 days in feces, 21.1 days in urines and 16.2 days in sera, indicating prolonged shedding of viral RNA in feces and urine compared with that in throat swabs. Prolonged duration of viral RNA detection in throat swabs and urine samples was observed in more severe patients. Moreover, in previously reported oseltamivir resistant patients, the NA gene with a 292K mutation could also be detected in their extra-pulmonary as well as in their respiratory samples.
  
  
  CONCLUSIONS
  Our data indicated a high frequency of viral RNA detection in feces, urine and sera in H7N9-infected patients and pointed out the potential risk of transmission.
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan 201508 Shanghai, China.
authors.forename: Zhaoqin
authors.initials: Z
authors.lastname: Zhu
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan 201508 Shanghai, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan 201508 Shanghai, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Xu
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan 201508 Shanghai, China.
authors.forename: Wencai
authors.initials: W
authors.lastname: Guan
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan 201508 Shanghai, China.
authors.forename: Xiaonan
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan 201508 Shanghai, China.
authors.forename: Tangkai
authors.initials: T
authors.lastname: Qi
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan 201508 Shanghai, China.
authors.forename: Bisheng
authors.initials: B
authors.lastname: Shi
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan 201508 Shanghai, China.
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Song
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan 201508 Shanghai, China.
authors.forename: Xinian
authors.initials: X
authors.lastname: Liu
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan 201508 Shanghai, China.
authors.forename: Yanmin
authors.initials: Y
authors.lastname: Wan
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan 201508 Shanghai, China.
authors.forename: Di
authors.initials: D
authors.lastname: Tian
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan 201508 Shanghai, China.
authors.forename: Jing
authors.initials: J
authors.lastname: He
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan 201508 Shanghai, China.
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan 201508 Shanghai, China.
authors.forename: Min
authors.initials: M
authors.lastname: Wu
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan 201508 Shanghai, China.
authors.forename: Hongzhou
authors.initials: H
authors.lastname: Lu
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan 201508 Shanghai, China.
authors.forename: Shuihua
authors.initials: S
authors.lastname: Lu
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan 201508 Shanghai, China.
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan 201508 Shanghai, China; Key Lab of Medical Molecular Virology, School of Basic Medical Science, Fudan University, 138 Yixueyuan Road, Xuhui, 200032 Shanghai, China. Electronic address: zhyuan@shaphc.org.
authors.forename: Zhenghong
authors.initials: Z
authors.lastname: Yuan
authors.affiliation: Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan 201508 Shanghai, China. Electronic address: ywhu0117@126.com.
authors.forename: Yunwen
authors.initials: Y
authors.lastname: Hu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002681:China; D005243:Feces / Q000821:virology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D064766:Influenza A Virus, H7N9 Subtype / Q000235:genetics / Q000302:isolation & purification*; D005585:Influenza in Birds; D007251:Influenza, Human / Q000635:transmission / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D010614:Pharynx / Q000821:virology*; D011200:Poultry; D012367:RNA, Viral / Q000097:blood / Q000652:urine; D060888:Real-Time Polymerase Chain Reaction; D012189:Retrospective Studies; D017201:Virus Shedding
chemical_list: D012367:RNA, Viral
keywords: Avian influenza virus; Extra-pulmonary viral RNA detection