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. 2008 Aug 21;3(8):e2985.
doi: 10.1371/journal.pone.0002985.

Clinical characteristics of 26 human cases of highly pathogenic avian influenza A (H5N1) virus infection in China

Hongjie Yu  1 , Zhancheng Gao, Zijian Feng, Yuelong Shu, Nijuan Xiang, Lei Zhou, Yang Huai, Luzhao Feng, Zhibin Peng, Zhongjie Li, Cuiling Xu, Junhua Li, Chengping Hu, Qun Li, Xiaoling Xu, Xuecheng Liu, Zigui Liu, Longshan Xu, Yusheng Chen, Huiming Luo, Liping Wei, Xianfeng Zhang, Jianbao Xin, Junqiao Guo, Qiuyue Wang, Zhengan Yuan, Longnv Zhou, Kunzhao Zhang, Wei Zhang, Jinye Yang, Xiaoning Zhong, Shichang Xia, Lanjuan Li, Jinquan Cheng, Erdang Ma, Pingping He, Shui Shan Lee, Yu Wang, Timothy M Uyeki, Weizhong Yang
Affiliations

Clinical characteristics of 26 human cases of highly pathogenic avian influenza A (H5N1) virus infection in China

Hongjie Yu et al. PLoS One. .

Abstract

Background: While human cases of highly pathogenic avian influenza A (H5N1) virus infection continue to increase globally, available clinical data on H5N1 cases are limited. We conducted a retrospective study of 26 confirmed human H5N1 cases identified through surveillance in China from October 2005 through April 2008.

Methodology/principal findings: Data were collected from hospital medical records of H5N1 cases and analyzed. The median age was 29 years (range 6-62) and 58% were female. Many H5N1 cases reported fever (92%) and cough (58%) at illness onset, and had lower respiratory findings of tachypnea and dyspnea at admission. All cases progressed rapidly to bilateral pneumonia. Clinical complications included acute respiratory distress syndrome (ARDS, 81%), cardiac failure (50%), elevated aminotransaminases (43%), and renal dysfunction (17%). Fatal cases had a lower median nadir platelet count (64.5 x 10(9) cells/L vs 93.0 x 10(9) cells/L, p = 0.02), higher median peak lactic dehydrogenase (LDH) level (1982.5 U/L vs 1230.0 U/L, p = 0.001), higher percentage of ARDS (94% [n = 16] vs 56% [n = 5], p = 0.034) and more frequent cardiac failure (71% [n = 12] vs 11% [n = 1], p = 0.011) than nonfatal cases. A higher proportion of patients who received antiviral drugs survived compared to untreated (67% [8/12] vs 7% [1/14], p = 0.003).

Conclusions/significance: The clinical course of Chinese H5N1 cases is characterized by fever and cough initially, with rapid progression to lower respiratory disease. Decreased platelet count, elevated LDH level, ARDS and cardiac failure were associated with fatal outcomes. Clinical management of H5N1 cases should be standardized in China to include early antiviral treatment for suspected H5N1 cases.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Progression of pulmonary disease in chest radiographs from adult (35-year-old male, Panels A day 6 and B day 23 of illness) and pediatric (6-year-old male, Panels C day 6 and D day 14 of illness) H5N1 cases.
See this image and copyright information in PMC

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