Heat map – Credit Laidback Al FluTrackers
# 7229
Our understanding of the H7N9 avian flu virus, while incomplete, grows a little more each day as new studies are published – principally by Chinese doctors and researchers - in journals like NEJM, The Chinese Science Bulletin, and the CDC’s EID Journal.
A new study slated for the July 2012 edition of the EID journal – published ahead of print – gives us a close look at the clinical course, and treatment, of four patients infected with the H7N9 virus. All were males, and ranged in age from 58 to 74.
One patient died, two recovered to discharge, and one was still in intensive care as of the writing of this dispatch (April 21st).
All received oseltamivir relatively late in their illness, and all received antibiotic treatment as well. Two required intubation and ventilatory support.
Clinical Findings for Early Human Cases of Influenza A(H7N9) Virus Infection, Shanghai, China
Shuihua Lu , Yufang Zheng, Tao Li, Yunwen Hu, Xinian Liu, Xiuhong Xi, Qingguo Chen, Qingle Wang, Ye Cao, Yanbing Wang, Lijun Zhou, Douglas Lowrie, and Jing Bao
Abstract
A novel strain of influenza A(H7N9) virus has emerged in China and is causing mild to severe clinical symptoms in infected humans. Some case-patients have died. To further knowledge of this virus, we report the characteristics and clinical histories of 4 early case-patients.
Avian influenza A(H7N9) virus normally circulates among birds; however, human infections with this virus were confirmed in China on March 31, 2013 (1,2). To help identify the best treatment strategies for influenza A(H7N9) virus infection, we summarized the clinical characteristics and outcomes for the first 4 patients who were transferred to Shanghai Public Health Clinical Center (SHPHCC) for treatment of influenza A(H7N9) virus infection. For each case, infection was confirmed by the Shanghai Municipal Centers for Disease Control and Prevention.
Case Reports
Clinical features of the 4 case-patients are listed in Table 1. All case-patients were 58- to 73-year-old married men, farmers or retirees, and long-term residents of Shanghai (Fengxian, Baoshan, Songjiang, and Pudong districts, respectively). Case-patient 1 had a history of coronary heart disease and hepatic schistosomiasis; case-patient 2 had no history of chronic disease; case-patient 3 had a history of hypertension and gout; and case-patient 4 had a history of hypertension and repetitive cough for >10 years during spring and autumn.
Although it is too large to fit legibly within the confines of this blog, Table 1 (below) provides a nice snapshot of the symptoms, and treatment of each patient.
The the entire dispatch provides important insight into the clinical course and treatment of the H7N9 virus, and should be of interest to all clinicians.
In the discussion section the authors state that,`. . patients 2 and 3 remained positive for the virus after 9–11 days of oseltamivir treatment’.
While oral delivery of antivirals may have reduced absorption in severely ill patients, the authors warn that, `. . . it is essential to determine whether the virus has developed resistance to oseltamivir’
More from the Dispatch:
Discussion
Clinical manifestations of disease in the 4 case-patients were consistent with those reported for other persons infected with influenza A(H7N9) virus (3). Case-patients 1 and 4 had a more severe disease course than case-patients 2 and 3. All patients sought medical care for unresolved fever, cough, expectoration of sputum, and shortness of breath. The severe cases progressed rapidly: body temperature was mostly sustained >39°C, and breathing was difficult and sometimes accompanied by hemoptysis. A rapid progression of acute respiratory distress syndrome occurred in case-patients 1 and 4, along with mediastinal emphysema, shock, disturbed consciousness, and acute kidney injury. No close contacts of the 4 patients have had signs or symptoms of infection.
The currently available drug treatment for influenza A(H7N9) virus infection is neuraminidase inhibitors (e.g., oseltamivir). Their early use may be recommended (4) but is not always achieved. Case-patient 4 only began neuraminidase inhibitors 16 days after the onset of symptoms, by which time he was in a severe condition. Case-patient 1 was treated with oseltamivir 6 days after the onset of symptoms and, despite treatment, died 6 days after admission to SHPHCC. Earlier, higher doses combined with continuous treatment might improve patient outcomes (5). On the basis of clinical judgment, we now use 150 mg of oseltamivir twice daily for severe cases, monitoring for toxicity.
Out of the nearly 130 known cases, the vast majority have presented with severe symptoms, and the case fatality rate (based on incomplete data) sits near 20%.
The majority of cases reported so far have been among older males, and many appear to have comorbidities.
Compounding the situation, the time from onset of illness to diagnosis and treatment has often been a week or more.
This study, combined with news reports of more than 20 patients already treated and released from Chinese hospitals - shows that this viral infection, even when severe, can be successfully managed – particularly if treatment is received early enough.
Which no doubt explains the recent calls in China’s state media for people not to try to treat `flu-like’ symptoms at home with over-the-counter or traditional remedies, as doing so only delays testing and proper treatment.
Expert: patients with early symptoms of the flu does not recommend self-treatment
May 3, 2013 07:26:31
Source: XinhuaXinhua Jinan, May 2 news (reporter Wang Haiying) At present, China has 10 provinces found that the H7N9 avian influenza. Shandong provincial disease control experts have warned that avian influenza is preventable and controllable, you do not have to panic over. For patients with early flu-like symptoms, do not recommend the use of medication to prevent or self-treatment, if not adapt promptly to the designated hospitals for medical treatment.
