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Volume 19, Number 7—July 2013
Letter

Avian Influenza A(H7N9) Virus Infections, Shanghai, China

Zeng Mei1, Shuihua Lu1, Xianzheng Wu1, Lingyun Shao1, Yu Hui1, Jiali Wang, Tao Li, Haixia Zhang, Xiaohong Wang, Feifei Yang, Jialin Jin, Ying Zhang, and Wenhong ZhangComments to Author 
Author affiliations: Children’s Hospital of Fudan University, Shanghai, China (Z. Mei, Y. Hui, X. Wang); Fudan University, Shanghai (S. Lu, T. Li, W. Zhang, Y. Zhang); Tongji Hospital of Tongji University, Shanghai (X. Wu, H. Zhang); Huashan Hospital of Fudan University, Shanghai (L. Shao, J. Wang, F. Yang, J. Jin, W. Zhang); Johns Hopkins University, Baltimore, Maryland, USA (Y. Zhang)

Main Article

Table

Characteristics for 4 patients infected with avian influenza A(H7N9) virus, Shanghai, China*

Chacteristic
 Patient 1†
 Patient 2
 Patient 3
 Patient 4
Age, y/sex 52/F 49/M 67/M 65/M
Exposure to poultry None Continuous None None
Sign or symptom at admission Fever (40.6°C) for 7 d, cough for 1 d, difficulty breathing starting 7 d after illness onset Fever (39.8°C) for 3 d, cough for 5 d, difficulty breathing and cyanosis starting 5 d after illness onset Fever (39.7°C) and cough for 7 d starting 7 d after illness onset Fever (39.0°C) for 5 d, cough for 2 d starting 5 d after illness onset
Physical examination results HR 120 bpm, RR 40 breaths/min, BP 140/75 mm Hg, decreased breath sounds, no rales RR 40 breaths/min, BP 240/160 mm Hg, diffuse moist rales HR 100 bpm, RR 30 breaths/min, BP 110/78 mm Hg, moist rales mainly in left lung HR 82 bpm, RR 21 breaths/min, BP 118/74 mm Hg, decreased breath sounds in lower left lung, no rales
Laboratory results
Leukocyte count, ×109/L 3.29 2.9 2.89 3.74
Neutrophils, % 92 69.1 78.6 76.7
Lymphocytes, % 5.5 25.2 15.4 18.2
Platelet count, ×109/L 155 71 172 82
AST, U/L 95 258 45 77
LDH, U/L 525 >2,150 209 492
CPK, U/L 351 >1,600 170 1,854
CK-MB, U/L 16 32 7 31
Creatinine, μmol/L 69.7 116.0 84.2 74.3
Medications after hospitalization
Oseltamivir Started d 13 after illness onset None Started d 11 after illness onset Started d 10 after illness onset
Antimicrobial drugs MOX started d 13 after illness onset MOX started d 10 after illness onset AZT started d 11 after illness onset, MOX started d 15 after illness onset CEF started d 11–12 after illness onset, MOX started d 13 after illness onset
Corticosteroids MEP, 80 mg/d started d 14 after illness onset MEP, 80 mg/d started d 10 after illness onset MEP, 80 mg/d started d 11 after illness onset, decreased to 40 mg/d, stopped after 1 wk None
Immunoglobulin Started d 13 after illness onset None Given d 11–15 after illness onset None
Other conditions Diabetes mellitus, surgery for thyroid cancer Obesity None Hypertension
Outcome Died 14 d after illness onset Died 10 d after illness onset Discharged 30 d after illness onset Discharged 27 d after illness onset

*HR, heart rate; RR, respiratory rate; BP, blood pressure, AST, aspartate aminotransferase; LDH, lactate dehydrogenase; CPK, creatine phosphokinase; CK-MB, creatine kinase isoenzyme MB; MOX, moxifloxacin; AZT, azithromycin; CEF, ceftriaxone; MEP, methylprednisolone.
†Data for patient 1 were reported by Yang et al. (3) and are included for comparison.

Main Article

References
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  2. World Health Organization. Human infection with influenza A (H7N9) virus in China [cited 2013 Apr 22]. ww.who.int/csr/don/2013_04_19/en/index.html
  3. Yang  F, Wang  J, Jiang  L, Jin  JL, Shao  LY, Zhang  Y, A fatal case caused by novel H7N9 avian influenza A virus in China. Emerging Microbes and Infections. 2013;2:e19 .DOIGoogle Scholar
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  7. Van Kerkhove  MD, Vandemaele  KA, Shinde  V, Jaramillo-Gutierrez  G, Koukounari  A, Donnelly  CA, Risk factors for severe outcomes following 2009 influenza A (H1N1) infection: a global pooled analysis. PLoS Med. 2011;8:e1001053. DOIPubMedGoogle Scholar

Main Article

1These authors contributed equally to this article.

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