Lisa Schnirring 
Staff Writer
Staff Writer
Apr 10, 2013 (CIDRAP News) – Doctors from China today published
the first case report of a patient infected with the H7N9 avian
influenza virus, a 52-year-old woman from Shanghai who was admitted to
the hospital late in her illness and died without having received
antiviral treatment.
The team from Fudan University's Huashan Hospital, where the woman
was seen in the emergency department, was hospitalized, and died,
described their findings today in an online edition of Emerging Microbes and Infections. The woman's death was first reported on Apr 4.
She experienced a sudden onset of chills and fever on Mar 27 and
was seen in the emergency department the next day. The patient had rough
breath sounds and was given antibiotics.
A few days later she sought care at the facility again, at which
point she still had a fever but no cough or shortness of breath.
Radiographs showed small patchy shadows in the lower lobe of her right
lung, and doctors treated her with intravenous antibiotics for 3 days.
Her condition quickly worsened, and she went to the emergency
department again, this time with respiratory symptoms, including
shortness of breath. After tests showed hypoxia and computed tomography
demonstrated evidence of pneumonia, the woman's medical team suspected
severe flu with respiratory distress, intubated the patient, and placed
her on mechanical ventilation.
Despite those measures and treatment with methylprednisolone,
antibiotics, and immune globulin treatment, her condition continued to
deteriorate and she died on Apr 3. Doctors sent respiratory sampled to
the Chinese Center for Disease Control, where tests detected the H7N9
virus.
An investigation into the source of her infection found no clear
history of contact with livestock or poultry, through the virus was
detected in poultry at a local market. "The most likely source of the
virus in this case seems to be from the environment or food contaminated
with this novel virus," the group wrote.
Close contact monitoring found that her husband had a fever, but
tests on his samples were negative and he has recovered, according to
the report. The group said animal-to-human transmission and
human-to-human transmission are both being considered in her case.
The group noted that the proportion of fatal cases in H7N9
infections so far appears to be lower than for H5N1 infections. However,
they noted that patients with fatal cases in Shanghai so far were
admitted to the hospital very late with shortness of breath, with
subsequent late treatment and a poor outcome, similar to the H5N1
experience.
Because the cause of illness was unclear, she and other H7N9
patients did not receive early antiviral treatment, which if given
earlier coupled with earlier hospitalization might have significantly
improved the woman's chances of surviving the H7N9 infection.
In a related commentary in the same issue, the Yu-Mei Wen, MD, a
virologist from the same university, and Hans-Dieter Klenk, MD, a
virologist from the University of Marburg in Germany, addressed the
clinical patterns seen in some of the early H7N9 cases. Wen and Klenk
are editors-in-chief of Emerging Microbes and Infections.
They noted that in Shanghai's first two cases, an 87-year-old man
and a 27-year-old man who died, the patients had fever and respiratory
symptoms early in their illness, which progressed to pneumonia and
breathing problems 5 to 10 days later.
The two men had contact with pigs but not poultry, while other
case-patients had a history of slaughtering chickens, they observed.
Many questions still remain about the animal reservoir and whether
the human H7N9 infections are rare or represent the tip of the
asymptomatic infection iceberg, Wen and Klenk wrote. They praised
China's quick progress so far with virus surveillance but said more
efforts are needed to integrate human and animal illness surveillance
and to remove the barriers between veterinarians and physicians.
See also:
Apr 10 Emerg Microbe Infect case report
Apr 10 Emerg Microbe Infect commentary
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