Zhang Wei, Wen Le-ying, Lu Min, Xiong Yu, Qian Ke-jian, Deng Ai-hua, Guo Lu-sheng, Xiao Zu-ke, Zhao Xin-sheng, Duan Shu-min, Xie Zhi-gang, Gao Zi-fen, Li Min, Shao Hong-quan, Wang Guo-gan, Liu Da-wei, Gao Zhan-cheng
Department of Respiratory Medicine, First Affiliated Hospital, Nanchang University, Nanchang 330006, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2006 May;29(5):300-6.
To describe the clinical, laboratory and radiological presentation of a human case infected by influenza A (H5N1), and to understand its management and prognosis.
The clinical and autopsy data of the first human case infected by influenza A (H5N1) in Jiangxi Province were collected and analyzed.
The first case infected by influenza A (H5N1) in Jiangxi Province was confirmed by laboratory findings with reverse transcription-polymerase chain reaction (RT-PCR) and influenza A (H5N1) isolation. The patient had been healthy in the past and exposed to the environment of bird flu before illness. The initial symptoms included high fever with influenza-like symptoms, and then cough and purulent sputum mixed with blood appeared. The clinical situation deteriorated progressively with occurrence of diarrhea and dyspnea. Laboratory abnormalities included decrease of peripheral white blood cells and lymphocytes, urine protein, dramatic increase of enzymes associated with hepatic injury and myocarditis and decrease of serum albumin. Six days later, penicillin-resistant streptococcus pneumoniae was isolated from multiple sputum cultures. With the deterioration of clinical situation, several other bacteria and fungi were found in sputum culture. Pulmonary infiltrates were evident in right middle and lower lobe at day 5 after illness, and rapidly progressed to involve bilateral lungs as acute respiratory distress syndrome (ARDS)-like changes. The patient was treated with antiviral, antibacterial, and antifungal reagents, and corticosteroids and invasive mechanical ventilation were also administered, but without any improvement. The patient died 27 days after the onset of symptoms and an autopsy was performed. Pathologically, the lungs exhibited diffuse alveolar damage. The lymphocytes in the spleen, the lymph nodes and the tonsils were depleted prominently with histiocytic hyperplasia and hemophagocytic phenomena. Edema and degeneration of myocytes in the heart and extensive acute tubular necrosis in the kidney were observed.
The prognosis was very poor if influenza A (H5N1) infected human cases was developed as ARDS with multiple organ damage or failure.
描述1例甲型H5N1流感病毒感染人类病例的临床、实验室及影像学表现，并了解其治疗及预后情况。
收集并分析江西省首例甲型H5N1流感病毒感染人类病例的临床及尸检资料。
江西省首例甲型H5N1流感病毒感染病例经逆转录-聚合酶链反应（RT-PCR）及甲型H5N1流感病毒分离的实验室检查得以确诊。患者既往健康，发病前接触过禽流感环境。初始症状为高热伴流感样症状，随后出现咳嗽及脓血痰。随着腹泻及呼吸困难的出现，临床情况逐渐恶化。实验室检查异常包括外周血白细胞及淋巴细胞减少、尿蛋白、肝损伤及心肌炎相关酶显著升高以及血清白蛋白降低。6天后，多次痰培养分离出对青霉素耐药的肺炎链球菌。随着临床情况恶化，痰培养中还发现了其他几种细菌及真菌。发病后第5天，右肺中叶及下叶出现明显的肺部浸润，并迅速进展为双侧肺出现类似急性呼吸窘迫综合征（ARDS）的改变。患者接受了抗病毒、抗菌及抗真菌药物治疗，还使用了糖皮质激素及有创机械通气，但病情无任何改善。患者在症状出现27天后死亡，并进行了尸检。病理检查显示，肺部呈现弥漫性肺泡损伤。脾脏、淋巴结及扁桃体中的淋巴细胞显著减少，伴有组织细胞增生及噬血细胞现象。观察到心脏肌细胞水肿及变性，肾脏出现广泛的急性肾小管坏死。
如果甲型H5N1流感病毒感染人类病例发展为伴有多器官损害或功能衰竭的ARDS，预后非常差。
