BMC Infect Dis. 2018 Dec 20;18(1):685. doi: 10.1186/s12879-018-3592-9. Muscle weakness associated with H7N9 infection: report of two cases.
The emerging avian influenza A (H7N9) virus, a subtype of influenza
viruses, was first discovered in March 2013 in China. Infected patients
frequently present with pneumonia and acute respiratory disorder
syndrome with high rates of intensive care unit admission and death.
Neurological complications, such as Guillain-Barré syndrome(GBS), and
intensive care unit-acquired weakness, including critical illness
polyneuropathy and myopathy, have only rarely been reported previously. CASE PRESENTATION:
In this study, we report on two Chinese patients with H7N9 severe pneumonia presenting neurological complications. These two patients had non-immune diseases prior to the onset of virus infection. A 56-year-old female patient (case 1) and a 78-year-old female patient (case 2) were admitted because of fever, cough, chest tightness and shortness of breath. These patients were confirmed to have H7N9 infection soon after admission followed by the development of acute respiratory distress syndrome and various severe bacterial and fungal infections. The case 1 patient was found to have muscle weakness in all extremities after withdrawing the mechanical ventilator, and the case 2 patient was found when withdrawing extracorporeal membrane oxygenation, both of these conditions prolonged ventilator-weaning time. Furthermore, the case 1 patient carried the H7N9 virus for a prolonged period, reaching 28 days, and both of them stayed in the hospital for more than two months. A clinical diagnosis of intensive care unit-acquired weakness could be confirmed. However, based on results from electrophysiological testing and needle electromyography of these 2 patients, it is difficult to differentiate critical illness polyneuropathy from GBS, since no lumbar puncture or muscle and nerve biopsy were conducted during hospitalization. Following a long-term comprehensive treatment, the patients' neurological condition improved gradually. CONCLUSIONS: Although there is great improvement in saving severe patients' lives from fatal respiratory and blood infections, it is necessary to pay sufficient attention and to use more methods to differentiate GBS from intensive care unit-acquired weakness. This unusual neurological complication could result in additional complications including ventilator associated pneumonia, prolonged hospital stay and then would further increase the death rate, and huge costs.
In this study, we report on two Chinese patients with H7N9 severe pneumonia presenting neurological complications. These two patients had non-immune diseases prior to the onset of virus infection. A 56-year-old female patient (case 1) and a 78-year-old female patient (case 2) were admitted because of fever, cough, chest tightness and shortness of breath. These patients were confirmed to have H7N9 infection soon after admission followed by the development of acute respiratory distress syndrome and various severe bacterial and fungal infections. The case 1 patient was found to have muscle weakness in all extremities after withdrawing the mechanical ventilator, and the case 2 patient was found when withdrawing extracorporeal membrane oxygenation, both of these conditions prolonged ventilator-weaning time. Furthermore, the case 1 patient carried the H7N9 virus for a prolonged period, reaching 28 days, and both of them stayed in the hospital for more than two months. A clinical diagnosis of intensive care unit-acquired weakness could be confirmed. However, based on results from electrophysiological testing and needle electromyography of these 2 patients, it is difficult to differentiate critical illness polyneuropathy from GBS, since no lumbar puncture or muscle and nerve biopsy were conducted during hospitalization. Following a long-term comprehensive treatment, the patients' neurological condition improved gradually. CONCLUSIONS: Although there is great improvement in saving severe patients' lives from fatal respiratory and blood infections, it is necessary to pay sufficient attention and to use more methods to differentiate GBS from intensive care unit-acquired weakness. This unusual neurological complication could result in additional complications including ventilator associated pneumonia, prolonged hospital stay and then would further increase the death rate, and huge costs.
https://www.ncbi.nlm.nih.gov/pubmed/30680746
J Med Virol. 2019 Jan 24. doi: 10.1002/jmv.25408. [Epub ahead of print]
Establishment of sandwich ELISA for detecting the H7 subtype influenza A virus.
Avian H7N9 subtype influenza virus infects human with high case-fatality
rate since it emerged in 2013. Although the vaccination has been
rapidly used in poultry due to the emergence of highly pathogenic
strain, this virus remains prevalent in this region. Thus, rapid diagnosis both in poultry and human clinic is critically important for the control and prevention of H7N9
infection. In this study, a batch of H7 subtype-specific monoclonal
antibodies (mAbs) were developed and a pair of mAb, 2B6, and 5E9 were
used to establish a double-antibody sandwich enzyme-linked immunosorbent
assay (ELISA) to quantify H7 protein and detect influenza
A virus baring H7 subtype HA. The lowest detection limit for the
recombinant H7 protein was 10 ng/mL and 0.5 HAU/50 μL of
A/Guangdong/17SF003/2016(H7N9), 2 HAU/50 μL of A/Netherlands/219/2003(H7N7) and A/Anhui/1/2013(H7N9) for live virus, respectively. The ELISA could not only detect the prevailing H7N9
virus, but also antigenic drift H7 subtype viruses, showing excellent
sensitivity and high specificity. Hence, it could serve as a valuable
approach to diagnose H7 subtype virus which showed great potential to
cause pandemic, as well as antigen quantification.
© 2019 Wiley Periodicals, Inc.
https://www.ncbi.nlm.nih.gov/pubmed/30592958
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018 Dec;30(12):1200-1201. doi: 10.3760/cma.j.issn.2095-4352.2018.012.019.
[The first case of severe avian influenza A (H7N9) in Guangdong Province in 2018 successfully treated with extracorporeal membrane oxygenation].
Human infection with avian influenza A (H7N9)
is easy to induce severe acute respiratory distress syndrome (ARDS),
and traditional mechanical ventilation cannot correct hypoxemia, so
patients may die from multiple organ failure (MOF) caused by persistent
hypoxia. Extracorporeal membrane oxygenation (ECMO) can provide
effective respiratory support and win time for the treatment of severe H7N9. The first case of severe H7N9 in Guangdong Province in 2018 was admitted to Zhongshan Hospital Affiliated to Sun Yat-sen University. The case was insult with severe ARDS caused by H7N9,
the traditional mechanical ventilation could not correct hypoxemia, and
the lung condition gradually improved with ECMO assistance. After 13
days of ECMO support, the patient was successfully weaned from ECMO and
was transferred to a general ward after 55 days. After 102 days of
rehabilitation, the patient was discharged from hospital and followed up
for 2 months, who was in good health and had a good quality of life.
This article states the diagnosis and treatment of severe H7N9 in details, providing experience for the treatment of severe H7N9 in the future.
https://www.ncbi.nlm.nih.gov/pubmed/30551738
Clinical, immunological and bacteriological characteristics of H7N9 patients nosocomially co-infected by Acinetobacter Baumannii: a case control study.
Liu WJ1,2, Zou R1, Hu Y3, Zhao M3, Quan C2, Tan S3, Luo K1, Yuan J1, Zheng H1, Liu J4, Liu M4, Bi Y1,3,5, Yan J3, Zhu B3, Wang D2, Wu G2, Liu L1, Yuen KY6, Gao GF7,8,9,10, Liu Y11.Abstract BACKGROUND: Bacterial co-infection of patients suffering from influenza
pneumonia is a key element that increases morbidity and mortality. The
occurrence of Acinetobacter baumannii co-infection in patients with
avian influenza A (H7N9)
virus infection has been described as one of the most prevalent
bacterial co-infections. However, the clinical and laboratory features
of this entity of H7N9 and A. baumannii co-infection have not been systematically investigated. METHODS:
We collected clinical and laboratory data from laboratory-confirmed H7N9 cases co-infected by A. baumannii. H7N9
patients without bacterial co-infection and patients with A.
baumannii-related pneumonia in the same hospital during the same period
were recruited as controls. The antibiotic resistance features and the
corresponding genome determinants of A. baumannii and the immune
responses of the patients were tested through the respiratory and
peripheral blood specimens. RESULTS: Invasive mechanical ventilation was the most significant risk factor for the nosocomial A. baumannii co-infection in H7N9
patients. The co-infection resulted in severe clinical manifestation
which was associated with the dysregulation of immune responses
including deranged T-cell counts, antigen-specific T-cell responses and
plasma cytokines. The emergence of genome variations of extensively
drug-resistant A. baumannii associated with acquired polymyxin
resistance contributed to the fatal outcome of a co-infected patient. CONCLUSIONS:
The co-infection of H7N9 patients by extensively drug-resistant A. baumannii with H7N9 infection is an important issue which deserves attention. The dysfunctions of immune responses were associated with the co-infection and were correlated with the disease severity. These data provide useful reference for the diagnosis and treatment of H7N9 infection.
The co-infection of H7N9 patients by extensively drug-resistant A. baumannii with H7N9 infection is an important issue which deserves attention. The dysfunctions of immune responses were associated with the co-infection and were correlated with the disease severity. These data provide useful reference for the diagnosis and treatment of H7N9 infection.
https://www.ncbi.nlm.nih.gov/pubmed/30126042
Clin Respir J. 2018 Nov;12(11):2539-2545. doi: 10.1111/crj.12953. Epub 2018 Oct 22.
A study on mother-to-fetus/infant transmission of influenza A(H7N9) virus: Two case reports and a review of literature.The prevention strategies for mother-to-fetus/infant transmission of H7N9 virus have not been well understood, and the study on this subject will provide further insights. METHODS:
Reverse transcriptase polymerase chain reaction assay was undertaken to detect H7N9 virus in samples from a pregnant women, a postpartum woman, and their fetus/infant. Pathological features of tissues from the dead fetus were evaluated with hematoxylin and eosin staining. Hemagglutination inhibition assay was used to detect virus-specific antibodies. Furthermore, relevant literatures were reviewed and analyzed. RESULTS:
A 28-year-old pregnant woman was hospitalized for H7N9 infection and prescribed with oseltamivir and peramivir for 2 days before admission. The fetal heart beating stopped on day 4, the dead fetus was delivered on day 13, and the woman expired on day 26. All fetal tissues were H7N9 virus-negative. A 28-year-old woman delivered a newborn on December 20, 2016. Five days later, she developed influenza-like symptoms and was confirmed with H7N9 infection. She had close contact with her infant for 9 days. Oseltamivir and peramivir were prescribed within 2 days after illness onset. A throat swab and a pair of serum samples from the infant were all negative for H7N9 virus during 4-week follow-up. In total, ten studies referring to transplacental transmission and four reports on maternal infection of H7N9 virus were reviewed and analyzed. CONCLUSION:
No evidence showed H7N9 virus infection in both fetus and infant. The early administration of neuraminidase inhibitor seemed beneficial in preventing mother-to-fetus/infant transmission of H7N9 virus.
https://www.ncbi.nlm.nih.gov/pubmed/30069787
Curr Infect Dis Rep. 2018 Aug 1;20(10):38. doi: 10.1007/s11908-018-0643-8.
Zoonotic Influenza and Human Health-Part 2: Clinical Features, Diagnosis, Treatment, and Prevention Strategies.
Zoonotic influenza viruses are those influenza viruses that cross the animal-human barrier and can cause disease in humans,
manifesting from minor respiratory illnesses to multiorgan dysfunction.
The increasing incidence of infections caused by these viruses
worldwide has necessitated focused attention to improve both diagnostic
as well as treatment modalities. In this second part of a two-part
review, we discuss the clinical features, diagnostic modalities, and
treatment of zoonotic influenza, and provide an overview of prevention strategies. RECENT FINDINGS:
Illnesses caused by novel reassortant avian influenza viruses continue to be detected and described; most recently,
Illnesses caused by novel reassortant avian influenza viruses continue to be detected and described; most recently,
- a human case of avian influenza A(H7N4) has been described from China.
- We continue to witness increasing rates of A(H7N9) infections, with the latest (fifth) wave, from late 2016 to 2017, being the largest to date.
- The case fatality rate for A(H7N9)
- and A(H5N1) infections among humans is much higher than
- that of seasonal influenza infections.
- Since the emergence of the A(H1N1) 2009 pandemic,
- and subsequently A(H7N9), testing and surveillance for novel influenzas have become more effective.
https://www.ncbi.nlm.nih.gov/pubmed/29996349
Zhonghua Jie He He Hu Xi Za Zhi. 2018 Jul 12;41(7):534-538. doi: 10.3760/cma.j.issn.1001-0939.2018.07.006.
[Analysis of 15 cases of avian influenza virus (H7N9) infection].
[Article in Chinese; Abstract available in Chinese from the publisher]
Objective: To describe the clinical, chest imaging, pathological manifestations and therapeutic experience of human infection with A/H7N9 virus. Methods: The features of 15 laboratory-confirmed cases of human infection with A/H7N9 virus in Taizhou, Jiangsu Province were retrospectively analyzed. Results:
The 15 patients with confirmed viral pneumonia included 12 males and 3
females, with a median age of 61 years(ranging from 33 to 81 years).
Twelve patients had a history of exposure to the poultry trading places,
or direct contact with ill/dead avian, while 3 patients denied exposure
or contact. The most common initial symptoms were fever, coughing, and
respiratory distress. The illness progressed rapidly to acute
respiratory distress syndrome (ARDS). Lab tests showed normal (8 cases)
or decreased (7 cases)white blood cell count , decreased (13 cases)
lymphocyte count and proportion , increased creatine kinase (CK, 12
cases) and lactate dehydrogenase (LDH, 15 cases), and respiratory
failure (13 cases). Chest radiographic examination showed that the most
common features were inflammatory infiltration in the lung, with partial consolidation. The average time of the diagnosis with influenza viral nucleic acid and onset of an oral anti-influenza
drug were 7.1 days and 6.5 days. All patients were treated by antiviral
drugs (oral oseltamivir 150 mg q12 h and/or intravenous paramivir 600
mg qd), with mechanical ventilation in 9 cases, glucocorticoid therapy
in 5 cases (intravenous methylprednisolone in 3 and dexamethasone in 2
patients), extracorporeal membrane oxygenation (ECMO) therapy in 2
cases, continuous renal replacement therapy (CRRT) in 6 cases, and
artificial liver therapy in 1 case. The pulmonary pathology was observed
from post-mortem biopsy for 2 fatal cases. Patient 1 had diffuse
alveolar damage with inflammatory exudation, hyaline membrane formation,
and cellular infiltration. Patient 2 had widened alveolar septum,
lymphocyte and monocyte cell infiltration in the alveolar septa, and
interstitial fibrous proliferation. Nine patients were discharged, and 6
died. Conclusions: Patients with influenza A/H7N9
virus mostly presented with fever, cough, and were prone to progression
to viral pneumonia. Once acute respiratory distress and important organ
dysfunction occurred, the fatality rate was higher. Early diagnosis and
rational treatment were critical for better outcomes.
https://www.ncbi.nlm.nih.gov/pubmed/29617693
Cell Physiol Biochem. 2018;46(2):633-643. doi: 10.1159/000488631. Epub 2018 Mar 28.The Protective Effects of the A/ZJU01/ PR8/2013 Split H7N9 Avian Influenza Vaccine Against Highly Pathogenic H7N9 in BALB/c Mice.
Wu XX1, Deng XL2, Yu DS1, Yao W3, Ou HL1, Weng TH1, Hu CY1, Hu FY2, Wu NP1, Yao H1, Zhang FC2, Li LJ1. Abstract
BACKGROUND/AIMS: Since the first case of novel H7N9 infection was reported, China has experienced five epidemics of H7N9. During the fifth wave, a highly pathogenic H7N9 strain emerged. In order to assess whether the H7N9 vaccine based on A/Zhejiang/DTID-ZJU01/2013(H7N9) was effective in protecting against highly pathogenic H7N9, we conducted this study. METHODS: Groups
of mice were immunized twice by intraperitoneal injection with 500 µl
of either split vaccine alone or MF59-adjuvanted vaccine. Serum was
collected 2 weeks after the second vaccine booster. The hemagglutinin
inhibition test was conducted on vaccine seed and highly pathogenic H7N9 to evaluate the neutralization of highly pathogenic H7N9. We also immunized mice and challenged them with highly pathogenic H7N9.
Mice were observed for illness, weight loss, and death at 1 week and 2
weeks post-infection. Then, the mice were sacrificed and lungs were
removed. Antibody responses were assessed and pathological changes in
the lung tissue were evaluated. RESULTS:The ability of serum to neutralize highly pathogenic H7N9 was reduced. In mice, highly pathogenic H7N9 was more virulent than A/Zhejiang/DTID-ZJU01/2013(H7N9). After challenge with highly pathogenic H7N9, all mice died while mice challenged with A/Zhejiang/DTID-ZJU01/2013(H7N9) all recovered. The A/ZJU01/PR8/2013 split H7N9 avian influenza vaccine was able to protect against infection with highly pathogenic H7N9 in mice, with or without MF59. Moreover, H7N9 vaccine adjuvanted with MF59 produced high antibody levels, which lead to better protection. CONCLUSIONS: The A/ZJU01/PR8/2013 split H7N9 avian influenza vaccine based on A/Zhejiang/DTID-ZJU01/2013(H7N9) is effective in protecting against highly pathogenic H7N9. H7N9 vaccine adjuvanted with MF59 offers better protection against infection with highly pathogenic H7N9. In order to make the H7N9 vaccine applicable to humans,
further clinical trials are required to evaluate MF59 adjuvanted
vaccine. Meanwhile, the vaccine strain should be updated based on the
highly pathogenic H7N9 gene sequence.
© 2018 The Author(s). Published by S. Karger AG, Basel. KEYWORDS:
Highly pathogenic H7N9; MF59 adjuvant; Protective immune responses; Split H7N9 vaccine
Inga kommentarer:
Skicka en kommentar