Human disease from influenza A (H5N1), Thailand, 2004

Tawee Chotpitayasunondh, Kumnuan Ungchusak, Wanna Hanshaoworakul, Supamit Chunsuthiwat, Pathom Sawanpanyalert, Rungruen Kijphati, Sorasak Lochindarat, Panida Srisan, Pongsan Suwan, Yutthasak Osotthanakorn, Tanakorn Anantasetagoon, Supornchai Kanjanawasri, Sureeporn Tanupattarachai, Jiranun Weerakul, Ruangsri Chaiwirattana, Monthira Maneerattanaporn, Rapol Poolsavathitikool, Kulkunya Chokephaibulkit, Anucha Apisarnthanarak, Scott F Dowell, Tawee Chotpitayasunondh, Kumnuan Ungchusak, Wanna Hanshaoworakul, Supamit Chunsuthiwat, Pathom Sawanpanyalert, Rungruen Kijphati, Sorasak Lochindarat, Panida Srisan, Pongsan Suwan, Yutthasak Osotthanakorn, Tanakorn Anantasetagoon, Supornchai Kanjanawasri, Sureeporn Tanupattarachai, Jiranun Weerakul, Ruangsri Chaiwirattana, Monthira Maneerattanaporn, Rapol Poolsavathitikool, Kulkunya Chokephaibulkit, Anucha Apisarnthanarak, Scott F Dowell

Abstract

Influenza A (H5N1) is endemic in poultry across much of Southeast Asia, but limited information exists on the distinctive features of the few human cases. In Thailand, we instituted nationwide surveillance and tested respiratory specimens by polymerase chain reaction and viral isolation. From January 1 to March 31, 2004, we reviewed 610 reports and identified 12 confirmed and 21 suspected cases. All 12 confirmed case-patients resided in villages that experienced abnormal chicken deaths, 9 lived in households whose backyard chickens died, and 8 reported direct contact with dead chickens. Seven were children <14 years of age. Fever preceded dyspnea by a median of 5 days, and lymphopenia significantly predicted acute respiratory distress syndrome development and death. Among hundreds of thousands of potential human cases of influenza A (H5N1) in Asia, a history of direct contact with sick poultry, young age, pneumonia and lymphopenia, and progression to acute respiratory distress syndrome should prompt specific laboratory testing for H5 influenza.

Figures

Figure 1
Figure 1
Epidemic curve showing the dates of onset for 12 confirmed and 21 suspected human cases of avian influenza A (H5N1) infection, Thailand, 2004.
Figure 2
Figure 2
Distribution of the absolute lymphocyte count (ALC), total leukocyte count, and platelet count on admission for 4 patients who survived and 8 who died of human influenza A (H5N1) infection, Thailand, 2004. ARDS, acute respiratory distress syndrome.
Figure 3
Figure 3
Chest radiographs from patients 8 and 9. Panel A demonstrates patchy alveolar infiltration of the right lower lung on day 5 of illness for patient 9; panel B demonstrates the progression to acute respiratory disease syndrome (ARDS) on day 8. Panel C shows interstitial infiltration of both lungs of patient 8 on day 4 of illness; panel D shows the rapid progression to ARDS by day 6.
Figure 4
Figure 4
Timing of the clinical course and oseltamivir treatment for 4 patients who survived and 8 patients who died of human influenza A (H5N1) infection, Thailand, 2004.
Figure 5
Figure 5
Pathologic findings from a patient (number 6) with confirmed influenza A (H5N1) infection. All slides are stained with hematoxylin and eosin, shown at 40x objective. Panel A shows hyaline membrane formation lining the alveolar spaces of the lung and vascular congestion with a few infiltrating lymphocytes in the interstitial areas. Reactive fibroblasts are also present. Panel B is an area of lung with proliferating reactive fibroblasts within the interstitial areas. Few lymphocytes are seen, and no viral intranuclear inclusions are visible. Panel C shows fibrinous exudates filling the alveolar spaces, with organizing formation and few hyaline membranes. The surrounding alveolar spaces contain hemorrhage. Panel D is from a section of spleen, showing numerous atypical lymphoid cells scattered around the white pulp. No viral intranuclear inclusions are seen.
Figure 6
Figure 6
Seasonal variation in viral isolations of human influenza A (H3N2), A (H1N1), and B, in Thailand.

References

    1. Chan PK. Outbreak of avian influenza A (H5N1) virus infection in Hong Kong in 1997. Clin Infect Dis. 2002;34:S58–64. 10.1086/338820
    1. Subbarao K, Klimov A, Katz J, Regnery H, Lim W, Hall H, et al. Characterization of an avian influenza A (H5N1) virus isolated from a child with a fatal respiratory illness. Science. 1998;279:393–6. 10.1126/science.279.5349.393
    1. Bridges CB, Lim W, Hu-Primmer J, Sims L, Fukuda K, Mak KH, et al. Risk of influenza A (H5N1) infection among poultry workers, Hong Kong, 1997–1998. J Infect Dis. 2002;185:1005–10. 10.1086/340044
    1. Shortridge KF, Gao P, Guan Y, Ito T, Kawaoka Y, Markwell D, et al. Interspecies transmission of influenza viruses: H5N1 virus and a Hong Kong SAR perspective. Vet Microbiol. 2000;74:141–7. 10.1016/S0378-1135(00)00174-7
    1. Nicholson KG, Wood JM, Zambon M. Influenza. Lancet. 2003;362:1733–45. 10.1016/S0140-6736(03)14854-4
    1. Peiris M, Yuen KY, Leung CW, Chan KH, Ip PL, Lai RW, et al. Human infection with influenza H9N2. Lancet. 1999;354:916–7. 10.1016/S0140-6736(99)03311-5
    1. Fouchier RA, Schneeberger PM, Rozendaal FW, Broekman JM, Kemink SA, Munster V, et al. Avian influenza A virus (H7N7) associated with human conjunctivitis and a fatal case of acute respiratory distress syndrome. Proc Natl Acad Sci U S A. 2004;101:1356–61. 10.1073/pnas.0308352100
    1. World Health Organization. Avian influenza A (H5N1)—situation (poultry) in Asia as at 2 March 2004: need for a long-term response, comparison with previous outbreaks. Wkly Epidemiol Rec. 2004;79:96–9.
    1. Tran TH, Nguyen TL, Nguyen TD, Luong TS, Pham PM, Nguyen VC, et al. Avian influenza A (H5N1) in 10 patients in Vietnam. N Engl J Med. 2004;350:1179–88. 10.1056/NEJMoa040419
    1. Centers for Disease Control and Prevention. Cases of influenza A (H5N1)—Thailand, 2004. MMWR Morb Mortal Wkly Rep. 2004;53:100–3.
    1. Centers for Disease Control and Prevention. Outbreaks of avian influenza A (H5N1) in Asia and interim recommendations for evaluation and reporting of suspected cases—United States, 2004. MMWR Morb Mortal Wkly Rep. 2004;53:97–100.
    1. World Health Organization. Animal influenza training manual. Harbin, China: The Organization; 2001.
    1. Ministry of Public Health T. Influenza A. (H5N1) laboratory training manual. Bangkok, Thailand: Ministry of Public Health; 2004.
    1. Spackman E, Senne DA, Myers TJ, Bulaga LL, Garber LP, Perdue ML, et al. Development of a real-time reverse transcriptase PCR assay for type A influenza virus and the avian H5 and H7 hemagglutinin subtypes. J Clin Microbiol. 2002;40:3256–60. 10.1128/JCM.40.9.3256-3260.2002
    1. Berhman R, Kliegman R, Jenson H. Nelson textbook of pediatrics. Philadelphia: Saunders; 2000. p. 2186–7.
    1. World Health Organization. WHO interim guidelines on clinical management of humans infected by influenza A (H5N1). Vol. 2004. Geneva: The Organization; 2004.
    1. Olsen S, Wannachaiwong Y, Chotpitayasunondh T, Chittaganpitch M, Limpakarnjanarat K, Dowell S. Human and avian influenza in Thailand: reducing opportunities for reassortment. Boston: Infectious Diseases Society of America; 2004.
    1. Nascimento-Carvalho CM, Rocha H, Santos-Jesus R, Benguigui Y. Childhood pneumonia: clinical aspects associated with hospitalization or death. Braz J Infect Dis. 2002;6:22–8. 10.1590/S1413-86702002000100004
    1. Marrie TJ, Carriere KC, Jin Y, Johnson DH. Factors associated with death among adults <55 years of age hospitalized for community-acquired pneumonia. Clin Infect Dis. 2003;36:413–21. 10.1086/346037
    1. Kanlayanaphotporn J, Brady M, Chantate P, Chantra S, Siasiriwattana S, Dowell S, et al. Pneumonia surveillance in Thailand: current practice and future needs. Southeast Asian J Trop Med Public Health. 2004;35:711–6.
    1. Horimoto T, Fukuda N, Iwatsuki-Horimoto K, Guan Y, Lim W, Peiris M, et al. Antigenic differences between H5N1 human influenza viruses isolated in 1997 and 2003. J Vet Med Sci. 2004;66:303–5. 10.1292/jvms.66.303
    1. Sims LD, Ellis TM, Liu KK, Dyrting K, Wong H, Peiris M, et al. Avian influenza in Hong Kong 1997–2002. Avian Dis. 2003;47:832–8. 10.1637/0005-2086-47.s3.832
    1. Sturm-Ramirez KM, Ellis T, Bousfield B, Bissett L, Dyrting K, Rehg JE, et al. Reemerging H5N1 influenza viruses in Hong Kong in 2002 are highly pathogenic to ducks. J Virol. 2004;78:4892–901. 10.1128/JVI.78.9.4892-4901.2004
    1. Perkins LE, Swayne DE. Pathogenicity of a Hong Kong-origin H5N1 highly pathogenic avian influenza virus for emus, geese, ducks, and pigeons. Avian Dis. 2002;46:53–63. 10.1637/0005-2086(2002)046[0053:POAHKO];2
    1. Guan Y, Poon LL, Cheung CY, Ellis TM, Lim W, Lipatov AS, et al. H5N1 influenza: a protean pandemic threat. Proc Natl Acad Sci U S A. 2004;101:8156–61.26.
    1. Normile D, Enserink M. Infectious diseases. Avian influenza makes a comeback, reviving pandemic worries. Science. 2004;305:321. 10.1126/science.305.5682.321a
    1. Yuen KY, Chan PK, Peiris M, Tsang DN, Que TL, Shortridge KF, et al. Clinical features and rapid viral diagnosis of human disease associated with avian influenza A H5N1 virus. Lancet. 1998;351:467–71. 10.1016/S0140-6736(98)01182-9
    1. Buxton Bridges C, Katz JM, Seto WH, Chan PK, Tsang D, Ho W, et al. Risk of influenza A (H5N1) infection among health care workers exposed to patients with influenza A (H5N1), Hong Kong. J Infect Dis. 2000;181:344–8. 10.1086/315213
    1. Katz JM, Lim W, Bridges CB, Rowe T, Hu-Primmer J, Lu X, et al. Antibody response in individuals infected with avian influenza A (H5N1) viruses and detection of anti-H5 antibody among household and social contacts. J Infect Dis. 1999;180:1763–70. 10.1086/315137
    1. Tam JS, Influenza A. H5N1) in Hong Kong: an overview. Vaccine. 2002;20:S77–81. 10.1016/S0264-410X(02)00137-8
    1. Chen H, Deng G, Li Z, Tian G, Li Y, Jiao P, et al. The evolution of H5N1 influenza viruses in ducks in southern China. Proc Natl Acad Sci U S A. 2004;101:10452–7. 10.1073/pnas.0403212101

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj