An analysis of clinical characteristics of human infection with H7N9 avian influenza complicated by acute respiratory distress syndrome / 中国中西医结合急救杂志

ABSTRACT

Objective To analyze the main clinical features of human infection with H7N9 avian influenza complicated by acute respiratory distress syndrome (ARDS).Methods A retrospective analysis of complete clinical data of 9 cases of human infection with H7N9 avian influenza complicated by ARDS admitted from March 2013 to December 2014 admitted to Department of Critical Care Medicine of the Affiliated Drum Tower Hospital of Nanjing University Medical School was conducted.Results Nine patients' mean age was (46.3±12.3) years, male accounting for 66.7% (6/9). The main clinical features ① In the duration of acute phase, high fever, cough, hemoptysis sputum, reduction of white blood cell count (WBC) and platelet count (PLT), and myocardial enzyme elevation were the features of the disease. Chest CT showed pulmonary consolidation and ground-glass like shadows. ② On admission, all their oxygenation indexes (PaO2/FiO2) were less than 200 mmHg (1 mmHg = 0.133 kPa) of which 66.7% (6/9) was less than 100 mmHg, mean (98.9±62.8) mmHg; 55.6% (5/9) required invasive mechanical ventilatory support; 77.8% (7/9) combined with shock, and hemodynamic monitoring showed peripheral vascular resistance was decreased. ③ There were secondary bloodstream infection in 5 cases and lung infection in 4 cases, accounting for 77.8% (7/9). ④ In 22.2% (2/9) patients, the virus relapsed after the anti-virus therapy was stopped for 7 days, then immediately antiviral treatment was used again, it was still effective.Conclusion Human infection with H7N9 avian influenza complicated by ARDS has typical clinical symptoms, laboratory tests and imaging features, often associated with distributive shock, and at the late stage, secondary pulmonary or blood infection and the virus resurgence may occur.