[The changes of chest imaging and clinical features in patients with severe infection of new influenza A (H1N1)].

OBJECTIVE: To study the clinical features and the pulmonary imaging changes of severe cases of new influenza A (H1N1). METHODS: This study included 10 severe cases with new influenza A (H1N1) infection in the Forth People's Hospital of Taiyuan from 20 Oct. 2009 to 22 Nov 2009.Six patients were males and 4 were females, with an average age of 19.3 years (range 5 - 41 years). The laboratory study included blood routine, blood gas analysis, liver and renal function tests, myocardium enzymology, chest radiograph and CT. RESULTS: The prominent clinical features included fever, cough and dyspnea. The pulmonary imaging changes were varied, including ground-glass opacity, consolidation, atelectasis, fluid pneumothorax and pleural effusion, and manifestations of acute pneumonia and interstitial pneumonia simultaneously. Extensive pulmonary infiltration developed quickly, and acute lung injury (ALI) occurred in 5 patients and acute respiratory distress syndrome (ARDS) in 3 cases. Oseltamivir, oxygen therapy and antibiotic therapy were effective for improvement of the disease and final recovery of all these patients. CONCLUSIONS: The severe cases of new influenza A (H1N1) infection has imaging manifestations of acute pneumonia and interstitial pneumonia. The disease progresses quickly and may lead to ALI/ARDS.

[Clinical experience of successful management of a child with A/H5N1 infection in Shanxi province].

OBJECTIVE: To explore the clinical features and treatment strategy of human influenza A (H5N1) virus infection. METHODS: The clinical data from a 2-year-old girl with A/H5N1 infection were collected and analyzed. RESULTS: The patient had a history of exposure to a living poultry market. A/H5N1 nucleic acid was detected by real-time polymerase chain reaction and reverse-transcription polymerase chain reaction in a nasopharyngeal aspirate. The prominent clinical features included fever, cough and dyspnea. Extensive multiple lobular infiltrates developed quickly, followed by acute respiratory distress syndrome (ARDS) and multi-organ dysfunction. Corticosteroids, oxygen therapy and non-invasive mechanical ventilation were administrated on day 9 after onset of the disease. The patient's condition became stable after the management. After A/H5N1 infection was confirmed, antiviral treatment with oseltamivir and A/H5N1 vaccinated plasma were used on day 11. Oxygenation and serum enzyme levels returned to normal gradually, and most of the lung infiltrates disappeared. The patient was discharged on day 28. CONCLUSION: Human A/H5N1 infection is a severe and rapidly progressive disease mostly manifested as ARDS. Corticosteroids may have some effects on the pulmonary lesions, but oxygen therapy and ventilatory support are the mainstay of the management. A/H5N1 vaccinated plasma may be useful for improving the prognosis.